Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering. With Greek roots, the word literally translates into ‘good death’ or ‘easy death’ and is also known as ‘mercy killing’. It is associated with people with terminal illness or who have suffered irreversible incapacitation and are undergoing incurable pain.
The right to die or end one’s life is not a novel aspect of modern society. Instances of active euthanasia are found in the Greek civilisation. Debates about the justifiability of euthanasia on moral, religious and practical grounds however, have been intrinsic to discussions on the theme.
I. Assisted Dying – It includes both physician-assisted “suicide” and voluntary active euthanasia. The difference lies in the degree of involvement and behaviour of the physician. Assisted suicide is the act of deliberately assisting another person to kill themselves. It entails making lethal means available to the patient to be used at a time of the patient’s own choosing, with no requirement of the physician’s participation. However, the risk of error in assisted suicide is higher than in voluntary euthanasia.
II. Palliative Care – This is ‘end-of-life’ care which aims to improve the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems. It intends neither to hasten nor postpone death. The aim is to offer a support system to help patients live as actively as possible until death.
III. DNR (Do Not Resuscitate) – A DNR order means that a doctor is not required to resuscitate a patient if their heart stops and is designed to prevent unnecessary suffering. Although DNRs can be regarded as a form of passive euthanasia, they are not
controversial unless they are abused, since they are intended to prevent patients suffering pointlessly from the bad effects that resuscitation can cause: broken ribs, other fractures, ruptured spleen, brain damage.
Euthanasia: An Assessment
Arguments in favour of euthanasia include:
Based on empathy and morality – it is a good human deed to relive someone of their pain where there is no scope for improvement.
Right to die peacefully is part of Fundamental Right to Life guaranteed under Article 21 of the Constitution.
Self-determination – Human beings should have the right to be able to decide when and how they die.
Euthanasia enables a person to die with dignity and in control of their situation.
Death is a private matter and should not involve intervention by the state.
Arguments against euthanasia include:
Distinction between active and passive euthanasia is morally significant.
Another moral dimension includes the weakening of society’s respect for value of human life.
It does not take into account, and leaves no room for unexpected results and recovery.
Allowing euthanasia will lead to deterioration of healthcare of the terminally ill and discourage research for new cures.
Not all deaths are painful; palliative care also ensures relief from pain.
Regulation of euthanasia, and ensuring zero that the process is not misused is a challenge.
There is no room for changing one’s decision beyond a certain point even if one changes her/his mind.
International Position on Euthanasia :
Euthanasia in India
The present law on euthanasia in India is a result of the landmark Supreme Court judgment in the Common Cause v. Union of India, 2018 case which legalised passive euthanasia and stated that the same was not an offence under IPC as it neither at par with murder, nor with attempt to suicide.
The SC used religious texts and scriptures and references from schools of jurisprudence to indicate the moral sanction for ending the life of the terminally ill.
It held that 'right to die' is a part of Article 21 of the Constitution, and a person has a right to live with dignity until his death. The judgment permitted the execution of a Living Will or advanced medical directives by declaring that a Living Will is a part of the right to live with dignity. The Apex Court also introduced guidelines to be followed while performing euthanasia, and a set of the procedures involved for executing a Living Will.
A Living Will is a document contains a person’s wishes in case s/he becomes incapacitated and it must be executed by a patient who is of sound mind and is capable of understanding its consequences.
Evolution of Laws on Passive Euthanasia
The first judgment to deal with the issue of euthanasia was the Maruti Shripati Dubal v. State of Maharashtra case, 1986 where the Bombay High Court declared that the rights have both negative and positive aspects. The right to life under Article 21 could therefore also be interpreted as the right not to live a forced life.
In the P Rathinam v Union of India, 1994, the Supreme Court held that criminal penalties for suicide violate the constitutional right to life by amounting to a double punishment and it rendered Section 309 of the IPC unconstitutional.
The above judgment was overturned by the Supreme Court in 1996 in Gian Kaur v. the State of Punjab, which pronounced the judgment that both active and passive euthanasia and assisted suicide is unlawful in India, and that the right to life did not include the right to die.
The landmark judgment in 2011 in the Aruna Shanbaug v. Union of India was a major milestone wherein the SC held that passive euthanasia is legally valid in the country under exceptional circumstances, which allowed withdrawal of life support to patients in a persistent vegetative state (PVS).
The Law Commission of India, in its 196th Report in March 2006, gave a clear definition and clarified the meaning of the terms related to euthanasia.
The report recommended that there must be a law made to protect terminally ill patients who refuse medical treatment, artificial nutrition, or hydration from Section 309 of the Indian Penal Code.
Laws should also be made to protect doctors who make the decision for incompetent patients in their interests. The commission recommended the law be called The Medical Treatment of Terminally Ill Patients (Protection of Patients, Medical Practitioners) Act.
The Law Commission re-examined passive euthanasia in 2012 and presented its recommendations in its 241st Report. While the report reiterated its previous recommendations, it clarified that palliative care may be given in any case to terminally ill patients and the government should devise schemes for the same.
It also recommended that Medical Council of India should provide guidelines in the matter of withholding or withdrawing of medical treatment to competent or incompetent patients suffering from terminal illness.
M R Rajagopal Committee presented its report to the government in July 2018 listing the parameters and the threshold values at which ‘passive euthanasia’ and ‘living will’ can be implemented in the state.
The report raised important concerns about terminology – the term ‘passive euthanasia’ is ‘misleading’ as it carries the meaning of intention to kill. The procedure should rather be called as ‘withholding or withdrawing futile treatment’.
The committee recommended the constitution of a doctors’ panel at the district-level to process ‘living will’.
It requested the government to direct the respective District Medical Officers to constitute the panel in advance as ‘when the need arises, time will not be wasted for finding the doctors’.
The Way Forward
The scope of transformation of mercy killing into murder for selfish gains must be reduced by introducing better regulations and laws. Since the issue deals with dignified life and death, utmost care must be taken to ensure informed decisions on part of the patients.
The Parliament should frame legislation to replace the court’s guidelines that govern passive euthanasia. The process needs to be fast tracked due to the immense complexity of the guidelines laid down by the court.
Many countries have sophisticated regimes on assisted dying while India has only just recognized a constitutional right to refuse medical treatment. The Supreme Court’s stand on active euthanasia may also be reconsidered.