 bill no 293 of  2016 the treatment of terminally-ill patients bill, 2016 byshri baijayant panda, mp a billto provide for the protection of patients and medical practitioners from criminal offences arising from withdrawing life-saving procedures or assisting for the right of a dignified deathbe it enacted by parliament in the sixty-seventh year of the republic of india as follows:—1 (1) this act may be called the treatment of terminally-ill patients act, 2016short title and commencement5(2) it shall come into force on such date as the central government may, by notificationin the official gazette, appointdefinitions2 in this act, unless the context otherwise requires,—(a) "adult"means an individual who is of eighteen years of age or more; (b) "advance medical directive" (called living will) means a directive given by aperson that he shall or shall not be given medical treatment in future when he becomes terminally-ill;(c) "attending medical practitioner" means a physician who has primary responsibility for care of the patient and treatment of the patient's terminal disease;(d) "competent patient" means a patient who is not an incompetent patient; (e) "incompetent patient" means a patient who is a minor below the age of sixteen years or a person of unsound mind or a patient who is unable to— 5(i) understand the information relevant to an informed decision about hismedical treatment;(ii) retain that information;10(iii) use or weigh that information as part of the process of making hisinformed decision;(iv) make an informed decision because of impairment of or a disturbancein the functioning of his mind or brain; or(v) communicate his informed decision (whether by speech, language orany other mode) as to medical treatment15(f) "independent medical practitioner"means a physician who has been consultedabout the attending medical practitioner's intention to terminate life on request or to provide assistance with suicide;20(g) "informed decision" means a decision by a competent patient, to request andobtain a prescription to end his life in a humane and dignified manner, that is based on an appreciation of the relevant facts and after being fully informed by the attending medical practitioner of—(i) his medical diagnosis; (ii) his prognosis; (iii) the consequences of remaining untreated;25(iv) the potential risks associated with taking the medication to beprescribed;(v) the probable result of taking the medication to be prescribed; and(vi) the feasible alternatives, including, but not limited to, palliative care,hospice care and pain control30(h) "medical power-of-attorney"means a document of decisions in future as tomedical treatment which has to be given or not to be given to a person if he becomes terminally-ill and becomes an incompetent patient;35102 of 1956(i) "medical practitioner" means a medical practitioner who possesses any'recognized medical qualification' as defined in clause (h) of section 2 of the indian medical council act, 1956 and who is enrolled on a 'state medical register' as defined in clause (k) of that section;(j) "medical treatment" means treatment intended to sustain, restore or replace vital functions which, when applied to a patient suffering from terminal illness, would serve only to prolong the process of dying and includes—40(i) life-sustaining treatment by way of surgical operation or theadministration of medicine or the carrying out of any other medical procedure; and(ii) use of mechanical or artificial means such as ventilation, artificialnutrition and hydration and cardiopulmonary resuscitation(k) "medically confirmed" means the medical opinion of the attending medical practitioner has been confirmed by an independent medical practitioner who has examined the patient and the patient's relevant medical records;4 of 1875(l) "minor" means a person who, under the provisions of the indian majorityact, 1875 is to be deemed not to have attained majority; 5(m) "palliative care" includes—(i) the provision of reasonable medical and nursing procedures for therelief of physical pain, suffering, discomfort or emotional and psycho-social suffering; and(ii) the reasonable provision for food and water10(n) "patient" means a patient who is suffering from terminal illness; and(o) "terminal illness" means—(i) an incurable and irreversible disease that has been medically confirmedand will, within reasonable medical judgement, cause death within six months; or15(ii) which has caused a persistent and irreversible vegetative conditionunder which no meaningful existence of life is possible for the patient3 (1) every patient including minor aged above sixteen years shall have the right to take a decision and express his desire to the attending medical practitioner attending to him—(i) for withholding or withdrawing of medical treatment to himself; or20(ii) to intentionally assist him to commit suicide by providing him with the meansto do sorefusal of medical treatment by competent patient or physicianassisted suicide(2) when a patient referred to in sub-section (1) communicates his decision to the attending medical practitioner, such a decision shall be binding on the medical practitioner if the following conditions are fulfilled:—25(i) the attending medical practitioner is satisfied that the patient is a competentpatient and that the patient has taken an informed decision based upon a free exercise of his free will;(ii) the medical opinion of the attending medical practitioner has been confirmedby a panel of three independent medical practitioners who have examined the patient and the patient's past medical records:30provided that if there is difference in the opinion of the three independent medical practitioners, the majority opinion shall prevail; and(iii) in the case of a minor above sixteen years of age, the consent has also been given by his parents35(3) in the case of an incompetent patient or a competent patient who has not taken an informed decision, the attending medical practitioner may take a decision referred to in clause (i) or (ii) of sub-section (1) provided—(i) the attending medical practitioner is of the opinion that the medical treatment to a patient should be withheld or withdrawn; or40(ii) the attending medical practitioner in his medical opinion suggests assistedsuicide for the patient with a humane and dignified death;and the medical opinion of the attending medical practitioner is backed by a panel of three independent medical practitioners who have examined the patient and the patient's past medical records:provided that if there is difference in the opinion of the three independent medical practitioners, the majority opinion shall prevail; and(iii) the high court having territorial jurisdiction has granted permission in accordance with section 6 5(4) the attending medical practitioner shall, while taking a decision under sub-section(3),—(i) adhere to guidelines as may have been issued by the medical council of india in this regard; and10(ii) consult the parents or relatives, if any, of patient but shall not be bound by their views (5) before proceeding further to give effect to the request of the patient, the attending medical practitioner must inform the patient that he may rescind the request at any time and in any manner154 every advance medical directive (called living will) or medical power-of-attorney executed by a person shall be binding on the attending medical practitioner during the course of medical treatment of the patientadvance medical directives and medical power-ofattorney5 (1) on completion of conditions laid down in section 3, the attending medical practitioner shall—role of the attending medical practitioner20(i) complete the medical record documentation requirements stipulated by themedical council of india;(ii) begin the process of getting clearance from the medical council of india for actions under clause (i) or (ii), as the case may be, of sub-section (1) of section 3; and(iii) ensure confidentiality of all documents and medical records of the patient25(2) upon receipt of clearance for action under clause (i) of sub-section (1) of section 3from the medical council of india, the attending medical practitioner shall withhold or withdraw medical treatment to a patient to end his life in a humane and dignified manner(3) upon receipt of clearance for action under clause (ii) of sub-section (1) of section 3from the medical council of india, the attending medical practitioner shall—30(i) prescribe the medication that would end the life of the patient in a humane and dignified manner; and(ii) ensure that the patient commits suicide in the presence of a witness other than the attending medical practitioner himself35procedure for permission from the high court6 (1) on completion of conditions laid down in section 3, any near relative, next friend, legal guardian of patient, the attending medical practitioner or any other person may apply to the high court having territorial jurisdiction for granting permission to the attending medical practitioner for withholding or withdrawing of medical treatment to the patient or assist in suicide of an incompetent patient or a competent patient who has not taken an informed decision40(2) the application under sub-section (1) shall be treated as original petition and the chief justice of the high court shall assign the same to a division bench without any loss of time for disposal within fifteen days(3) for the purpose of deciding on the application, the division bench shall appoint an expert committee of three members comprising a medical practitioner, a legal expert and an expert on moral or ethical issues in such manner as may be prescribed(4) the expert committee shall give its recommendations within one week of its constitution 5(5) the division bench of the high court shall, having due regard to therecommendations of the expert committee and the wishes of close relations, namely, spouse, parents, major children or in their absence, such other persons as the high court deems fit to put on notice and on consideration of the best interests of the patient, pass orders granting or refusing to grant permission or granting permission subject to any condition45 of 1860107 notwithstanding anything contained in the indian penal code, 1860, a patient seekingaction under section 3 shall not be deemed to be guilty of any offence under the indian penal code or any other law for the time being in forceprotection of competent patients from criminal action8 any action of the attending medical practitioner or any other person acting underthe direction of the attending medical practitioner on the express desire of a patient under section 3, shall be deemed to be a lawful actionprotection ofattending medical practitioner from criminal action159 (1) for the purposes of this act, the medical council of india shall, from time to time,—guidelines by medical council of india(i) prepare and issue guidelines for the use of medical practitioners; and (ii) issue documentation requirements to be followed by medical practitioners(2) the guidelines and documentation requirements under sub-section (1), shall be published in the gazette of india and on the website of the medical council of india20power to make rules10 (1) the central government may, by notification in the official gazette, make rules for carrying out the purposes of this act25(2) every rule made under this act shall be laid, as soon as may be after it is made, before each house of parliament, while it is in session, for a total period of thirty days which may be comprised in one session or in two or more successive sessions, and if, before the expiry of the session immediately following the session or the successive sessions aforesaid, both houses agree in making any modification in the rule or both the houses agree that the rule should not be made, the rule shall thereafter have effect only in such modified form or be of no effect, as the case may be; so, however, that any such modification or annulment shall be without prejudice to the validity of anything previously done under that rule statement of objects and reasonsin a 2015 report by the economist intelligence unit, it was found that india was one of the worst 15 countries in the world to die in, coming 67th out of 80 in "quality of death" we have treated persons with terminally-ill diseases, less as human beings that afford a humane and dignified death, but as innate objects that must be treated despite irreversible or incurable medical conditionsthis bill hopes to allow a terminally-ill individual a dignity even in his last months, when one should be with his or her family, rather than be isolated from their loved ones in an intensive care unit the bill codifies passive euthanasia in a more or less similar manner as the hon'ble supreme court in its 2011 judgement in the case of aruna ramachandra shanbaug vs union of india  moreover, this bill recognizes living wills and medical power-of-attorney, measures that allow a patient to make decisions before the consequences of severe health conditions kick inlastly, the bill lays down a careful procedure for allowing for assisted suicide in the case of terminally-ill patients this bill incorporates safeguards that will protect both the patient and the medical practitioner and preserve the essential right to a dignified deaththe bill seeks to achieve the above objective financial  memorandumclause 6 of the bill provides that for the purpose of deciding on the application seeking death for terminally ill patient, the division bench of the high court concerned shall appoint an expert committee of three members comprising a medical practitioner, a legal expert and an expert on moral or ethical issues the expenditure in this regard shall be met out of the budgetary grants of the concerned high court in the case of union territories, the bill, therefore, if enacted would involve expenditure from the consolidated fund of india at this stage, it is not possible to give the exact amount of expenditure that would be involved as it would depend on number of applications under section 6 however, a recurring expenditure of about rupees ten crores per annum would be involved from the consolidated fund of indiano non-recurring expenditure is likely to be involved memorandum regarding delegated legislationclause 10 of the bill empowers the central government to make rules for carrying out the purposes of this bill as the rules relate to matters of detail only, the delegation of legislative power is of  a normal character———— a billto provide for the protection of patients and medical practitioners from criminal offences arising from withdrawing life-saving procedures or assisting for the right of a dignified death————(shri baijayant panda, mp)gmgipmrnd—2656ls(s3)—24-11-2016