Vajawat Bhavika, Hegde Prakyath R, Malathesh Barikar C, Kumar Channaveerachari Naveen, Sivakumar Palanimuthu T, Math Suresh Bada
Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India.
Indian J Psychol Med. 2021 Sep;43(5 Suppl):S31-S36. doi: 10.1177/02537176211031077. Epub 2021 Aug 19.
There is an increased risk of debilitating illnesses that often have no curative treatment with aging. The mainstay of treatment in many such conditions is palliative care: a holistic approach focused on preventing and relieving physical, psychosocial, legal, ethical, and spiritual problems. It involves the facilitation of end-of-life care decisions aimed at relieving distress and improving quality of life. In this article, the authors discuss the role of mental health professionals in legal issues related to palliative care in the elderly around decision-making, right to autonomy, euthanasia, and advanced directive. The cognitive decline associated with aging and mental health issues in the palliative care setting of an individual such as dementia, depression, and hopelessness, and impact on the family members like burnout may influence the overall capacity of that individual to make decisions about their treatment. While an individual has a right to self-determination and autonomy, withholding or withdrawing treatment has many legal and ethical implications, more so in those with incapacity, especially in India due to the absence of uniform legislation. The decision to withhold or withdraw treatment might be a restrictive choice due to limited options in a setting with a lack of palliative care options, poor psychosocial support, nonaddress of mental health issues, and lack of awareness. As the right to health is a constitutional right, and the right to mental health is legally binding under Section 18 of the Mental Health Care Act 2017, systematic efforts should be made to scale up services and reach out to those in need.
随着年龄增长，患使人衰弱且往往无法治愈的疾病的风险会增加。在许多此类情况下，治疗的主要方式是姑息治疗：一种注重预防和缓解身体、心理社会、法律、伦理和精神问题的整体方法。它涉及推动临终护理决策，旨在减轻痛苦并提高生活质量。在本文中，作者讨论了心理健康专业人员在老年人姑息治疗相关法律问题中所扮演的角色，这些问题涉及决策、自主权利、安乐死和预先指示。在姑息治疗环境中，与衰老相关的认知能力下降以及个体的心理健康问题，如痴呆、抑郁和绝望，以及对家庭成员的影响，如倦怠，可能会影响该个体做出治疗决策的整体能力。虽然个体有权自主决定，但停止或撤销治疗有许多法律和伦理含义，对于无行为能力者而言更是如此，尤其是在印度，因为缺乏统一的立法。由于在缺乏姑息治疗选择、心理社会支持不足、心理健康问题未得到解决以及缺乏认识的环境中选择有限，停止或撤销治疗的决定可能是一个受限的选择。由于健康权是一项宪法权利，且根据《2017年精神卫生保健法》第18条，精神健康权具有法律约束力，因此应做出系统性努力来扩大服务范围并惠及有需要的人群。
