In a landmark ruling that revisits one of medicine’s toughest ethical questions, the Supreme Court on Wednesday allowed the withdrawal of artificial life support — or passive euthanasia, as it is commonly called — for a 31-year-old man who had been in a coma for more than 13 years. The judgment in the Harish Rana case is the first time that the court has directly allowed passive euthanasia for a patient in a permanent vegetative state. Dr. Sushma Bhatnagar Former AIIMS chief and professor of onco-anesthesia and palliative medicine explains times of India What does this mean in medical practice, and how do doctors decide when to withdraw life support?What does passive euthanasia mean in medical practice?In simple terms, it involves withdrawal of life support, stopping some types of artificial support that prolong life without improving the patient’s condition. For example, doctors may discontinue artificial nutrition, fluids, or other life-sustaining measures when they are no longer beneficial. The aim is not to actively end life, but to prevent treatments that only increase suffering, and allow the disease to continue its course when recovery is not possible.

In what situations do doctors consider withdrawing life support?Doctors consider this when the treatment is not providing any benefit to the patient and his suffering is only increasing. In such cases, continuing aggressive medical support may not be in the best interests of the patient. Conditions may include permanent vegetative state, severe and irreversible brain injury, terminal cancer, end-stage kidney failure where dialysis is no longer effective, or advanced heart disease where treatment options have been exhausted. This may include withdrawal of ventilatory support, stopping medications that artificially maintain blood pressure, dialysis, artificial feeding through tubes, or other interventions that maintain physical functions without improving the patient’s condition.

How do doctors determine whether a patient has no chance of recovery, and what safety measures should be followed before withdrawing life support in India?There are established medical criteria and tests. For example, specific instruments are used to confirm conditions such as coma or vegetative state. In incurable diseases such as advanced cancer, prognosis and chances of cure are assessed using evidence-based medical guidelines. In India, review is usually done by primary and secondary medical boards before any decision is taken. In some cases, hospital ethics committees may also be involved to ensure that the procedure follows medical ethics and legal guidelines set by the Supreme Court. These measures ensure that the decision is medically appropriate and ethically correct.How important are living wills or advance directives?They are extremely important. If a patient has clearly stated in advance what type of treatment they would or would not like in such circumstances, the doctor and family may follow their wishes. Respecting patient autonomy is a fundamental principle of medical ethics.How often do doctors in India receive requests to withdraw life support?It is still relatively rare in India.Awareness of advance directives is limited. Culturally, many families find it difficult to accept death as a natural part of life.What is the difference between active and passive euthanasia, and how does the latter differ from assisted suicide or assisted death?Active euthanasia involves deliberately administering drugs that cause death. Passive euthanasia refers to the withdrawal or stopping of treatments that artificially maintain life and includes stopping medical interventions that are no longer beneficial. Assisted suicide involves actively helping a person end their life, usually by providing medication that the person takes themselves.What are some common misconceptions about passive euthanasia?Many people believe that this means that doctors are actively trying to end the patient’s life. In fact, it usually involves stopping medical interventions that are no longer useful, and focusing on comfort, care, and respect at the end of life.From a medical ethics perspective, why are these practices treated differently?Medical ethics emphasize doing no harm and avoiding treatments that provide no benefit. When treatment only increases suffering with no real possibility of cure, it may be considered morally justified to withdraw it.

New Delhi: Amid concerns over the impact of the Iran war on India’s energy supplies, Prime Minister Narendra Modi on Thursday said his government is making no efforts to mitigate its impact on citizens and accused opposition parties of spreading fear to further their agenda at the cost of national interest.He said that no country is untouched by this global crisis and India is making efforts at various levels to deal with it, including efforts to deal with supply chain disruptions. He said at the NXT Summit, he has spoken to global leaders.On a day when Leader of Opposition in Lok Sabha Rahul Gandhi hit out at the government over the “LPG crisis” in the House, Modi hit back without naming anyone and said everyone, including political parties, has a role to play in ensuring that the country successfully deals with the crisis.He said, “Some people are trying to spread panic. They want to push their agenda. I do not want to give any political reaction right now, but I would like to say that they are exposing themselves to the people and causing huge loss to the country.” He stressed that India will definitely be able to deal with the challenges posed by the war.He listed several measures taken by his government since 2014 to build India’s alternative energy sources, reduce its dependence on oil, increase its petroleum storage capacity as well as ensure more people benefit from them.India used to have negligible storage capacity to deal with any crisis but now it has 5 million tonnes, while it has become one of the largest refining centers in the world. Before targeting his critics, he said, people’s aspirations have increased and their government welcomes them.“Many of my ‘well-wishers’ are hoping that I will collapse under the weight of expectations… their intentions are dishonest and their expectations will never be fulfilled,” he said, adding that he has people’s blessings. He asked the states to take strict action against those spreading rumors and black marketing.He said India will emerge from the crisis as successfully as it did during Covid, describing the present era as a period like never before.He compared the rise of the Indian economy to people’s enduring interest in cricket, saying that now they are curious to know about the latest details all the time. “If you want to be part of the future, you have to live in India,” he said. “Despite many global challenges, the world looks at India with great hope,” he said.

New Delhi: The Supreme Court has said that parents’ income cannot be the sole criterion for excluding a candidate from the OBC quota on the basis of being part of the ‘creamy layer’, stressing that the status and category of parents’ jobs should be considered, along with the income/assets test as an additional criterion for exclusion. Currently, the income limit to determine the ‘creamy layer’ is Rs 8 lakh per annum.The court’s judgment will have a major impact on the children of PSU and private sector employees as for them income was taken as the sole determining factor to decide on ‘creamy layer’ status, whereas in the case of children of government employees, their job category is the deciding factor. A bench of Justices PS Narasimha and R Mahadevan said that children of Group A and B government employees are barred from availing the benefits of OBC reservation due to their job status, but children of Group C and Group D employees are eligible to get the benefit of OBC reservation due to promotion and time loss, even if their income level exceeds the limit.The court rejected the Centre’s contention that it insisted on the income/asset test criteria and accepted the plea of ​​the aggrieved children of PSU employees, who had fought the case through their lawyer Shashank Ratnu for over a decade.An office memorandum issued by the Center in 1993 stated that the same principle would be applied to employees of public sector undertakings, banks, insurance organizations, universities and similar bodies holding equivalent or comparable posts. But “equality of positions” has not been carried out as contemplated in the OM, and a clarification letter was issued by the Government in 2004, making the income/asset test the sole criterion for PSU and private sector employees.The Supreme Court said that placing excessive emphasis on the 2004 letter, regardless of the status or category of service of the parents, would defeat the structural framework of exclusion envisaged under the 1993 OM.There cannot be double standards for children of government employees: Supreme CourtIt is also clear from a wide reading of the 1993 Office Memorandum along with the explanatory letter that salary income alone cannot be the sole criterion to decide whether a candidate falls in the creamy layer or not. Along with the position, the category of post to which the parents of the candidate belong is also required. Exclusions under Categories I to III of the Schedule are status-based rather than being entirely income-based, reflecting the policy understanding that advancement within the government service hierarchy reflects social progress independent of fluctuations in pay levels. The status of a candidate, whether he falls in the creamy layer of OBC or the non-creamy layer, cannot be decided on the basis of income alone,” Justice Mahadevan, who wrote the judgment, said. “Thus, determination of the creamy layer status solely on the basis of income group, without reference to the categories of posts and position parameters mentioned in the 1993 OM, is clearly untenable in law.”Highlighting that there cannot be different standards for children of government employees and others, the court said this would amount to discrimination which cannot be permitted.“Adopting an interpretation that disadvantages a section of the same backward class without rational justification would amount to treating similar people unequally and would thus become antithetical to equality… Keeping in mind the specific facts of the present cases, the logic adopted by the HC that treating similar employees of private entities and PSUs differently from government employees and their wards, while deciding their entitlement to reservation, would amount to hostile discrimination, certainly inspires the confidence of this court,” it said. Said.

An Indian passenger was welcomed by family members upon taking off from Saudi Arabia at the Sardar Vallabhbhai Patel International Airport in Gujarat, amid the ongoing Iran-Israel conflict. (PTI photo)

New Delhi: With the Israel-Iran war escalating by the day, Indian missions in West Asia, including Qatar, Bahrain and the United Arab Emirates, are working hard to evacuate as many compatriots as possible. While Bahrain has had no air connectivity since February 28, Doha and the UAE have some flights. But since they are clearly not close to the travel demand, given the fact that more than one crore Indians live and work in the Gulf Cooperation Council countries – Saudi Arabia, UAE, Qatar, Kuwait, Oman and Bahrain, these missions are coordinating with the Indian embassies in Saudi Arabia and Oman (for those residing in the UAE) to obtain transit visas so that people can travel to Dammam, Jeddah, Riyadh and Muscat. Can go out of.But given the odds amid the war, Indians in the GCC are feeling the heat. A Doha-based Indian said, “I applied for a Saudi pass (transit) visa for myself, wife and my child on March 2. He has not yet arrived. I keep buying Qatar Airways tickets for Delhi flights but am unable to go out. Every time there is an explosion, our child gets very scared and we have difficulty consoling him.”

According to the aviation ministry, more than 1.5 lakh people have flown from the GCC to India between February 28 and March 11. Indian carriers resumed Riyadh flights from Thursday, with the first day seeing four flights each from Air India, IndiGo and AI Express.Aviation analytics company Cirium says that between March 6 and 12, Dubai International (DXB) saw a maximum of 167 departures to India, with Mumbai accounting for the highest number of departures at 62, followed by Delhi at 56; Hyderabad at 25th and Bengaluru at 24th. India has been the largest market for DXB for years.The Indian Embassy in Qatar on Thursday said Qatar Airways is expected to operate 1-2 daily flights to India in the coming days. “Indian nationals wishing to travel out of Qatar have the option of either taking a limited number of flights operated by Qatar Airways or transiting to Saudi Arabia via the Salwa border if a valid Saudi visa is available. We continue to facilitate temporary transit visas valid for 96 hours to Saudi Arabia for Indian nationals who were on a visit visa to Qatar and wish to transit through Saudi Arabia.”The UAE does not have regular flights and is giving slots to airlines as per availability. India is trying to get as many slots as possible but the demand is very high.Those who managed to reach home narrated their ordeal and also spoke about the pressure under which Indian Mission staff in the GCC are working. An Indian who returned to Mumbai on Thursday said, “The situation at Saudi embassies is strange in other GCC countries. Indian embassies are coordinating in getting Saudi transit visas which is a big help. We are really grateful to the embassy officials in Bahrain for helping us with our Saudi visas.”The Embassy in Qatar has set up a war room from where requests to get confirmed seats on Qatar Airways flights or Saudi visas are being handled.

New Delhi: Prime Minister Narendra Modi on Thursday downplayed the energy crisis arising in the country due to the ongoing conflict between the joint forces of the United States and Israel with Iran. Addressing the NXT summit, the Prime Minister indirectly hit out at those who are “trying to create panic” and claimed that, by doing so, they are exposing themselves to the public.PM Modi said, “We have to make collective efforts while keeping the national interest paramount and fulfilling our duties. Nowadays there is a lot of discussion about LPG. There are some people who are trying to create panic. They want to push their agenda.” He said, “At this time I do not want to make political comments on them. But I must say that by doing this they are not only exposing themselves to the public but are also causing great harm to the country.”The Prime Minister said the government has given priority to self-reliance in the energy sector to ensure that the country does not have to depend solely on foreign sources for energy.PM Modi said, “To ensure that we do not have to depend solely on foreign sources for energy, emphasis was laid on self-reliance in the energy sector. Till 2014, there were only 14 crore LPG connections in the country. Today, there are more than double that i.e. 33 crore domestic LPG connections. In 2014, there were only 4 LNG terminals in the country.”He said, “Today their number has also doubled. No country is untouched by the impact of this global crisis. Everyone is a victim of this crisis to a greater or lesser extent. India is also leaving no stone unturned to deal with this crisis.”The Prime Minister also said that the government is making every effort to ensure that the burden of conditions arising from war does not fall on the citizens of India.He said, “The Government of India has always made every possible effort to ensure that the burden of conditions arising from war does not fall on the citizens of India.”He said, “This time too we will make every possible effort to ensure that the war has minimal impact on the lives of the country’s farmers and citizens of the country.”Fears of LPG shortage began to spread across the country as the global energy supply chain was disrupted due to the escalating conflict in the Middle East.The closure of the Strait of Hormuz following Iranian retaliation against the US-Israeli strikes has triggered panic buying, led to long queues at LPG agencies and petrol pumps and forced restaurants and small businesses to switch to alternative cooking methods.Sujata Sharma, joint secretary in the oil ministry, said some measures have helped in increasing domestic LPG production by 28 per cent and with some alternative sources being used abroad, the government has decided to allow some sales of commercial LPG to meet one-fifth of the demand.“State governments will have to identify the beneficiaries,” he said.As panic buying continues to rise, the government has extended the LPG refill ordering window for rural users to 45 days, up from 25 days set for all users last week, replacing the previous 21-day limit. He said the move is aimed at managing demand and ensuring equitable distribution amid the ongoing energy supply disruptions due to the West Asia crisis.The increase in the monthly quota of kerosene released to states is the first in more than a decade and temporarily reverses the government’s stated objective of phasing out the fuel, which was also used for adulteration of petrol, apart from being heavily subsidized.

New Delhi: The Center has proposed amendments to drug rules to stop repeated virus testing on drugs made from human plasma, mandating that the raw plasma used to produce these products is tested for infections like HIV and hepatitis even before manufacturing begins.These medications include albumin, intravenous immunoglobulin (IVIG), and clotting factors such as Factor VIII and Factor IX, which are used to treat immune disorders, serious infections, and bleeding conditions such as hemophilia.Officials said the move is aimed at bringing India’s drug regulations in line with international pharmacopoeia standards. Global guidelines require plasma collected to be tested for hepatitis B surface antigen, hepatitis C virus RNA and HIV antibodies before being used for fractionation, and only plasma that tests negative is approved for the manufacture of plasma-derived drugs.Currently, plasma collected to manufacture these medicines is first collected and tested for viruses including HIV, hepatitis B and hepatitis C. However, once medicines are made from this screened plasma, the finished products are again tested for the same viral markers under existing regulations. The government now proposes to remove this second round of testing.The Health Ministry has issued a draft notification seeking public comments on amendments to the Drugs Rules, 1945, which govern testing of blood-derived products. Dr Asim Kumar Tiwari, senior director, department of transfusion medicine, Medanta, Gurugram, said the surplus plasma collected from blood donors can be used by plasma fractionators to manufacture many life-saving medicines.“Plasma-derived medicinal products (PDMPs) such as albumin, intravenous immunoglobulin (IVIG), and clotting factors such as Factor VIII and Factor IX are widely used to treat immune disorders, serious infections, and bleeding conditions such as hemophilia,” he said.He said blood centers often generate surplus plasma after meeting a patient’s needs, which can be supplied to specialized fractionation facilities where different proteins are separated to manufacture these drugs.Dr. Tiwari said that PDMPs undergo several security checks before reaching the patients. “Donated plasma is screened for infections such as HIV, Hepatitis B, Hepatitis C, malaria and syphilis and the manufacturing process includes viral inactivation steps to ensure safety,” he said.“Globally, these medicines, known as plasma-derived medicinal products, have not been linked to infection transmission due to stringent testing and viral inactivation during manufacturing,” he said.Officials say repeating the same viral tests at the finished product stage does not require duplication under global practices. The proposed amendment aims to rationalize testing requirements while maintaining strict safety checks at the plasma screening stage.The draft rules were issued after consultation with the Drugs Technical Advisory Board, and stakeholders have been given 30 days to submit comments before the amendments are finalised.

Hardeep Singh Puri speaks in the Lok Sabha during the budget session of Parliament

Union Minister of Petroleum and Natural Gas Hardeep Singh Puri Telling the Lok Sabha on Thursday that India is well prepared to manage the disruption in global energy supplies caused by the ongoing conflict in West Asia, he assured MPs that domestic fuel availability and power generation is completely secure, while also urging them to avoid rumours.Addressing the House amid protests by opposition members, Puri said the government has ensured adequate production and alternative supply arrangements to maintain energy needs even as the conflict continues. “India has adequate gas production and supply system to sustain this situation even in the event of a prolonged conflict. Power generation for every household and industry is completely safe,” Puri said.The Union minister said the hostilities have effectively shut down commercial shipping through the Strait of Hormuz, a key route that typically transports about 20 percent of the world’s crude oil, natural gas and LPG. Despite the disruption, as about 45 percent of India’s crude oil imports previously went through this route, the country has managed to stabilize supplies by increasing alternative sourcing. He noted that “Non-Hormuz sourcing has increased to approximately 70 percent of crude oil imports, up from 55 percent before the conflict began.”Puri attributed the resilience partly to long-term diversification of crude oil suppliers, noting that India now imports oil from 40 countries, whereas in 2006-07 it imported from 27 countries. He assured the House that “there is no shortage of petrol, diesel, kerosene, ATF or fuel oil. The availability of petrol, diesel, aviation turbine fuel, kerosene and fuel oil is completely assured,” adding that domestic refineries are operating at high capacity utilisation, in some cases “more than 100 per cent”.He urged public and political stakeholders to avoid spreading misinformation during the ongoing energy crisis caused by the Middle East conflict, and stressed that the government’s preparedness and response mechanisms are working effectively. “This is not the time for rumor mongering or fake narratives. India is facing the most severe global energy disruption in recorded history. Fuel supplies are flowing, gas has been prioritized for homes and farms, and LPG production has increased by 28%. Consumer prices are being held well below those otherwise set by market trends and regional competitors. Schools are open and petrol is available at fuel stations… India must unite behind energy workers, behind the institutions managing the crisis, and behind the national interest. The record of preparation and the record of response speaks for itself,” he said.On natural gas supply, the minister said the government has introduced a priority allocation system under the Natural Gas Control Order issued on March 9. While a major facility in Qatar has declared force majeure on 30 MMSCMD gas imports, domestic production is stable at 90 MMSCMD.“Domestic piped gas for homes and CNG for vehicles receive 100 per cent supply without any cut. Industrial and manufacturing consumers will receive up to 80 per cent of their last six month average. Fertilizer plants will receive up to 70 per cent, thereby protecting the agricultural input chain ahead of the sowing season. Refineries and petrochemical units absorb the managed reductions, with that gas redirected to higher-priority sectors. I am happy to tell the House that the shortfall has been compensated to a large extent through alternative procurement,” Puri said.The government has also taken steps to secure LPG availability for approximately 33 crore families. According to the minister, domestic LPG production has increased by 28 percent in the last five days following the refinery instructions. To curb hoarding and control demand, authorities have introduced a minimum gap of 25 days between LPG cylinder bookings in urban areas and expanded the delivery authentication code system to cover 90 per cent of consumers.Puri also clarified that the distribution cycle of domestic LPG will remain unaffected. “Domestic supply is completely secure, and the delivery cycle is unchanged. The standard time from booking to delivery for domestic LPG cylinders is 2.5 days, unchanged from pre-crisis norms,” ​​he said.To further reduce pressure on gas supplies, the government has activated alternative fuel options. Kerosene is being made available through Public Distribution System channels, while the Ministry of Environment, Forest and Climate Change has “advised State Pollution Control Boards to allow the use of biomass, RDF pellets and kerosene/coal as alternative fuels for the hospitality and restaurant segment for 1 month, for the duration of this crisis, which will enable a wide range of establishments to switch to LPG and free up space for priority consumers.”

New Delhi: Mani Shankar Aiyar and Shashi Tharoor erupted into a public spat on Thursday, with the two exchanging sharply worded open letters on foreign policy, ideology and personal comments.The confrontation began when Aiyar wrote an open letter to Tharoor, published in Frontline magazine, criticizing his comments during a televised discussion on the ongoing conflict involving Iran, Israel and the United States.In the letter, Aiyar said he was “extremely shocked” by Tharoor’s comments and claimed that the issue had troubled him so much that he woke up in the morning to write the message.Recalling the Congress presidential election, Aiyar said he had supported Tharoor’s candidature even though he knew he would lose to Mallikarjun Kharge. Aiyar also said that he argued publicly that Kharge should give Tharoor a respectable position in the party hierarchy despite his defeat.However, Aiyar said he now regretted that support, accusing Tharoor of supporting a “might make right” approach to international affairs and being overly cautious about criticizing the United States because of the potential economic consequences for India.Aiyar also questioned Tharoor’s position as Chairman of the Parliament’s Standing Committee on Foreign Affairs, arguing that deferring foreign policy decisions to the government undermined the purpose of the role.The veteran Congress leader also criticized Tharoor’s previous stance on the issue of entry into the Sabarimala temple and said his position on temple restrictions on menstruating women had earlier raised doubts about his ideological affiliation with the party.Concluding his letter, Aiyar declared that their differences had reached breaking point, adding that this marked a “parting of ways”.Tharoor responded with an open letter of his own, published by NDTV on Thursday, rejecting Aiyar’s allegations and defending his views.He said dissent was natural in a healthy democracy, but criticized Aiyar for questioning his intentions and character.Tharoor said that his views on international affairs come from a “clearly nationalist perspective”, adding that geopolitical realities and economic consequences for India should be seen not as a moral compromise but as a basis for responsible policy making.“No generation has a monopoly on patriotism, nor on the interpretation of Gandhi or Nehru. The true tribute to his legacy lies in intelligently applying his values ​​to the realities of our times,” he wrote.He also rejected Aiyar’s comments regarding his foreign travel, calling them baseless. Tharoor said that except for participation in an all-party delegation associated with Operation Sindoor, his foreign trips were undertaken in a personal capacity and were not arranged or funded by the government.Responding to criticism on the Sabarimala issue, Tharoor said he supported the official stand of the Congress party and had earlier explained his position in detail.Acknowledging Aiyar’s support during the Congress president election, Tharoor said he too had defended Aiyar in the past when the veteran leader faced disciplinary action within the party.Tharoor wrote, “I also supported you very strongly with the ‘high command’ of the party, especially when you were suspended from its membership. I have no regrets that that injustice has been reversed.”The Thiruvananthapuram MP said Aiyar’s claim of “parting of ways” was disingenuous, arguing that the separation had already become clear through repeated personal comments made to him in recent months.