Life, Death, and Dignity: A Comprehensive Indian Perspective on Euthanasia

https://www.psychologs.com/what-is-euthanasia-types-and-related-controversies/

"The right to die with dignity is a fundamental universal right of all living creatures.“

Abstract

Euthanasia, often a controversial topic, involves the intentional ending of a person’s life to relieve suffering, particularly in the context of incurable or terminal illnesses. Advocates argue that it provides a compassionate option for those enduring unbearable pain, granting them the autonomy to decide the timing and manner of their death. Conversely, opponents stress ethical concerns, fearing the potential for abuse or coercion. This article attempts to delve into the concept of Euthanasia and the right to die in the  Indian context. The author has attempted to provide a peripheral overview of three significant judgments regardingEuthanasia. Furthermore, the article scrutinizes India’s ambivalent stance on the right to die, examining the challenges posed by the country’s legal and societal frameworks.

Introduction

The word Euthanasia was derived from the Greek term “euthanatos” meaning good death. Since its inception, euthanasia has been a highly debated topic that raises fundamental questions about autonomy, compassion, and the ethics of medical practice. Euthanasia is further divided into active and passive forms, with the former involving the administration of lethal drugs upon explicit request, and the latter referring to the withholding or withdrawal of life-sustaining treatments. Active euthanasia can be classified into three categories based on the consent of the individual involved. Voluntary euthanasia is conducted at the explicit request of the patient, highlighting a conscious and willing decision to end their life. On the other hand, involuntary euthanasia transpires without the patient’s consent, suggesting a decision made on their behalf, often due to an inability to communicate their wishes. Involuntary euthanasia, often referred to as “mercy killing,” occurs when a patient is unable to provide consent, yet the intention is to alleviate their pain and suffering by terminating their life. This classification underscores the ethical complexities surrounding the act of actively ending a person’s life, emphasizing the significant role of informed consent in such sensitive matters.

Euthanasia Jurisprudence in India

It is enshrined in our Constitution that every individual has the right to life and personal liberty, but there is still no specific legislation that addresses the issue of euthanasia. The Supreme Court accepted the practice of Euthanasia in the year 2011 in the case of Aruna Shaunbaug v. Union of India. In this case, Ms Aruna Shanbaug, a nurse, was strangled by a dog chain and then sodomized. The hypoxic damage in the brain cells from the incident left her in a permanent vegetative state. She was in a vegetative state for almost 42 years before a journalist in Mumbai published a book bringing her situation to the public eyes. In 1999, Pinki Virani also filed a case stating that Aruna Shanbaug should be allowed to die with dignity through passive euthanasia. As a result, in March 2011, the Supreme Court passed its landmark judgement on passive euthanasia, allowing for the withdrawal of life-sustaining treatment in certain circumstances.

In another landmark judgement of 2018 in the case of Common Cause (a Registered Society) v. Union of India and Another, the Supreme Court of India upheld the legality of passive euthanasia, specifically allowing for the withdrawal of life support to patients in a permanent vegetative state. The Supreme Court dealt with this question of whether the right to life guaranteed under Article 21 of the Constitution covers within its ambit a “right to die with dignity”. Answering in the affirmative, the Court emphasised the dynamic and constantly evolving nature of fundamental rights. Individual dignity having been reaffirmed as falling under Article 21 by the Puttuswamy I judgement, the Court interpreted the right to live with human dignity as necessarily meaning a right to live a dignified life until the point of death. In order to ensure a dignified procedure of death, it should allow a terminally ill person or a person in permanent vegetative state to seek passive euthanasia to safeguard their right to a respectful and dignified death under Article 21. Thereby, on March 9th 2018, a five-judge Bench comprising Dipak Misra CJI, A K Sikri, A. M. Khanvilkar, D Y Chandrachud and Ashok Bhushan JJ held that the right to die with dignity is a fundamental right.

An individual’s right to execute advanced medical directives is an assertion of the right to bodily integrity and self-determination and does not depend on any recognition or legislation by a State. To supplement this legal framework, the Court in this case also directed the government to issue guidelines regarding Advance Directives (AD), which are documents that describe the choices made by an individual regarding their medical treatment in the event that they become unable to make decisions for themselves. The guidelines were then amended in February 2023 to assist in easier implementation and understanding of Advance Directives to larger sections of society. However, the same places an onerous responsibility or burden on each applicant as every AD is subjected to an opinion formulated by two medical boards which can only be challenged in accordance with the established legal procedure, which in this case would require approaching the High Court under Article 226. This doesn’t however benefit the applicants or their families in any way as the entire process is rigorous and burdensome for individuals and their families who are already dealing with the emotional and physical challenges of a terminal illness or a loved one in a permanent vegetative state. Apart from the psychological burden, the bureaucratic process required to permit an AD which are notarized documents signed and testified in front of a judicial magistrate is also physiologically exhausting.

However, despite unanimously upholding the right to die with dignity as a fundamental right, the practical implementation of advance directives and the process for seeking passive euthanasia in India remains burdensome and impractical in many cases. This was again challenged in the case of the Indian Society for Critical Care vs. the Union of India, where an application was filed to modify the guidelines that were prescribed in the 2018 judgement. The application sought to simplify the process and make it more accessible for individuals and their families who are already facing immense emotional and physical challenges. The application emphasized the need to create a more streamlined and less burdensome procedure for obtaining Advance Directives and seeking passive euthanasia in India. However, it is worthwhile to note that Passive Euthanasia can, practically, often take place by simply not paying the Hospital Bills by the concerned family.

Conclusion

In conclusion, the debate over euthanasia and the right to die in India has come a long way with landmark judgments acknowledging the right to die with dignity as a fundamental right and legal recognition given to advance directives. However, there are significant challenges in the practical implementation of advance directives and the process for seeking passive euthanasia, as highlighted in the case of the Indian Society for Critical Care vs. Union of India. It is evident that while the legal framework has made significant strides, there is a pressing need for practical reforms to ensure that individuals and their families can exercise their rights in a more accessible and efficient manner. The complexities and challenges in the current process underscore the need for further reforms to truly ensure the right to die with dignity and the effective implementation of advance directives in India.

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