Mitras Analysis of News : 5-05-2017

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1.Advance health care directive (The Hindu)

2.The long arc to Ankara (The Hindu)

3.Scale of progress needed in SDG (The Hindu)

4.Explained: Brain stem death (is it same as vegetative state?)


1.Advance health care directive (The Hindu)

Synoptic line: It throws light on the issue of bringing advanced care directive, so that people can make choices about their life. (GS paper II)


  • A living will to dignified death is neither clearly legislated nor widely discussed in India.
  • There is an urgent need to reflect on this issue and construe it as a fundamental right, to ensure human dignity and freedom.

What is advance care directive?

  • An advance healthcare directive, also known as living will is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.
  • Advance directives were created in response to the increasing sophistication and prevalence of medical technology
  • Numerous studies have documented critical deficits in the medical care of the dying; it has been found to be unnecessarily prolonged, painful, expensive, and emotionally burdensome to both patients and their families.
  • A living will usually provides specific directives about the course of treatment healthcare providers and caregivers are to follow. In some cases, a living will may forbid the use of various kinds of burdensome medical treatment. It may also be used to express wishes about the use or foregoing of food and water, if supplied via tubes or other medical devices.
  • The living will is used only if the individual has become unable to give informed consent or refusal due to incapacity.

Scenario in India

  • In India, the law is not clear as to when a person really dies. Section 2(b) of the Registration of Births and Deaths Act, 1969 does not recognise brain stem deaths. So, hospital authorities continue to sustain the patient till his heart ceases to beat.
  • However, Transplantation of Human Organs Act, 1994 says that if a person is willing to donate his organs, his brain stem death is certified and recognised.
  • It leaves various questions unanswered as whether a person should be left to the whims of these contradicting laws in the final moments of his life?
  • Does the dignity of human life end when a terminally-ill patient, already ‘brain dead’ and in a vegetative state, is forcibly subjected to insensitive medical technology and life-support mechanisms like such as ventilators by institutional hospitals authorities who want to avoid the risk of being dragged up for violating the law?
  • Petitions have been filed in Supreme Court regarding, the right of a person to plan the course of his own treatment or Advance Care Directives, to avoid being subjected to any kind of medical treatment which violates both physical and personal dignity during the last moments of life.

Is it a suicide?

  • Fundamental right to choose one’s medical treatment or even to decide to deny oneself any treatment is confused with euthanasia or other forms of attempts to suicide. It is submitted even if the result of not taking treatment is enhanced likelihood of death (for nobody can predict with certainty) it does not amount to an attempt to commit suicide if a person who is affected with illness, declines treatment.

Advanced directive in other countries


  • In the United States, most states recognize living wills or the designation of a health care proxy.
  • Several states offer living will “registries” where citizens can file their living will so that they are

more easily and readily accessible by doctors and other health care providers.

The Netherlands

  • In the Netherlands, patients and potential patients can specify the circumstances under which they would want euthanasia for themselves.
  • They do this by providing a written euthanasia directive. This helps establish the previously expressed wish of the patient even if the patient is no longer able to communicate.

Way ahead

  • As long as a person has the capacity to decide, it is the will of the patient and that alone should decide treatment, the extent of the treatment, the form of the treatment and also the right to completely refuse any kind of treatment. Equally, a patient has the right to terminate at any point of time treatment which he considers unacceptable for any reason.
  • The proposed Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill only addresses the issue of euthanasia and not the right of a person to refuse treatment under Article 21 (right to life) of the Constitution. Hence, its scope should be widened to include the right to refuse treatment.
  • Moreover, Supreme Court should judicially declare a legal framework for Advance Care Directives, and at least allow a person to embrace death with the same dignity as he has lived his life.

Question: It is high time that we should recognise the right to die with dignity as a fundamental right. Critically discuss. 


2.The long arc to Ankara (The Hindu)

 Synoptic line: It throws light on of the recent visit made by Turkey president Recep Tayyip Erdogan to India. (GS paper III)


  • Recep Tayyip Erdogan, President of Republic of Turkey has recently visited India to give a boost to sagging ties between Delhi and Ankara. This is the second visit of the President Erdogan to India. Earlier he had visited India as prime Minister in 2008. He also has had substantive meetings with Prime Minister on the margins of G-20 Summit in Antalya in 2015.
  • India and Turkey agreed to boost bilateral trade from the current level by 2020 and expressed the resolve to fight the global menace of terrorism together.

Turkey and India

  • India is a strategic partner to Turkey because of its location, resources and its economy. They enjoy close, friendly and deep rooted ties dating back to several centuries. There are rich historical and cultural connections between our two countries in the field of art and architecture.
  • Bilateral relations have been strengthened by the exchange of visits of leaders of both countries in recent times. President of India visited Turkey during October 2013. Prime Minister visited Turkey for G-20 Summit in November 2015.
  • Turkey and India enjoy strong economic ties. A large business delegation including about 100 representatives of Turkish Industry and business will accompany President. The India-Turkey Business Forum will meet during the visit.
  • India’s main export products to Turkey are textiles and fabrics, chemicals, pharmaceuticals, plastic products, machinery and automotives. There is scope for cooperation in other sectors such as construction and infrastructure development, renewable energy, tourism and film shooting. A number of Indian companies have established their presence in Turkey through production facilities or project participation.
  • During the visit PM mentioned that Turkey’s companies can easily participate in this task of building India fast. We plan to build 50mn houses by 2022. For this purpose we have repeatedly refined our FDI policy in construction sector.

Talk on Kashmir issue

  • Turkey president expressed concern at the continuing stand-off between India and Pakistan on Kashmir. He had suggested a “multilateral dialogue” on Kashmir. According to him “We should not allow more casualties to occur, and by strengthening multilateral dialogue, we can be involved, and through multilateral dialogue, I think we have to seek out ways to settle this question once and for all”, which will benefit both countries.
  • President has been a vocal supporter of the Organization of Islamic Cooperation’s position on Kashmir. During his visit, he referred that the only the threat from Naxalism is issue for India-related terrorism.
  • However, India was categorical in asserting that “the issue of Kashmir is essentially an issue of terrorism,” and that its disputes with Pakistan must be settled bilaterally.

NSG bid

  • Turkey is a member of the NSG and President Erdogan indicated that Ankara wishes to pursue a hyphenated policy as far as India’s multilateral campaigns are concerned. Turkey also shares close ties with Pakistan. He also said he supported both India and Pakistan’s bid to be part of the NSG, adding that India should give up its attitude of distancing itself from Pakistan which has a track record of nuclear proliferation.
  • He was willing to support India’s bid for a permanent seat in the United Nations Security Council (UNSC), even as he called for major institutional reforms. But the story is complicated as Turkey is a member of the group called Uniting for Consensus which opposes expansion of permanent membership in the Security Council and this group includes Pakistan.

Cyprus’s president visit to India

  • India hosted Cyprus President before Mr. Erdogan’s arrival, our Vice President also recently visited Armenia, a country which accuses Turkey of having killed an estimated 1.5 million Armenians during World War I. Turkey does not recognize Cyprus, the northern part of the Mediterranean island country is under Turkish occupation in 1974.
  • Cyprus’s president mentioned that “We look to friends and allies such as India to convey the message to Turkey that the status quo is unacceptable, and that it needs to engage constructively and actively in the efforts underway”.

Way ahead

  • Turkey under Mr. Erdogan has in recent years turned away from the old equation, as he sought to bolster his image as a leader of the Islamic world. At a time when Europe is not so welcoming to Turkey, new markets in Asia are needed.
  • As a major regional power in West Asia, Turkey cannot be ignored by India. But New Delhi is signalling that if Turkey wants to reach out to India, then Indian sensitivities on core issues have to be respected.

Question: How can relation between Turkey and India holds the potential to bring peace to the destabilised regions of Central Asia and West Asia?


3.Scale of progress needed in SDG (The Hindu)

 Synoptic line: It throws light on issue of fixing responsibilities of countries for their performance in SDG (GS paper II)


  • The ambitious targets taken under SDG in 2015 are not held legally binding on the Nations and hence subjected to whims and fancies of the countries.
  • There is an urgent need to fix a mechanism to hold the responsibility of the countries with regard to their responsibilities to eradicate global problems.


  • The Sustainable Development Goals(SDGs), officially known as Transforming our world: the 2030 Agenda for Sustainable Development is a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.
  • These 17 Goals build on the successes of the Millennium Development Goals, while including new areas such as climate change, economic inequality, innovation, sustainable consumption, peace and justice, among other priorities. The goals are interconnected often the key to success on one will involve tackling issues more commonly associated with another.
  • The SDGs work in the spirit of partnership and pragmatism to make the right choices now to improve life, in a sustainable way, for future generations. They provide clear guidelines and targets for all countries to adopt in accordance with their own priorities and the environmental challenges of the world at large.

Need to measure the progress of goals

  • It is ambitious enough to address several socioeconomic concerns and make the development process inclusive. However, since it’s not binding on member nations, there is apprehension that it may end up becoming another of the Millennium Development Goals, which were only partially achieved.
  • The High-level Political Forum comprising the political representatives (heads of states or ministers) of the members meets every July at the UN in New York to review progress on Agenda 2030.
  • The voluntary national reviews (VNR) aim to facilitate the sharing of experiences, including successes, challenges and lessons learned, with a view to accelerating the implementation of the 2030 Agenda.
  • In India, the process is led by NITI Aayog, Research and Information System for Developing Countries, a think tank attached to Ministry of External Affairs, and the Ministry of Statistics and Programme Implementation.
  • The government has already identified existing programmes and policies which are linked to different goals under SDGs. Sources suggest that the government has also sought inputs from civil society, especially to the VNR process. It’s not clear whether the inputs of civil society organisations (CSO) will be part of the government report
  • However, there are several questions as whethe the VNR process an effective mechanism to review SDGs?
  • The governments try to show that they already do very well. There is no reflection about problems, challenges or what policies should be changed to achieve the SDGs. A closer look at last year’s VNR by nations gives a clear impression that they presented only a rosy picture of their performance.

Way ahead

  • There should be a clear mechanism to hold a moral as well as binding responsibility on the nations with regard to achievement of the SDG(s). Seeing the advent of global problems and issues such as increasing inequality, poverty, climate change, there is a need of immediate attention.

Question: What should be the mechanisms to fix the responsibility of nations to pursue the SDG ?


4. Brain stem death (is it same as vegetative state?) (GS paper III)

Brain stem

  • The brain stem is the lower part of the brain that’s connected to the spinal cord (part of the central nervous system in the spinal column).
  • The brain stem is responsible for regulating most of the body’s automatic functions that are essential for life. These include:
  1. breathing
  2. heartbeat
  3. blood pressure
  4. swallowing
  • Brain stem also relays information to and from the brain to the rest of the body, so it plays an important role in the brain’s core functions, such as consciousness, awareness and movement.

 Brain stem death

  • Brain stem death is said to be occurred when a person no longer has any brain stem functions, and has permanently lost the potential for consciousness and the capacity to breathe.
  • In such a situation, a ventilator keeps the person’s heart beating and oxygen circulating through their bloodstream.
  • A person is confirmed as being dead when their brain stem function is permanently lost. After brain death, it’s not possible for someone to remain conscious.

Causes of brain death

  • Brain death can occur when the blood and/or oxygen supply to the brain is stopped. This can be caused by:
  1. Cardiac arrest– when the heart stops beating and the brain is starved of oxygen.
  1. Heart attack– a serious medical emergency that occurs when the blood supply to the heart is suddenly blocked.
  1. Stroke– a serious medical emergency that occurs when the blood supply to the brain is blocked or interrupted.
  1. Blood clot– a blockage in a blood vessel that disturbs or blocks the flow of blood around your body.

Organ donation

  • After brain death has occurred, it may be possible for the person’s organs to be used in transplantations, which can often save the lives of others.

Vegetative state vis-à-vis brain stem death

  • There’s a difference between brain death and a vegetative state, which can occur after extensive brain damage.
  • Someone in a vegetative state can show signs of wakefulness – for example, they may open their eyes, but not respond to their surroundings.
  • In rare cases, a person may demonstrate some sense of response that can be detected using a brain scan, but not be able to interact with their surroundings.
  • However, the important difference between brain death and a vegetative state is that someone in a vegetative state still has a functioning brain stem.

 Question: What is a difference between brain stem death and vegetative state? What are law regarding it in India?

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