“Out beyond ideas of wrongdoing and rightdoing, there is a field. I’ll meet you there.”
— Rumi

Imagine a moment fraught with emotion, where life hangs delicately in the balance. Mrs. Aruna Mehta (name changed), a 67-year-old woman, is brought to the hospital with an acute ischemic stroke. Her body is already weakened by diabetes, high blood pressure, chronic kidney disease, and a severe infection. Her condition is grim, and as her doctor, I stand beside her family at the intersection of hope and despair, contemplating the painful decision of whether to continue life-saving measures or allow her a peaceful departure.

The decision to implement a Do Not Resuscitate (DNR) order is a profound challenge. It is a delicate balance between the instinct to preserve life and the recognition of when treatment becomes more harmful than helpful. In cases of severe head injuries, terminal brain tumors, or catastrophic strokes, this balance becomes an agonizing tightrope walk. The question haunts us: when does our intervention cease to be a gift and start to be a curse?

As doctors, our calling is to heal, to save. Yet, there are moments when our efforts cannot mend what is broken, and our role shifts to easing the final journey. When the prospects of recovery fade into the distance and the days ahead are filled with suffering, continuing aggressive treatments can feel like prolonging agony rather than life.

For the families, this decision is a passage through an emotional tempest. They stand vigil by their loved one’s side, caught between the desperate hope for a miracle and the stark reality of the situation. Their hearts are heavy with the impending loss, their minds clouded with uncertainty and grief. The financial strain of ongoing medical care adds another cruel layer to their anguish, often forcing choices that no family should have to make.

In India, the decision to withdraw life support from terminally ill patients or those with severe brain injuries is a complex tapestry of legal, ethical, and emotional threads. While guidelines exist, the chasm between policy and practice can be vast. Doctors like me often find ourselves navigating this challenging terrain, balancing medical judgment with the wishes of the family and the best interests of the patient.

Sometimes, the heartache is compounded by financial realities. Families may not be able to bear the cost of prolonged care, leading to decisions driven more by economic necessity than medical advice. This harsh reality raises urgent questions about fairness and compassion in our healthcare system, highlighting the need for policies that support families in these difficult moments.

Navigating these decisions calls for gentle, honest conversations. It requires us to explain the patient’s condition and prognosis with clarity and sensitivity, to listen to the family’s fears and hopes, and to find a path that honors the dignity of the patient and the love of the family.

In the end, as Rumi so beautifully reminds us, there is a space beyond right and wrong where we must meet. It is in this field that we find the humanity in our choices, recognizing that there is no absolute answer—only the best course of action for each unique situation. In this field, we, as doctors, can offer the most compassionate care, ensuring that our patients’ final moments are filled with peace and dignity.

As we strive to improve our healthcare system, we must remember the profound impact of these decisions on both patients and their families. Together, we can walk this delicate path with empathy, respect, and unwavering support, knowing that in the space beyond right and wrong, we can find our way.

“The wound is the place where the Light enters you.”
— Rumi

With compassion,

Dr. Nitin Jagdhane
Your Trusted Neurosurgeon