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All you need to know about living will for passive euthanasia

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Supreme Court of India

New Delhi: The Supreme Court in a landmark judgement on Friday recognised a terminally ill patient’s right to refuse medical treatment through an advance medical directive or a living will. Here are court laid down rules relating to the procedure for its execution.

*What is advance medical directive or living will?

It is a medical power of attorney that allows an individual to appoint a trusted person to take health care decisions when the patient is not able to take such decisions. The trusted person is allowed to interpret the patient’s decisions based on their mutual knowledge and understanding. The trusted person can decide on the patient’s behalf how long the medical treatment should continue when the patient in unconscious or in a coma state is not in a position to decide.

*Who is allowed to execute or draw up the will?

According to the Supreme Court rules, it can be executed only by an adult who is of a sound and healthy state of mind and in a position to communicate, relate and comprehend the purpose and consequences of executing the document.

It must be voluntarily executed and should have characteristics of an informed consent given without any undue influence or constraint.

It shall be stated clearly as to when medical treatment may be withdrawn or no specific medical treatment shall be given which will only have the effect of delaying the process of death that may otherwise cause the patient pain, anguish and suffering and further put him or her in a state of indignity.

In order to overcome the difficulty faced in case of patients who are unable to express their wishes at the time of taking the decision, the concept of advance medical directives emerged in various countries.

*What should the will speak about?

It should indicate the decision relating to the circumstances in which withholding or withdrawal of medical treatment can be resorted to.

Be in specific terms and the instructions must be absolutely clear and unambiguous.

Mention that the executor may revoke the instructions/authority at any time.

Disclose that the executor has understood the consequences of executing such a document.

Specify the name of a guardian or close relative who, in the event of the executor becoming incapable of taking decision at the relevant time, will be authorized to give consent to refuse or withdraw medical treatment in a manner consistent with the advance directive.

In the event that there is more than one valid living will, none of which have been revoked, the most recently signed advance directive will be considered as the last expression of the patient’s wishes and will be given effect to.

*How should the will be recorded, preserved?

The document should be signed by the executor in the presence of two attesting witnesses, preferably independent, and counter-signed the jurisdictional Judicial Magistrate of First Class (JMFC) so designated by the concerned district judge.

The JMFC shall preserve one copy of the document in his office, keep another in digital format, forward one copy of the document to the registry of the jurisdictional district court, inform the immediate family members of the executor.

A copy be handed over to the competent officer of the local body. A copy of the directive be handed over to the family physician, if any.

*When and by whom can it be given effect to?

In the event the executor becomes terminally ill and is undergoing prolonged medical treatment with no hope of recovery and cure of the ailment, the treating physician, when made aware about the advance directive, shall ascertain the genuineness and authenticity thereof from the jurisdictional JMFC before acting upon the same.

The document should be given effect to only after being fully satisfied that the executor is terminally ill and is undergoing prolonged treatment or is surviving on life support and that the illness of the executor is incurable or there is no hope of him/her being cured.

The physician or hospital where the executor has been admitted for medical treatment shall constitute a medical board that shall visit the patient and form an opinion whether to certify or not to certify carrying out the instructions of withdrawal or refusal of further medical treatment.

The Chairman of the board nominated by the collector, that is, the Chief District Medical Officer, shall convey the decision of the board to the jurisdictional JMFC before giving effect to the decision to withdraw the medical treatment administered to the patient.

The JMFC shall visit the patient at the earliest and, after examining all aspects, authorise the implementation of the decision of the board.

It will be open to the executor to revoke the document at any stage before it is acted upon and implemented.

What if the board refuses the permission?

If permission to withdraw medical treatment is refused by the Medical Board, it would be open to the patient or his family members or even the treating doctor or the hospital staff to approach the high court and its chief justice will have to constitute a division bench to decide upon case.

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Eating high-carb diet can help lose weight

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Here’s how a high carb diet may help lose weight. (Photo Credit- Shutterstock)

New York, Sep 25: Struggling hard to shed those extra kilos? If so, foods high in carbohydrates — found in fruits, vegetables, whole grains, and legumes — may help you reduce body weight and fat as well as improve insulin function, suggests a study challenging previous beliefs.

It is because these complex carbohydrates are naturally rich in fibre — a nutrient found in plant foods that adds bulk to the diet without adding extra calories.

The study, led by US-non-profit Physicians Committee for Responsible Medicine, showed that a plant-based, high-carbohydrate diet can help with weight regulation and body composition and reduce the risk for Type-2 diabetes.

“Fad diets often lead people to fear carbohydrates. But the research continues to show that healthy carbohydrates — from fruits, vegetables, beans, and whole grains — are the healthiest fuel for our bodies,” said lead author Hana Kahleova, Director at the organisation.

In the study, published in the journal Nutrients, the team included nearly 100 participants for a 16-week randomised clinical trial and placed participants in either a plant-based, high-carbohydrate, low-fat diet group or asked them to maintain their current diet.

The plant-based diet group avoided all animal products and added oils and limited fat intake of 20-30 grams per day. There were no limits on calories or carbohydrate intake.

The control group maintained their current diets, which included meat and dairy products. Neither group altered their exercise routines.

The results demonstrated that total carbohydrate intake did not change in the control group, but increased significantly in the plant-based diet group, both as absolute intake and as a percentage of total calories.

At the end of the trial, body mass index, body weight, fat mass, visceral fat volume, and insulin resistance decreased significantly in the plant-based diet group. There were no significant changes in the control group, the researchers noted.

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New blood test in pregnancy to predict autism risk in babies

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New York, Sep 22: Researchers have developed a novel blood test for pregnant mothers that can, with nearly 90 per cent accuracy rate, predict the probability of having a child that will be diagnosed with autism.

According to studies, if a mother has previously had a child with autism, the risk of having a second child with the developmental disorder is approximately 18.7 per cent, whereas the risk in the general population is approximately 1.7 per cent.

In the study, led by Juergen Hahn, Professor at Rensselaer Polytechnic Institute in New York, metabolites of the folate-dependent transmethylation and transsulfuration biochemical pathways of pregnant mothers were measured to determine whether or not the risk of having a child with autism could be predicted by her metabolic profile.

Pregnant mothers who have had a child with autism before were separated into two groups based on the diagnosis of their child whether the child had autism or not.

Then these mothers were compared to a group of control mothers who have not had a child with autism before.

The results, appearing in the journal Research in Autism Spectrum Disorders, showed that while it is not possible to determine during a pregnancy if a child will be diagnosed with autism by age 3, they did find that differences in the plasma metabolites are indicative of the relative risk (18.7 per cent vs 1.7 per cent) for having a child with autism.

“These are exciting results as they hint at differences in some metabolic processes that potentially play a role in increasing the risk of having a child with autism,” Hahn said.

“However, it would be highly desirable if a prediction based upon physiological measurements could be made to determine which risk group a prospective mother falls into,” Hahn noted.

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Eat fish thrice a week to boost your unborn’s eyesight, brain

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London, Sep 21: Pregnant women can enhance the development of their unborn child’s eyesight and brain function by regularly eating fatty fish during the pregnancy, a new study has found.

The findings suggested that infants whose mothers ate fish three or more times a week during the last trimester of their pregnancy fared better than those whose mothers ate no fish or only up to two portions per week.

“The results of our study suggest that frequent fish consumption by pregnant women is of benefit for their unborn child’s development,” said lead author Kirsi Laitinen of the University of Turku in Finland.

“This may be attributable to long-chain polyunsaturated fatty acids within fish, but also due to other nutrients like vitamin D and E, which are also important for development,” Laitinen added.

For the study, published in the journal Pediatric Research, the research team analysed the results of a small group of mothers and their children drawn from a larger study.

The mothers had to keep a regular food diary during the course of their pregnancy. Fluctuations in their weight before and during pregnancy were taken into account, along with their blood sugar level and blood pressure.

The team recorded the levels of nutritional long-chain polyunsaturated fatty acid sources in the mother’s diet and blood serum, and the levels in the blood of their children by the age of one month.

Their children were further tested around their second birthday using pattern reversal visual evoked potentials (pVEP). This sensitive and accurate, non-invasive method is used to detect visual functioning and maturational changes occurring within a young child’s visual system.

“Our study therefore highlights the potential importance of subtle changes in the diet of healthy women with uncompromised pregnancies, beyond prematurity or nutritional deficiencies, in regulating infantile neurodevelopment,” Laitinen noted.

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