14 of world’s 15 most polluted cities in India : is crime and pollution related?

The WHO report said 14 of world’s 15 most polluted cities were in India which includes Delhi, Kanpur and Varanasi. This will need soul searching and introspection by every one including policy makers.

Air pollution is related to lung diseases like asthma, emphysema or COPD. It can have effects on pregnant women, Heart patients and outdoor workers etc. but another aspect of relationship of pollution with crime is also coming up, which concerns the psychological aspect.

There is a study in London which relates pollution and crime rate. Although it appears strange but it gives some thing to ponder. If proved correct it may be dangerous environment to the people living in polluted cities.

A new report by researchers at the London School of Economics (LSE) suggests that crime in the capital is being driven by air pollution.

Their results show more polluted areas will see spikes in crime, particularly for less serious offences.

While the study relies on observational data and therefore cannot make definitive conclusions, it adds to a small but growing body of evidence linking pollution and crime.

Previous experiments have shown that increased levels of particulate matter in the air lead to increased blood levels of stress hormones such as cortisol.

The authors therefore suggest that behavioural changes resulting from increased stress hormone levels may in turn lead to an increased likelihood a person will commit a crime.

This means is that pollution can have a negative effect on people’s ways of thinking, including decision making and the way they think about future punishment.

Higher levels of pollution mean higher levels of cortisol. Higher levels of cortisol affect the way that punishment is being perceived by criminals.

Though the paper has yet to be peer reviewed and published in an academic journal, it has undergone internal peer review at LSE’s Grantham Research Institute on Climate Change and the Environment.

The research is not the first to explore links between air pollution levels and crime.

May 8, 2018 0

Death of radio executive TANIA: result of misplaced priorities of media in civic negligence: hundreds healthy deaths vs one in hospital due to disease

Just Compare the media projection, burden of negligence and accountability of hundreds of healthy deaths by civic negligence with one hospital death by disease. In fact the burden of negligence here in healthy deaths is massive and these deaths are unpardonable. But reality is opposite. It is just to compare how a naked “negligence in deaths of healthy people” in such cases to the “alleged and perceived negligence ( with no proof and no investigation ) in death of someone already having disease and death in hospital” during treatment is projected by our society and media.

An unfortunate incident of untimely death of a young and talented person happened yesterday due to civic negligence. The family lost their dear daughter due to an incident which was totally preventable . Another recent incident was of unlicensed school vans being driven rashly, again leading to entirely preventable loss of lives. These incidents bring fore to my mind the misplaced priorities of media and society which too have contributed to some extent to these unabated ongoing preventable deaths of hundreds of healthy people.

An open drain and a poorly lit road claimed the life of a young executive in Noida in the early hours of Wednesday. The victim, Tania Khanna was driving car that plunged into the eight-foot-wide drain. Such a huge drain has been left uncovered and there is no proper mechanism of streets lights in the area. There is also no CCTV camera installed there. Noida Authority officials did not respond to requests for a comment.

An open drain next to a road with no barrier or signage and not even street lighting is a recipe for disaster. No civilized part of the world would allow such a situation to exist. That this particular area is still in the process of being developed is beside the point. Whether an area is fully developed or is being developed, there should either be no open drain or if there is one that has not yet been covered, it must be clearly separated from the road and pavements by barriers. There should also be clear signs warning people of the potential danger and lighting to ensure they can see it. That this is not done amounts to negligence by the civic authorities, for which individual accountability must be fixed and action taken.

Multiple Deaths in healthy people by civic negligence :

Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods etc. Which somehow are never made as headlines or breaking news by media due to lack of sensational substance. These deaths of people are in thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of negligence here is massive and these deaths are unpardonable. It’s time media took it upon itself to bring to fore these issues so that many innocent lives of many more healthy people like Tania can be saved.

Single Death in Hospital due to disease:

The media has always, instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient. However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault. Media has been responsible for creating a misunderstanding about the whole process of treatment . The patient coming to hospital already is diseased and some are critical and have a finite percent chance of death. The doctor tries his best to treat him but may not always succeed. Making an issue out of a hospital death of a sick patient despite the doctors’ best efforts may get some high viewership to the paper but is it right? No. They have ignored other important things like civic negligence and has instead trained their entire energy in blaming the doctors in an effort to get something sensational out of nothing.

The whole blame is cleverly put on doctors. Even after doing everything possible, doctor may be running for his life, trying to save himself from goons. He may be an object for revenge. He may be running after lawyers, if a medical lawsuit is filed. He may have to stand like a culprit in front of relatives of deceased, who can abuse or threaten him in the language they choose, in garb of emotional outburst. Doctors are advised in such situations to be calm and suffer silently or just apologize, as it is thought to be correct in front of relatives stuck with grief. Even if court give the judgement after decades in favor of doctor, harassment of the doctor is permanent and irreversible damage is done to doctor. He is already punished.

Here it will be seen later, whether some one can be punished or not.

Point to ponder-Misplaced priorities:

Who is to be blamed for the deaths of healthy people which occur because of civic negligence? Here relatives may be helpless and the vital questions may go unanswered or taken as a routine. There are no punching bags like doctor for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media forgetting the fact that thousands of patients are saved everyday by doctors. But media instead chose to defame medical profession by igniting the emotions of people by sensationalising death of diseased and ill, who probably were already at risk of death and did not give due importance to highlighting prevention of healthy and absolutely 100% preventable deaths.

Is it due to a misplaced priorities of the media or in an effort to create sensational news? Had media made an appropriate noise about right issues and scratched the right pole for preventing death of healthy people , Tania might have been alive today and thousands more.

May 4, 2018 2

Hospital, Doctors fined for unfair trade practices: Doctors “ be clinically and legally correct so as to save themselves”

Since Hannurabi times 1750BC, medical profession or health care has been regulated. For thousands of years, attempts have been made, laws enacted to regulate or control medical treatments or doctors. It has never been perfect. In today’s time, where medico-legal issues have become as important as much as treatment, it is strange to find such practices, where transplant was done without valid license. More importantly, it was done in a well known hospital in Delhi and not in unknown location.

Going by the news item, Jaipur Golden Hospital New Delhi conducted renal transplant without having a valid license for the same in 2006. It could have gone unnoticed, in case everything had gone well. But in today’s scenario, no one accepts even small and routine complications. So doing a procedure like transplant without license is asking for trouble.

Medical fraternity is clear that there are no treatments without complications. Even simple procedures can get complicated. Therefore, doing anything which is legally not correct, can be a blunder. Consequences of even little mistakes can be disastrous in current environment, which is not very supportive to doctors. Temptation for doing procedures without being legally correct can be many, like holding a license previously, or just to maintain a continuity of performing a special surgery. Money generated may or may not be a great incentive in such circumstances . Reason can be as simple as to continue doing procedure while license is awaited and take temporary invalidity of licensing requirements lightly.

Legalities should be taken in correct perspective always. Doctors can save themselves by just following well laid protocols and legal requirements. This is not right for doctors doing procedures against the law or without legal permissions. Because no one, including patient will not support the doctor in adverse circumstances.

Doctors can save themselves by doing procedures, which are clinically and legally correct.

May 1, 2018 1

Expensive Medical college education (NEET) & poor health system: systematic root rot

Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college. Even an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 20 -25 % marks also becomes eligible to become a doctor. What is the need to dilute and shortlist around half a million for few thousand seats. Answer to that is simple. To select and find only those students from millions, who can pay millions to become doctors.

Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession. By allowing a intentional dilution of quality can be advantageous only to few and detrimental to others.

Beneficiaries are rich candidates, medical colleges who collecting fee and may be public who will get numbers of doctors. Surplus of doctors is thought to be an advantage to society. But here quality is least of the consideration.
Disadvantage to students, who are meritorious but can’t pay, and possibly society in long run, who is deprived of good quality doctors.

Dilution of Merit :

Before NEET was made mandatory in 2016, the cut-offs for admission were 50% marks for the general category, and 40% for the reserved categories. From the 2016 admission year, these were changed to 50th and 40th percentile, respectively, opening the doors to candidates with just 18-20% marks in the NEET aggregate. Thereby candidates securing 5% marks (physics) and 20% in biology are also eligible to be doctors (times of India).
The student with the highest NEET marks among those admitted into the private university had lower marks than the last student admitted to the open category in each of the government colleges.
In the private university, the fees for the MBBS course are Rs 64 lakh compared to just Rs 4 lakh in the government colleges.
when NEET was introduced, many private colleges increased their tuition fees many fold. This ensured that meritorious students without money would never get admission. The tuition fee is fixed arbitrarily to cater to only rich or super rich students. (times of India) System of medical business and medical education is created based on willful dilution of merit. Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it especially those candidates who may have invested in heavy fees or bought a seat in medical colleges with hefty amount. Some of them, who invested millions for becoming doctors, will be even probably unable to recover their investments. The students with strong financial backgrounds may be more benefited as they can become health investors or health managers. But for others, it could be a dream turning into a nightmare.
If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way forward. So children have to be careful while choosing medical careers from the beginning.

A famous axiom “as you sow so shall you reap” has an application to health system in this scenario, so people should not rue scarcity of good doctors.

April 27, 2018 1

Apollo Hospital fined 5 lakh: “Doc, Talk less, write more”.Doctor save yourself by “documenting the communication”

Doctors are trained to treat patients and that is they keep on doing. But in today’s era that is not enough. They are expected to examine, investigate, diagnosis , treat correctly and communicate to the family or patient. Everything should be speedy and financially suitable to the patient’s expectations. Even if that is done, the things do not end here. Doctor need to document, what has been communicated to the family. It is hard to believe that doctor at a hospital like Apollo, who really did well to diagnose a disease like SLE and still did not communicate. Yes, news item mentions that in file that there was no evidence of communication. Doctors still behave like doctors and do not treat patient as consumer. Usually , doctor trust their patients and there is lot of verbal communication takes place. Verbally they sympathize, communicate and tell many things which are not documented as a routine.

The Delhi State Consumer Commission, in its judgment, made it essential for a hospital to disclose to the patients or their attendants, the line of treatment and the potential risks involved in it.
The judgment came in connection with the death of a 23-year-old student, who died during a treatment at Indraprastha Apollo Hospital in 2004.

Many times patients are sincere enough to admit to verbal communication. But sometimes when during ongoing medico legal lawsuits, a feeling of revenge prevails or as guided by lawyers, patient may not admit to the verbal communication. Specially if verbal communication is not documented in file.

How to save yourself by “documenting the communication”

examine, investigate, diagnosis , treat correctly and communicate
Make a note of plan of treatment and prognosis, and communicate to patient or attendants.
Sign yourself and ask the patient or nearest relative to sign.
It is not uncommon that relative will refuse to sign. In that case just write a note and mention that attendant refuses to sign.
It is also a common issue that after listening to everything, relative will say that he does not understand or will ask his uncle or aunt. These are difficult moments and commonly happen. Just make a note of everything. Besides it wastes crucial time.
Can use camera for communication in difficult cases.
Never rely on verbal communication. It has little value. Commonly people refuse to admit verbal communication, and will say that they were not told anything.

As time for everything is limited in life, be it treatment, communication, consent or documentation. So message is clear for doctors. “Talk less and write more”. You will be judged by documents after many years. Therefore, do save the patient, but save yourself also.

April 17, 2018 6

Two doctors from Fortis Hospital arrested – How doctors may save themselves by learning from such cases.

Doctor, do save the patient but save yourself also.

Doctors continue to treat and save many patients in the years they work. But present law and regulatory system does not take into account those years of good and hard work. It does treat doctor as a petty criminal for some single mistake or unfortunate incident. Law just deals with it in a harshest possible manner. Patient may have died because of disease, but when in side the hospital, it is very easy to relate death with actions or inaction of doctors. Specially because inquiries are always done with retrospective analysis, with wisdom of hindsight. Although there is a feeling among doctors that what is really happening these days, something may not be very appropriate, but there is no room for leniency here.

News of this kind brings tsunami of fear in minds of doctors all over. It can be anyone in such situation, where it is just that a particular doctor did not have that eye for danger in that moment. The doctor did not realize or anticipate the gravity of the consequence and outcome of the patient in real time. It may be difficult to pick up or just not take the situation very seriously. That can simply be poor training or working without good application of mind. But looking retrospectively, situation becomes clear.

Two senior doctors of Fortis Hospital in Haryana’s Gurgaon were arrested on Friday for a “delay in administration of emergency medicines” to a 51-year-old woman, who died of cardiac arrest last year, police said.

Lessons to be learnt: What options doctors have at present? Because they are at receiving end always. They have to learn from such cases and do something in their routine to prevent disasters. How can they save themselves?

All patients to be seen by primary consultants or someone from concerned unit at the earliest. It is important as emergency doctor may not be equipped to deal with specialty problem. Prompt diagnosis by specialty doctor and written findings are important.
Initial assessment should be quick and with in minimum time.
Good communication and documentation of the problem.
Assess the patient and make a note of treatment to be given.
Document the plan of action, that is investigation and management.
Avoid phone call consultations and leaving treatment loosely. Well thought documented plan should be in place.
Situation may be different for smaller nursing homes. Treatment of an emergency will remain same, whether patient goes to bigger or smaller hospital. Nursing homes may not be equipped for all the emergencies. So challenge before the smaller hospitals will be to identify the problem and diagnose them quickly and if required send them to proper hospital, rather risking themselves in today’s times.
Aspiring doctors can have a cue about what they are getting into. So as to adapt to prevalent adverse circumstances for doctors, if they aspire to be one.

Doctor, do save the patient but save yourself also.

April 15, 2018 2

NEET: Buying an expensive medical college seat & want to be doctor. Worthless and unfair

At a time when students, parents and even doctors are uncertain whether opting for medical college along with the vulnerability and risk associated with becoming a doctor is worth it or not, some are naive enough to pay millions as fee for medical education and for securing a seat in medical college. The noble intentions of NEET were to minimize wastage of seats due to multiple admission procedures running concurrently and to do away with the variable criteria for selection used for admissions. But there has been unregulated steep increase in fees of private medical colleges. So in the end, seats remain unfilled and may be a kind of auction, whosoever can pay millions, takes the seat.

Going by selection of candidates as doctors, If given a choice, by whom a patient will like to get treated? A candidate who scored 30 % marks or a person getting 60% or 80% marks. NEET eligibility getting lower and a candidate getting around 30 % of marks may be able to secure a degree to treat patients. What will be the deciding factor? The criteria as to why a person with 60% marks will not be given a seat and with 30% marks will be able to secure. It will depend upon, whether a student is able to pay the exorbitant fee or not. Present system and mechanism of admission permit and accept such huge variation! That strange equation is acceptable in lieu of money paid!

It is ironical that the medical profession is regulated, but medical business or medical education is not. Such business of producing doctors based on their paying capacity should be clearly trounced for the benefit of public. Foundations of healthcare should be on touchstone of merit, ethics and character and not based on business deals. Therefore meritorious students, especially from average backgrounds, who opt to become doctors feel cheated when they pay massive fee to buy a seat. It is an insult to the very virtue of merit which should have been the sole criteria for these admissions.

Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it especially those candidates who may have invested in heavy fees or bought a seat in medical colleges with hefty amount. Some of them, who invested millions for becoming doctors, will be even probably unable to recover their investments. The students with strong financial backgrounds may be more benefited as they can become investors or health managers. But for others, it could be a dream turning into a nightmare.

Buying a seat may be a compulsion for many as a result of entrapment into a system. Once aspiring child decides to be a doctor and there may not be any other way forward.

A famous axiom “as you sow so shall you reap “ has an application to health system. As NEET has been implemented and there has been some effort to find out information about admissions to medical colleges, at least tip of the iceberg is getting visible. More you know or read the news items about NEET, more one is convinced that industry selling medical college seats has been quite powerful and practically, every technique to sell seats is prevalent to by pass the merit and deny seat to deserving candidates. These meritorious children, who are denied seats could have been good doctors and real custodian for the health of people. But if for some reason, business prevails and government fails to prevent this cruel and corrupt selling of medical seats, an Einstein brain is not required to guess the whole malaise prevalent in health system. Foundation of medical system is suffused with sand rather than touch stone of merit.

Astronomical and unreasonable fee of medical colleges without proper facilities and medical education can be born only by investors and not good candidates. It is the people and society, who will be the real sufferers in future. Therefore resentment to such system should come from the society.

If every one is happy by the arrangement, then one has to introspect, whether society really deserve kind of doctors, they wish.

April 11, 2018 3

Dr Hazida Bawa-Garba case: sacrificial lambs “The doctors” and not health administrators? Dangerous precedence for doctors worldwide

Dr Hazida Bawa case is of importance worldwide in many ways, an (lost)opportunity for learning some hard and truthful lessons, as it touched upon various crucial aspects involved in treatment, especially in difficult situations , for doctors. At the time of death of patient, a constant and universal last link is only the doctor, that is visible. This visibility of doctor at the time of declaration of death or while treating the patient on his bedside, makes him vulnerable to all kinds of accusations. By application of an average wisdom, all deaths can be easily attributed or linked to fault of the doctor. Subtle presentations of severe disease, rapid deterioration, multi organ complexities, under staffing and sub optimal systems, equipment and other innumerable shortcomings of the whole system may not be visible or not given consideration in the haze, as compared to publicity and attention given to only doctor’s faults. This is specially so when the wisdom is applied retrospectively, with knowledge of hindsight, and by the people who have never treated emergencies or have never been in such difficult situations themselves.

Analogy to Dr Hazida Bawa case

Imagine a situation where during a bad sea storm, large number of people are trapped and are in mortal danger. The coast guard on the duty tries his best in the emergency situation with his limited resources and saves a large number of people. There were only a few coast guards present, equipment were inadequate and sub optimal. However the guards manage to salvage the situation by doing the best possible in the circumstances. There were instances, where they decide, act, communicate and document events simultaneously, in an instant. Those who could not be saved were exposed to risk of death as resources allocated by authorities were limited. The near and dear ones of those who died were unhappy and revengeful with the services. Inquiry is done to find out the cause of failure in preventing those deaths. Rather than appreciating the facts that greater proportion of victims were saved in those difficult circumstances, the guards are blamed for those who could not be saved. Guards who are already apologetic for not been able to save the few, are blamed for doing their duty shabbily after careful fault finding analysis of the event. The administrators who are responsible for allocating the inadequate number of guards and equipment, who actually failed in their duty, also participate in pointing fingers at the guards.

The saddest part was that courts also were unwilling to apply wisdom to look beyond the guard faults and reach beyond the fog in present hazy circumstances. Systems and administrative lapses and inadequacy of number of coast guards was not raised as a concern. The responsibility of the deaths is thus fixed on the persons who struggled to save the lives of many. Every one has great sympathies for the deceased, but there is another angle for doctors in such difficult situations.

This is an analogy to Dr Hazida Bawa case, but similar unfortunate incidents are happening to medical professionals worldwide, more so in developing countries. The new regulated system of medicine has an aberrant evolution and chooses to hang their own wounded soldier for not putting up the best fight, rather than accepting the limitations of medical science or errors in the supporting systems. Was she an easy scapegoat for some obviously non- admissible reasons prevalent?

Why is it always necessary to punish a doctor, and conveniently overlook errors of the sub optimal system in cases of unfavorable prognosis, especially in sick patients. Why a sub optimal system or unsafe working conditions like all other registrars were on leave simultaneously, or only one registrar in place of three and that too a trainee. There was no consultant or registrar covering her? Why is a single doctor stuck in a difficult situation not treated as just another human being in an emergency situation, especially in cases of very sick patients? Why administrators or managers are not punishable for putting doctor and patients at risk and unsafe condition ?

If a doctor is supposed to raise concern (may be at cost of his career), then what is the role of managers, management and administration? Are they inefficient or incompetent to anticipate the situation? A new doctor coming on duty can not anticipate the deficiency of system. He will not have time to assess the managerial deficiencies. Therefore raising a concern by doctor on duty is something, which is expected but at the same time not feasible always, in true sense. This expectation to raise a concern may be used to later implicate the doctor as to why he or she did not raise a concern. At the same time it takes responsibility off, from the administrators whose duty was to raise concerns.

NHS is looked upon in the world as one of the better organized health care organization in terms of uniformity. If such an organization has to sacrifice its working hands in the form of scapegoats to prove its quality, deliberately overlooking its system errors, then it is a sad state for doctors all over the world. This would set a precedence for governments and health administrators, world over to be fearless in putting errors of sub optimal system under the carpet by punishing the doctors instead. Since there will always be a doctor in the end who will declare the death, is the last and common link in all deaths. Other circumstantial issues would be overlooked because of sheer unwillingness to do so.

Irony of the situation is that generally people who have been invested with the power to decide on these issues of medical negligence may have never faced such situations themselves. They may be the people in administrative positions who have never treated a single patient, leave aside emergencies. They do not even know, what it takes to deal with emergencies of life and death, that too multiple ones, with limited resources. The court takes years to decide on these issues discussed retrospectively with wisdom of hindsight, on issues which the doctor had to decide in a jiffy. A person who perhaps can only imagine such a situation, or never handle it himself, even in his wildest dreams is the one who decides what went wrong merely based on how the situation is placed and presented before him.

If there is unsaid immunity to governments and administrators for providing a suboptimal systems, then the doctor should be the first person to get this immunity. But unfortunately nobody seems to be willing to find out who is responsible for putting the doctor in such a difficult situation, making everything error prone.

If in such system a doctor is punished, then the administrator, manager or trust should be an automatic accomplice to the doctor’s punishment. Firstly for providing an unsafe and suboptimal system, and secondly for not raising a concern as management . Thirdly for putting it’s doctor in difficult circumstances. If it was an understaffed system, then disaster was bound to happen sooner or later. This is a perfect example how management lapses contribute to death but doctors are the only ones who are entirely blamed and punished in isolation.

Another sad part is the unwillingness of judiciary system to look at the larger picture and the fault in the system, which has led to mass demoralization of the doctors. The doctors are denied the true justice in many such cases. They are being used as sacrificial lambs. Health administrators are obviously at an advantage enjoying the invisible immunity and perks, at the cost of medical professionals. By crucification of the doctors, vengeance of the society is fulfilled and everyone feels satisfied with false sense of justice. But does this give any advantage to the society? Definitely not. In fact the society is thus raising a demoralized force to be their care providers, who under duress, will definitely not perform to their very best. If this is quality of justice for saviours, this demoralized force may also not be available in future.

April 5, 2018 2

Supreme Court judgement on End of Life & Living Will: Partaking moral and ethical dilemma of doctors and relatives

A welcome, long awaited judgement, where law has come to help the doctors and relatives of terminally ill patients. Doctors are often accused of over treatment, without realizing that law does not permit them the termination of treatment as desired by patients or relatives. commonly doctors come to face these difficult situations, where moral and ethical dilemma is larger than treatment itself.

The Supreme Court ruled on Friday that individuals have a right to die with dignity, in a verdict that permits the removal of life-support systems for the terminally ill or those in incurable comas.

The court also permitted individuals to decide against artificial life support, should the need arise, by creating a “living will”.

Living will

A ‘living will’ is a concept where a patient can give consent that allows withdrawal of life support systems if the individual is reduced to a permanent vegetative state with no real chance of survival.

It is a type of advance directive that may be used by a person before incapacitation to outline a full range of treatment preferences or, most often, to reject treatment. A living can detail a person’s preferences for tube-feeding, artificial hydration, and pain medication when an individual cannot communicate his/her choices.

In its verdict on Friday, SC has attached strict conditions for executing “a living will that was made by a person in his normal state of health and mind”.

The US, UK, Germany and Netherlands have advance medical directive laws that allow people to create a ‘living will’.

Active and passive euthanasia

Active euthanasia, the intentional act of causing the death of a patient in great suffering, is illegal in India. It entails deliberately causing the patient’s death through injections or overdose.

But passive euthanasia, the withdrawal of medical treatment with the deliberate intention to hasten a terminally ill patient’s death was allowed by the Supreme Court in Friday’s landmark verdict.

The court also laid down guidelines on who would execute the will and how a nod for passive euthanasia would be granted by a medical board set up to determine and carry out any “advance directive”.

In cases where there is no “advance directive”, the patient, family, friends and legal guardians can’t take the decision on their own, but can approach a high court for stopping treatment .

Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill

In 2012, the union health ministry posted a draft of the Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill on its website and invited public reactions.

The Bill is popularly referred to as the Passive Euthanasia Bill although its draft did not use the emotive word “euthanasia” to skirt complications around the term, a health ministry official told HT in 2016. It says every advance medical directive (also called ‘living will’) or medical power of attorney executed by a person shall be taken into consideration in matter of withholding or withdrawing medical treatment but it shall not be binding on any medical practitioner.

Misuse of law

A major concern is the misuse of the law. If it is legal to passively allow or hasten death, what’s to say an aged parent won’t be hastened in favor of an inheritance, or a spouse have treatment withdrawn for the sake of a hefty insurance payout? That is why there are legal provisions in the judgement by Supreme court, to safe guard the patients.

The bench also stipulated strict conditions for the execution of the living will, which includes the setting up of two medical boards and certification by the judicial magistrate. It also directed high courts to maintain a record of all living will documents prepared within the state.

Euthanasia in other countries

Euthanasia and physician-assisted suicide have been legal in The Netherlands and Belgium since 2001 and 2002. In the US, Switzerland and Germany, euthanasia is illegal but physician-assisted suicide is legal. Euthanasia remains illegal in the UK, France, Canada and Australia.

Source- Hindustan times

March 11, 2018 0

20 interesting facts about the kidneys : World Kidney Day

Kidneys are very important and fundamental organs of human body. They are extremely complex in mechanism and they have two functions that is blood purification and waste elimination.
An adult kidney weighs around 142 grams and is the size of human fist.
In case of new born human babies, the kidney to body weight ratio is 3 times the kidney to body weight ratio in adults. In case of adults, kidneys form only 0.5% of the entire body weight.
Largest kidney stone recorded was of coconut size and weighed 1.1 kg.
If a child is borne without a kidney, the one kidney will grow and weigh the same as of two kidneys.
The right kidney is below the liver ( largest organ ) and smaller than left kidney.
There are 1.1 million nephrons ( very tiny filters that are capable of filtering blood) in the body. If stretched end to end, they will be 8 KM long.
Kidney filter blood around 400 times a day.
If kidney detect fall in Blood pressure, they signal blood vessels to shrink.
A single kidney with only 75 % of its functional capacity can sustain life very well.
They are capable of activating vitamin D in our body. This vitamin is usually produced by special skin cells when they are exposed to sunlight.
Kidneys cleanse 1.3 liters of blood every minute to produce about the same quantity of urine in a day.
Most common cause of renal stones is not drinking enough water.
About 25 % of the blood from heart, goes to kidneys.
High BP and diabetes can both lead to failure of kidneys.
When the kidney functions are completely lost, it is known as ESRD or End Stage Renal Disease.
People suffering with ESRD can live longer with help of kidney transplant or dialysis.
The first ever kidney transplant was conducted by Yuri Voronoy, a Russian surgeon in year 1933, but was unsuccessful.
The first ever successful kidney transplant was conducted by Dr. Joseph E. Murray in December 1954, in Massachusetts at Peter Bent Brigham Hospital.
A kidney transplant would be normally put in pelvis and disabled kidney will not be extracted.