The Debate on Euthanasia – Explained, pointwise

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Introduction

A Bengaluru-based woman had recently filed a petition before the Delhi High Court. The woman had appealed the Court to stop her friend from travelling to Switzerland to undergo euthanasia. The man is suffering from Chronic Fatigue Syndrome since 2014. According to the petition ‘the man is completely bed bound and just able to walk a few steps inside home’. This has deteriorated his ‘quality of life’ and he is allegedly looking forward to travel to Switzerland for a physician-assisted suicide. The petition was subsequently withdrawn. Nevertheless, the whole episode has reignited debate on euthanasia or mercy-killing.

What is Euthanasia?

The word euthanasia is derived from the Greek words ‘eu’ which means good and ‘thanotos’ which means death. Thus the word literally means ‘good death’. The idea is that instead of condemning someone to a slow, painful, or undignified death, euthanasia would allow the patient to experience a relatively ‘good death’. The term is commonly known as ‘mercy killing’ and is legally and medically defined as ‘an act of terminating or ending the life of an individual who suffers from an incurable disease or situation especially painful’.

There are different types of euthanasia practised across the world. Active euthanasia where a patient is killed a patient by active means, for example, injecting a lethal dose of a drug.

There’s also Passive euthanasia, which is described as letting a patient die by withholding artificial life support such as a ventilator or a feeding tube.

Understanding Key Terms:

  • Physician Assisted Suicide (PAS): PAS, sometimes called as aid-in-dying, is a semi-passive method of euthanasia in which a medical practitioner prescribes or introduces the appropriate amount of lethal dose to end life at the patient’s request.
  • Permanent Vegetative State (PVS): It is a state in which a patient is unable to sustain himself or herself and requires the assistance of one or more life support systems or even other people to perform basic human functions.
  • Terminal disease: It refers to a medically confirmed incurable and irreversible sickness or condition that will, within reasonable medical judgement, result in death.
  • Advanced medical directive: It is also known as a ‘living will,’ and it is a direction issued by a person who wishes to avoid receiving extraordinary medical care if he or she is diagnosed with a fatal illness. To be legal, such a direction must be voluntary, competent, and given in advance.
What is the Status of Euthanasia in India?

Under the IPC, both suicide (Section 309) and abetment to suicide (Section 306) are criminal offences. While person attempting suicide can be imprisoned up to 1 year, the punishment for abetment is imprisonment up to 10 years.

(Section 309 has been restricted by the Mental Healthcare Act, 2017).

Regulation 6.7 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 explicitly prohibit the practice of euthanasia.

Multiple judgments have been passed by the Supreme Court in this regard (discussed later in the article).

In March 2018, the Supreme Court passed an order that allowed passive euthanasia (Common Cause Judgment). The Court declared that right to die with dignity is a fundamental right.

What is the Global Status regarding Euthanasia?

There are many countries that permit passive euthanasia, but just a handful of them allow active euthanasia.

Switzerland is probably the most famous spot where assisted suicide is considered a legitimate way to end one’s life. Many people from countries that forbid assisted suicide come to Switzerland to end their lives as assisted suicide is legal under Swiss law.

In the Netherlands, euthanasia is allowed in cases where someone is experiencing unbearable suffering and there is no chance of improving.

Belgium, Luxembourg, Canada, New Zealand, Spain and Colombia are other countries where assisted dying is permitted for adults with serious and incurable “disease, illness or disability”.

What are the arguments in favor of Euthanasia?

First, forcing terminally ill patients to live undermines their dignity and exposes them to pain and suffering. In such a scenario, euthansasia ensures a dignified death. 

Second, allowing those who are in a vegetative state to undergo euthanasia prevents them from futile treatments and becoming a further financial burden on the family.

Third, the Indian Judiciary has time and again recognized that the right to life means more than a mere animal existence. In such cases, withdrawal of life support is considered valid.

Fourth, some experts argue that in a civilized society, people should have full autonomy over their lives and be able to choose when they want to die.

Arguments in favour of Euthanasia

What are the arguments against Euthanasia?

First, death is decided by fate and a person should live his/her due share of life. No human has a right to take the life of another human. More religious doctors believe that PAS should not be considered since it would be against their faith.

Second, it causes ‘irreparable loss and hardship to one’s parents, other family members, and friends.

Third, many activists argue that legalising the practice would lead to a ‘slippery slope’ phenomenon which leads on to more number of non voluntary euthanasia — where the patient’s consent isn’t known or taken

What is the Judicial View regarding Euthanasia?

P. Rathinam v. Union of India (1994): The Supreme Court ruled that Section 309 (Attempt to Suicide) of the Indian Penal Code, 1860 is violative of Article 21 of the Indian Constitution. The Court stated that Section 309 of the Penal Code should be repealed in order to make our penal rules more humane.

Gian Kaur v. The State of Punjab (1996): Article 21, which deals with the ‘right to life,’ was deemed to exclude the ‘right to die.’ The constitutionality of Sections 306 (Abetment to Suicide) and 309 of the 1860 Code was confirmed.

Aruna Ramchandra Shanbaug v. Union of India (2011): It was recognized that the patient (Aruna Shanbaug) was no longer a living person and her life was devoid of any human element. The Supreme Court directed a team of three doctors to submit a report to them after assessing the mental and physical conditions of the patient. Accordingly, passive euthanasia was permitted for the first time in the history of India. The Supreme Court also laid down the guidelines for the grant of permission for passive euthanasia.

Common Cause v. Union of India (2018): The Supreme Court ruled that under Article 21 of the Indian Constitution, an individual has the right to die with dignity as part of his or her right to life and personal liberty. An adult of competent mental capacity is entitled to make an informed decision and has a right to refuse medical treatment including withdrawal from life-saving devices. As a result of this judgement, life-support systems for the terminally ill or those in incurable comas can be removed. 

The Court also recognised the importance of writing a living will (Advanced Medical Directive) and allowed people to opt out of artificial life support.

Chandrakant Narayanrao Tandale v. the State of Maharashtra (2020): Active euthanasia is a form of euthanasia that is illegal. The Court expressed sympathy towards the petitioner in this case but his petition of active euthanasia was not allowed.

What should be done going ahead?

First, passive euthanasia should strictly be done according to the guidelines of Supreme Court.

An application under Article 226 has to be filed with the Chief Justice of the High Court. The High Court shall constitute a bench of at least two judges to decide the application. Before deciding the same, the bench should seek the opinion of a committee of three reputed doctors. Preferably, one of the three doctors should be a neurologist, one should be a psychiatrist and the third should be a physician. The report of the doctors shall take into account the following factors: (a) Examination of the patient; (b) Records of the patient; (c) View of the hospital staff.

Second, suicide prevention is not just a social and public health goal in India, but also a traditional mental health practice. As a result, the time has come for mental health practitioners to take a more proactive approach to suicide prevention. In addition, the Government should initiate a national discourse on suicide prevention.

Conclusion

The Judiciary has made it clear that Active Euthanasia is prohibited in India in any form and under any circumstances. But a lenient view has been taken when it comes to passive euthanasia. The Supreme Court has recognized that a person with Persistent Vegetative State (PVS), with no scope of improvement has a right to end his life with dignity. Thus, passive euthanasia has been recognized in India as a facet of the Right to Life under Article 21 of the Indian Constitution.

Source: Firstpost, Indian Express, The Hindu

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