The church advises doctors to fight for a patient’s life to the extent possible, says Father Stephen Fernandes (inset)
Several major Catholic hospitals have begun active deliberations about offering the controversial “Do Not Resuscitate” alternative to patients who are terminally ill. While the church is unequivocal in its stance against euthanasia, these medical institutions have held consultations with Fr Stephen Fernandes, an ethicist and moral theologian, about the permissibility of DNR, which does not involve deliberate intervention to end life.
DNR is a legal order signed by a living person declaring that he or she should not be resuscitated when in a terminally ill state. While many developed countries have considered laws regarding DNR, there are no such legal guidelines in India. “The church says that we must fight for life, but only to the extent that it is possible,” said Fr Fernandes, a professor at the St Pious College, also known as the Goregaon seminary. “Any patient must continue to get the basic medical care, food, water or artificial nutrition and hydration. This level of care cannot be stopped. However when a terminally-ill patient needs aggressive therapy but there is no hope of success, the patient or relatives should take a call.” Fernandez is of the opinion that this decision does not contravene canon law.
Hospitals like Holy Spirit, Andheri; Holy Family, Bandra; Karuna, Borivali; St Elizabeth, Malabar Hill and Stella Maris, Uttan have sought his views on the ethics of withholding or withdrawing high level treatment or invasive therapy when there is no hope for recovery and both the patient and relatives have invoked the DNR option. “We often get cases where the patient’s relatives request us to stop aggressive treatment or do not permit us to put the patient on ventilator. This happens mostly when the patient is extremely critical and there is no hope of recovery,” said Sister Aquinas, executive director of Holy Family Hospital. “In such cases, we continue the basic medical care as we cannot offer aggressive high level treatment without consent.”
According to Dr DK Khanna, medical director of Andheri’s Holy Spirit hospital, the ethics and legality of withholding treatment occupy nebulous space in Indian law. “This is not only a question for Catholic hospitals. The problem is bothering all healthcare institutions for a long time,” said Khanna adding that by creating debates and discussions, the idea is to install in place a proper protocol. “What does one do when a relative refuses any kind of invasive procedure for the patient or the family does not want any escalated form for treatment? This is a dilemma every hospital faces.”
DNR, in the absence of explicit legal provisions, is a solution for situations that are deemed tricky, said Sister Lissy, executive director of Holy Spirit Hospital. Medical experts pointed out that until such time that a well-defined legal framework is made available, DNR will continue to be a solution. “Passive form of euthanasia is informally followed in all hospitals,” said Dr Lalit Kapoor, a medical-legal expert who belongs to the Association of Medical Consultants. However, no medical institution will commit to such a solution – the withholding of treatment – on paper. Instead, the patient or relatives are asked to opt for Discharge Against Medical Advice (DAMA). “There is no other option available,” Dr Kapoor said.
Dr Sanjay Nagral, a consulting surgeon at Jaslok Hospital’s department of surgical gastroenterology cited a case about a man suffering from intestinal gangrene to illustrate how DAMA works in cases where a patient is deemed terminally ill. “He showed no signs of improvement and the hospital bill had crossed Rs 20 lakhs, so I informed the family that what we were doing was probably futile,” Dr Nagral said. “They told me the next day that they wanted us to stop treatment. I said it would be difficult to disconnect the ventilator but we could stop other life support systems, an act vaguely termed as ‘passive euthanasia’ in India.” Nagral said the family eventually chose DAMA.