Euthanasia: Indian Laws and Perspectives on the Right to Die

The topics of palliative care, euthanasia, and physician-assisted suicide (PAS) have gained attention in medical and legal discussions. Euthanasia debates revolve around patient autonomy and medical ethics. Passive euthanasia involves withholding treatment for a peaceful death, while PAS involves doctor-assisted self-administered death. The right to life raises questions about the right to die, with differing court opinions. Euthanasia comes in three forms: voluntary, non-voluntary, and involuntary. The Aruna Shanbaug case and “living wills” have sparked discussions on euthanasia’s legality and ethics. Arguments include personal choice, morality, religion, patient competence, and societal implications.

“Life and death are inseparable. Every moment our bodies undergo change… life is not disconnected from death. Dying is a part of the process of living.”

Introduction

The issues that are related to palliative care and quality of life for patients who are suffering from various terminal diseases such as advanced cancer and AIDS now have a significant place in the interest of clinicians. Another contentious topic, including the “mercy killing” of terminally sick patients, has emerged concurrently with this one. According to proponents of physician-assisted suicide (PAS), a person’s autonomy immediately gives him the right to select a painless death. The opponents believe that a doctor’s involvement in someone’s death violates a key medical ethical principle. Euthanasia’s ethical foundations are further called into doubt by untreated depression and the potential for societal “coercion” among those who request it. Strict criteria for applying PAS have been created in response to these worries. It becomes necessary to evaluate the patient’s mental health prior to their signing the PAS consent form, and this is where the psychiatrist’s role is crucial. Despite being illegal in our nation, PAS has a number of supporters in the form of nonprofit organizations like the “Death with Dignity” Foundation. The recent Honorable Supreme Court ruling in the Aruna Shaunbag case has given this some momentum. How long it will take for this delicate subject to ruffle the feathers of the Indian legislature is still up in the air.

The purposeful withholding or withdrawal of medical care with the objective of enabling a terminally ill patient to die is known as passive euthanasia. This may include cutting off the patient’s breathing apparatus, removing any medications that keep them alive, or even depriving them of food and water until they pass away from malnutrition or dehydration.

It is named “passive” because no aggressive killing procedure, such as a fatal injection, is used; instead, all life-supporting procedures are suspended and life-extension medications are withdrawn.

In contrast, PAS entails a doctor giving a patient drugs or guidance to help them terminate their own lives. While there may not be much of a difference theoretically or ethically between PAS and euthanasia, there may be a big difference practically.

Euthanasia and PAS have been legally and morally distinguished from the use of high-dose painkillers intended to ease a patient’s suffering but which may expedite death (often known as the rule of double effect) or even the removal of life support. The distinction between euthanasia/PAS and the use of potentially lethal high-dose analgesics is based on the act’s motivation. While the goal of pain medicine delivery, which may also hasten death, is to relieve suffering, the goal of euthanasia and PAS is to end the patient’s life.

The Right to life

As soon as a person takes person they are endowed with a fundamental human right. One of the most significant and fundamental rights is the right to life, without which no other right can be exercised.However, if a person is entitled with the right of life is that person also endowed with right to not live or to die?While providing this response, the Indian courts voiced various viewpoints.

The Bombay High Court ruled in M.S. Dubal v. State of Maharastra that article 21 of the Indian Constitution’s right to life also includes the “right to die.” In contrast, the AP High Court ruled in Chenna Jagadeeswar v. State of AP that the right to die is not a constitutionally guaranteed right under Article 21. However, the Supreme Court of India noted in the case of P. Rathinam that the “right to live” also encompasses the “right not to live,” or the right to die or end one’s life. However, in Gain Kaur v. State of Punjab, a five-member panel overturned P. Rathinam’s argument and determined that Article 21’s right to life does not include the right to death or to be slain.

Given that it entails the intentional taking of human life, euthanasia is contentious. When a patient has a terminal illness, they are frequently in a lot of pain as their condition slowly deteriorates until they pass away. This might be so terrifying for them that they choose suicide rather than go through it. So the question is whether people should be provided assistance with in taking their own lives or if they should be left to go through the suffering brought on by a terminal illness.

There are numerous varieties of euthanasia, making it a complicated topic. According to consent, euthanasia can be divided into three categories.

1. Voluntary euthanasia is that in which the individual who is suffering has expressed a desire to die.

2. Non-voluntary euthanasia occurs when the individual who is killed neither asked for nor consented to being killed. In other words, it is carried out when a person is in a coma and unable to express his wishes.

3. Involuntary euthanasia occurs when the individual being killed expresses a desire to the contrary. To put it another way, it is involuntary when the victim offers his or her agreement to not die.

Suicide versus Euthanasia

The distinction between the two ideas is barely different since they are so intricately interwoven. It can be challenging to fathom a legal system in which a patient’s family can choose to end his life but a fully competent adult is prohibited from doing the same.

According to Section 309 of the Indian Penal Code, 1860, attempting to commit suicide is a crime in India and is sanctioned by a fine and a term of imprisonment of up to one year. Some have referred to this punitive clause as unique because, while a failed suicide attempt results in penalty, a successful attempt results in no punishment because there is no one to punish. According to Section 306 of the IPC, anyone who aids in suicide may face up to ten years in prison and a fine. This was India’s sole defense against sati incitement for a very long period of time.

The Delhi High Court reportedly remarked that it was a bizarre paradox that suicide was still criminally punishable in an era with proponents of euthanasia.

India and Euthanasia

The mercy killing debate began with the Aruna Shanbaug case; the Mumbai nurse spent 42 years in a vegetative state after a brutal assault by a sweeper.

The Supreme Court deemed an advanced healthcare directive, or ‘living will, valid and legally enforceable. A living will is a legal document by which any person can lay down instructions for what specific actions should be taken (or not taken) regarding their health if they are unable to make decisions for themselves in the future.

“A person is entitled to draft a living will specifying that he (or she) should not be given life support treatment if he slips into an incurable coma state in future”,the court stated.

In cases where a person has not made a living will, the apex court said that relatives can approach high courts for permission to allow passive euthanasia.

Debate upon Compassion Killing

Due to the Aruna Shanbaug case, the ethical discussion around euthanasia, sometimes known as “mercy killing,” acquired popularity in India. An employee of the K.E.M. Hospital in Mumbai named Shanbaug was beaten and sexually assaulted by a sweeper after her shift one night, and she was left for 42 years in a vegetative condition.

The right to a dignified death is not recognised under the Indian Constitution, despite the right to a dignified life being recognised. As a result, the discussion up until now has included not only moral relevance but also legal practicability, constitutional legality, and concern over misuse.

“The ability of modern medical science to prolong life must be balanced with a responsibility to provide quality of life,” Justice D.Y. Chandrachud ruled in a separate decision.

In nations including Belgium, Luxembourg, Canada, and the Netherlands, assisted suicide is permitted. If done in accordance with the rules, it is also permitted in Switzerland, Germany, and the US states of Oregon, Vermont, California, Montana, Colorado, and Washington, D.C.

Case Laws

Suicide punishment was raised as a constitutional issue in the Supreme Court case P Rathinam v. Union of India (Rathinam). The court decided after hearing the writ petition that attempting suicide was more indicative of a psychological issue than of any innate criminal tendencies. After carefully considering the ethical and legal ramifications of criminalizing suicide attempts, the court declared Section 309 of the IPC to be invalid and ineffective. The court determined that Section 309 violated Article 21 right to life.

This conclusion did not last for very long. In Gian Kaur v. State of Punjab, a married couple appealed their judgment of aiding suicide in accordance with Section 306. They claimed that since the “right to die” was covered by Article 21’s right to life (as the Supreme Court held in Rathinam), anyone who assisted another person in killing themselves would simply be facilitating the exercise of a fundamental right. This implied that Section 306 of the IPC, which penalized aiding in suicide, was also unconstitutional. This defense was rejected by the Supreme Court. Nevertheless, it also nullified the earlier decision in the Rathinam case and determined anew that the constitutional right to life did not encompass the right to death.

The Supreme Court issued this historic decision on March 9, 2018, paving the way for physician-assisted suicide (PAS), commonly known as passive euthanasia. As previously stated by the constitutional bench in the Gian Kaur case, the court reaffirmed that the right to pass away with dignity is a fundamental right. According to its declaration, an adult human being with the mental capacity to make an informed choice has the right to refuse medical treatment, including the removal of life-supporting equipment. A person with a competent mental facility is permitted to sign an advance medical directive, according to the Apex Court.

The Supreme Court’s 2018 ruling in Common Cause v. Union of India and Anr, which recognized passive euthanasia, was changed on January 24, 2023, by a Constitutional bench. By reducing the role played by government officials, this was done to make the process of removing (withholding) life support from terminally ill patients considerably less complicated for the patients, their families, and the doctors. But before talking about the aforementioned development, it’s crucial to comprehend the ideologies, philosophies, legal restrictions, and historical developments around the subject of passive euthanasia.

Guidelines

The prior ruling was modified by the Supreme Court to do away with the requirement that a judicial magistrate attests or countersign a living will.
The Supreme Court ruled that a notary’s or gazetted officer’s attestation would be sufficient for someone to form a legally binding living will.
The National Health Digital Record, which hospitals and clinicians from around the nation can access, will house the document in place of the living being in the custody of the relevant district court, according to the SC.
The patient’s family can go to the appropriate high court, which creates a new board of medical specialists to give the court the ability to withdraw medical treatment if the hospital’s medical board declines permission.

Arguments in favor of:

Freedom of Choice: Supporters contend that everyone should have the freedom to choose what they want.
Quality of Life: Only the individual truly understands how they feel and how extended illness and death affect their quality of life.

Every person should be able to pass away with dignity.

Resources: It makes more sense to allocate highly qualified personnel, equipment, hospital beds, and pharmaceuticals to life-saving therapies for people who want to survive than for those who do not.
Humane: Giving someone in unbearable agony the option to end their suffering is more humane.
Loved ones: It may assist in lessening their agony and sadness.

Arguments against:

Moral and religious objections: Euthanasia is viewed as ethically repugnant and a form of murder by a number of religions. Some religions also consider suicide to be “illegal”. There is a moral argument that euthanasia will erode society’s adherence to the value of human life.
Patient Competence: Euthanasia can only be performed voluntarily if the patient is mentally sound, has a clear comprehension of the alternatives and potential outcomes, and is able to communicate both their understanding and their desire to end their own life. Competence is difficult to determine or define.
Guilt: Patients could feel like a drain on resources and that giving consent is being psychologically forced upon them. They can believe that their family is under too much of financial, emotional, and mental strain.