dissertation on euthanasia in india

Euthanasia: Global Scenario and Its Status in India

Affiliations.

1 Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India. [email protected].
2 Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India.
3 Department of Forensic Medicine, Nepal Medical College Teaching Hospital, Kathmandu, Nepal, India.
4 Department of Anthropology, Panjab University, Chandigarh, India.
PMID: 28726026
DOI: 10.1007/s11948-017-9946-7

The legal and moral validity of euthanasia has been questioned in different situations. In India, the status of euthanasia is no different. It was the Aruna Ramachandra Shanbaug case that got significant public attention and led the Supreme Court of India to initiate detailed deliberations on the long ignored issue of euthanasia. Realising the importance of this issue and considering the ongoing and pending litigation before the different courts in this regard, the Ministry of Health and Family Welfare, Government of India issued a public notice on May 2016 that invited opinions from the citizens and the concerned stakeholders on the proposed draft bill entitled The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill. Globally, only a few countries have legislation with discreet and unambiguous guidelines on euthanasia. The ongoing developments have raised a hope of India getting a discreet law on euthanasia in the future.

Keywords: Aruna Shanbaug; Euthanasia; Indian law; Physician-assisted suicide (PAS).

Publication types

Euthanasia / ethics
Euthanasia / legislation & jurisprudence*
Legislation, Medical*
Patient Rights / legislation & jurisprudence*
Suicide, Assisted / ethics
Suicide, Assisted / legislation & jurisprudence*

Home » Articles » Legality Of Passive Euthanasia In India: Right To Die With Dignity

Legality Of Passive Euthanasia In India: Right To Die With Dignity

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by Varsha | Sep 1, 2022 | 0 comments

Legality Of Passive Euthanasia In India: Right To Die With Dignity

In 2005, a PIL was filed by NGO ‘Common Cause’ seeking a solid system for certification of Passive Euthanasia and legalisation of ‘living will’ in India. The killing of a patient suffering from an incurable and terrible sickness or in an irreversible coma painlessly. A person who chooses euthanasia has a terminal illness. However, there are times when some people wish to end their lives. In many circumstances, it is done at the desire of the person, but there are times when they are too ill, and relatives or the courts must make a choice. For many years, the problem has been the subject of passionate arguments and debates, surrounded by religious, ethical, and practical factors.

Introduction — Right To Die In India

According to the Constitution of India, the Right to life is one of the basic fundamental rights, without which no other rights may be exercised. The term “right to life” refers to a person’s fundamental Right to live. However, if a person has the Right to life, does he also have the RIGHT NOT TO LIVE, i.e. does he have the RIGHT TO DIE? The Right to life, which includes the Right to live with human dignity, would imply that certain rights are guaranteed until the end of an average lifespan. This could involve a dying man’s Right to die with dignity. However, the right to die with ‘dignity’ must not be mistaken for the Right to die an unnatural death that shortens one’s lifespan. As a result, the problem has been the subject of passionate arguments and debates about whether passive euthanasia should be legal in India.

Euthanasia is derived from a Greek word called “Euthnatos”, which means easy killing. The killing of any person or patient suffering from an incurable and terrible sickness or is in an irreversible coma painlessly. Euthanasia can be understood as mercy killing. A person who chooses euthanasia has a terminal illness. However, there are times when some people wish to end their lives. In many circumstances, it is done at the desire of the person, but there are times when they are too ill, and relatives, doctors or the courts must make a choice. The Supreme Court of India legalised passive euthanasia in 2018 with some conditions and permitted ‘living will’ by patients to withdraw medical support if they go into an irreversible coma. However, active euthanasia is still illegal in India.

Research Questions

1. When and why does someone opt for passive euthanasia? What are the types of euthanasia? 2. What is Living Will? What are the Guidelines related to the living will? What will happen if there is no willing will? 3. What is the difference between suicide and euthanasia?

When and why does someone opt for passive euthanasia? What are the types of euthanasia? A person suffering from terrible sickness and incurable diseases causing unbearable pain to the patient opts for passive euthanasia. However, a survey was done regarding passive euthanasia, and the result was that less than a one- third of patients request euthanasia because of severe pain. These terminally ill patients want Passive Euthanasia because physical conditions severely damage their quality of life, e.g. incontinence, paralysis, and difficulty swallowing. Another factor is Psychological, which directs patients to consider euthanasia, including loss of dignity, feeling like a burden on family, friends and relatives, and Depression.

FORMS OF EUTHANASIA

Active euthanasia and passive euthanasia.

Through active euthanasia, a person brings the patient’s death directly and purposefully. In passive euthanasia, the patient’s life is not taken directly; instead, they are left to die.

Illustration: When a person dies due to an act, such as being given an overdose of painkillers, this is known as active euthanasia.

When someone dies due to someone else’s omission, this is known as passive euthanasia. This can be accomplished by discontinuing or delaying treatment. Discontinuing treatment means turning a machine that keeps a person alive so that the person dies of their illness, whereas delaying treatment means not performing a surgery that will extend the life of a patient suffering from a particular illness.

Passive euthanasia is traditionally regarded to be less harmful than active euthanasia. However, some people believe that active euthanasia is morally superior.

Voluntary Euthanasia and Non-voluntary Euthanasia

An individual who is about to die requests voluntary euthanasia then, this is known as voluntary euthanasia.

Non-voluntary euthanasia happens when a person is in an unconscious state of mind and thus unable to make a meaningful choice between living and dying (for example, a newborn or a person with severely low intelligence), and an eligible person makes the decisions or takes action on his behalf.

Non-voluntary euthanasia also includes situations in which the person is a kid who is cognitively and emotionally capable of making the decision but is not legally considered old enough to do so, so someone else must make the decision on their behalf.

When a person chooses life but is killed anyhow, this is called involuntary euthanasia. This is commonly referred to as murder; however, in some situations, the killing could be justified as being for the good of the person who died.

Indirect Euthanasia

This occurs when a treatment (typically to relieve pain) has the unintended consequence of hastening the patient’s death. Some people consider this morally acceptable because the primary goal is not to kill. The idea of double effect offers a formal justification along these lines.

Assisted Suicide

This generally refers to situations where the individual about to die wants and requests assistance in killing himself. It could be as simple as obtaining medicines for the individual and placing those substances within their grasp.

What is Living Will?

A person’s Right to provide an advance directive on the course of his or her treatment, including the withdrawal of life support, if such a circumstance arises, is known as a living will.

A living will relieve grieving family members of the moral weight of determining whether or not to remove life support from a terminally sick person. When patients have signed a living will, doctors may be exempt from accusations of wrongdoing or negligence.

The Guidelines For Living Will

After having full awareness, an adult of sound mind can execute the will without coercion, and the document must be signed in front of a First Class Judicial Magistrate in the presence of witnesses.
It must specify when medical treatment may be stopped or when no particular medical treatment shall be given that has the only purpose of postponing the dying process that would otherwise cause him/her unbearable pain.
The name of the guardian or close relative who will be authorized to refuse or withdraw medical treatment should be specified.

If There Is No Living Will

In the absence of an Advance Directive, the procedures and safeguards must follow the same guidelines as in an Advance Directive, with a few exceptions.
The family members shall be informed of the pros and cons of withdrawing or refusing further medical treatment for the patient, and if they give consent in writing, the Hospital Medical Board shall certify the course of action to be taken.
The hospital must notify the jurisdictional Collector, who will form a Medical Board consisting of the Chief District Medical Officer as Chairman and three experts with experience in critical care from general medicine, cardiology, neurology, nephrology, psychiatry, or oncology.
If the board approves the withdrawal of life support, notice must be given to the First Class Judicial Magistrate and the patient’s family members.
Once again, the Magistrate must verify the medical reports, evaluate the patient’s condition, consult with the patient’s family members, and, if satisfied in all aspects, may support the Collector’s nominated Medical Board’s judgement.
In case of conflicting opinions – the patient’s nominee, a family member, the treating doctor, or hospital staff can ask the High Court for authorization to remove life support.
The High Court may appoint an Independent Committee of Doctors, and in such circumstances, the High Court must make a decision as soon as possible.
The High Court must give detailed reasons, keeping in mind the principle of “best interests of the patient.”

What Is The Difference Between Suicide And Euthanasia?

Between suicide and euthanasia, there is a conceptual distinction to be made. Suicide occurs when a person kills himself voluntarily by getting himself stabbed, consuming poison, or any other means. Without question, suicide is a deliberate attempt to end one’s life. It is the act or occurrence of someone purposefully killing themselves, usually owing to sadness or other factors such as frustration, exam failure, or difficulty finding a good job. Euthanasia, on the other hand, is the action of another person to end the life of a third person. A third party is either actively or passively involved in euthanasia, meaning he aids or abets the killing of another person.

It is also worth noting that this situation distinguishes between ‘assisted suicide’ and ‘euthanasia’. Assisted suicide is when someone knowingly assists someone else in committing suicide, such as by giving the person the means to do so. A ‘physician-assisted suicide’ occurs when a doctor assists a patient in killing himself (by prescribing fatal drugs). As a result, because the patient is the one who commits suicide, the patient has absolute control over the process that leads to death. The other person only assists (for example, providing the means for acting). Euthanasia, on the other hand, can be active, such as when a doctor administers a lethal injection to a patient or passive, such as when a doctor removes the patient’s life support system.

Scenario Throughout The world

As of March 2018, euthanasia is legal in the Netherlands, Belgium, Colombia, Canada and India.
Assisted suicide is legal in Switzerland, Germany, Japan, the United States of Washington, Oregon, Colorado, Vermont, Montana and California.
South Korea has also become a euthanasia legal country, both active and passive euthanasia.

Landmark Cases Of Euthanasia In India

In the case of Gyan Kaur vs State of Punjab (1996)[i], the Supreme Court held that euthanasia and assisted suicide are unlawful in India. The court held that the Right to life under Article 21 of the Indian Constitution does not include the Right to die.
In Aruna Ramchandra Shanbaug vs Union of India (2011)[ii], the Supreme court held that passive euthanasia could be allowed under exceptional circumstances under strict monitoring.
In 2014, a three-judge bench of the Supreme court of India termed the judgment in the Aruna Shanbaug case[iii] to be ‘inconsistent in itself’ and referred the issue of euthanasia to its five-judge Constitution bench.
In Common Cause vs Union Of India (2018)[iv], a Constitution bench, led by the Chief Justice of India Dipak Mishra, upheld that the fundamental Right to life and dignity includes the Right to refuse treatment and die with dignity. It held that the Fundamental Right to a meaningful existence includes a person’s choice to die without suffering.

Justice Chandrachud held:

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

In my opinion, the Right to life is one of the most basic fundamental rights, without which no other rights may be exercised. The term “right to life” refers to a person’s fundamental Right to live. However, if a person has the Right to life, does he also have the Right not to live?

According to the above research, we can conclude that only severely ill patients want Passive Euthanasia because physical conditions severely damage their quality of life.

In my opinion, legalising passive euthanasia was correct, and I support it entirely as the person suffers from such a condition that the Right to die should be safeguarded under Article 21 .

This article is written and submitted by Mohd Shaaz Peerbaksh during his course of internship at B&B Associates LLP. Mohd Shaaz is a 5th year law student from IMS Unison University, Dehradun .

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Recent Landmark Judgements

Joseph Shine Vs Union of India
Smt. Sowmithri Vishnu Vs Union of India & Anr
Sri Sankari Prasad Singh Deo Vs. Union of India and State of Bihar(and Other Cases).
I.R. Coelho (Dead)by Lrs. Vs The State of Tamil Nadu
Vineeta Sharma Vs. Rakesh Sharma & Ors.

Position of Euthanasia in India - an Analytical Study

Related Papers

Rouf Ahmad Bhat

DR.C.KARTHIKEYAN DR.C.KARTHIKEYAN

Mitali Jain

Indian Journal of Critical Care Medicine

Praveen Khilnani , S. Prayag

Dr. Pyali Chatterjee , International Journal of Scientific Research in Science and Technology IJSRST

Article 21 of Indian Constitution grants Right to life only. According to Article 21 says, " No person shall be deprived of his life or personal liberty except according to procedure establishedby law ". Right life under Article 21 does not include Right to die. Right to life is a natural right. The question regarding Right to die first time comes before Bombay High Court in State of Maharashtra v. Maruty Sripati Dubal, 1987 Cri LJ 743. And here in this case court declared that Right to Life includes Right to die, thus making Section 309 of Indian Penal Code, 1860 which makes attempt to suicide as punishable offence unconstitutional. But Supreme Court in Gian Kaur v. State of Punjab (1996)2 SCC 648, held that Right to life does not include " Right to die " or " Right to be killed ". Right to life is a natural right and right to die is not a natural right and no one has a right to finish their life in unnatural way. It was only after the case of Aruna Ramchandra Shanbaug versus Union of India (2011) 4 SCC 454, Supreme Court in its judgment declared that Passive Euthanasia is legal in India. Here my question is whether Right to life with dignity includes Right to life with dignity. If the answer is Yes then why a cancer patients who were already in their last stage has to suffer lots till their death. In such cases active euthanasia is the only option, getting relief from the pain of cancer. A person who is already bedridden and is dependent on other for each and everything in that case how can we say that he is living with his dignity? In cancer (last stage), most of the patients died in pathetic conditions, where neither they can bear the pain of the diseases nor their family can watch their loved one in such an intolerable pain for such a long time. In such cases death with dignity is last option for the family members as well as for the patients to finally get relived from the ultimate pain. There is a need of Active Euthanasia for such patients. Lastly, judgment of Aruna Ramchandra Shanbaug versus Union of India should be reviewed once again and medical committee should be formed to find out the cases where active euthanasia will be the ultimate option for the patients to die with dignity and without tolerant any pain.

Samuel G Waiganjo

Journal of Law Policy and Globalization

Navin Battan

Professor (Dr) Naresh Vats

Euthanasia literally means good death but in this context it means mercy killing. The debate is regarding the legalization of euthanasia. This debate is a continuing one as some people are of the view that life is sacred and no one has got the right to end it whereas on the other hand some say that life belongs to oneself and so each person has got the right to decide what he wants to do with it even if it amounts to dyeing.

India's stand on Euthanasia: Supporting Right to Die with Dignity

The debate on euthanasia is a momentous one. It has been one of the controversial issues of all time. Euthanasia is seen as a conundrum due to the presence of many conducts justified on several grounds.It was difficult for a country like India to take a decision which is rational and morally acceptable for all.Not only the views on euthanasia differed based on religion but also on factors like education, age and gender. There has been a long history of multiple cases on this issue. Finally, in the landmark case of Common Cause v. Union of India, the Apex Court pronounced to legalize passive euthanasia in the country. The judgement gave a robust interpretation of Article 21 of the constitution.The court held that passive euthanasia is not an offence under IPC. Neither the patient is liable under Section 306 nor the doctors are liable under Section 309 of IPC. The judgement faced both approbation and criticism. Further, this article proposes to talk about euthanasia, its types, historical background and the legal aspect of it. It discusses the constitutionality of euthanasia and the present scenario of the country.

Keywords: Euthanasia, Right to life, Suicide, Living will, Right to Die, Doctors

INTRODUCTION

The progress and evolution in technology and medical science have not only improved the general human health by completely demolishing the epidemics, but have also found the cure for others. They have interfered with the natural life span of people by finding treatments and drugs for prolonging it. Such dependence on medical treatments for artificially prolonging the lifespan is usually painful, undignified and against individual autonomy.[1] If a person is undergoing suffering due to the incurable illness, in such situations patient’s autonomy should supersede everything.[2]A person has all the rightsover his decision, be it regretting over the bad choices or rejoicing over the good ones. In such heart-wrenching situations, here comes the issue of euthanasia.

Euthanasia is defined as an intentional termination of a patient’s life by an or omission of medical care.[3]The constitutionality of euthanasiahas been amuch-debated issue throughout the world.[4]As this controversy between legality and morality of euthanasia has been a significant phenomenon during the past decades, it can be much expected that this will continue further into the twenty-first century also.[5]The conundrum over this subject lies on the clashes between the principle of sanctity of life, dignity of an individual and the right of self-determination.

The constitutionality of euthanasia was always asubject of dispute. The reason liesin the fact that the impact of granting euthanasia is not only at an individual level but at a larger level as well; which includes society, government, institutions etc.[6] The consequence of legalizing euthanasia affects both the present and the future. Each nation decides whether they should legalize euthanasia or not, and making this requires time as it is a complex process. An individual has a right to enjoy and power over his life till his death. The dignity of a person cannot be effaced by sickness or sufferings. Euthanasia is not an offence. It is an end to the excruciating sufferings and agony of a terminally ill patient.

BACKGROUND OF EUTHANASIA

The Black's Law Dictionary[7] (8th edition) defines euthanasia as an act of killing a person or causing the death of a person who is in a permanent vegetative state or is suffering from an incurable disease. It is a way of ending the life of a person to provide relief from distress and unbearable conditions.[8] It is done to ensure painless death to a person when there are no hopes for improvement.[9]The word euthanasia is derived from the Greek word, 'eu' and 'Thanatos' which means 'good death' and 'easy death' respectively. Euthanasia is adopted in different countries to give patients a death in a painless way and to reduce the burden on their families. It is giving drugs to a patient to end his life after taking his consent.[10]Several countries across the world have legalized euthanasia. The different types of euthanasia are-

1. Active or Positive Euthanasia 2. Passive or Negative Euthanasia 3. Voluntary Euthanasia 4. Involuntary Euthanasia 5. Non-voluntary Euthanasia

ACTIVE OR PASSIVE EUTHANASIA- It involves giving lethal medicines to a patient suffering from an incurable disease to end his life painlessly.[11]

PASSIVE OR NEGATIVE EUTHANASIA- Passive euthanasia involves removing the life-saving devices or to stop giving the medication. It is a way of ending life through a natural means. It means a process in which the doctor is not saving a patient.[12]

VOLUNTARY EUTHANASIA- In this type, the consent of the patient matters. Euthanasia is performed only with the permission and the expressed desire of the patient. It is performed when it is in the best interest of the patient and also everyone else.

INVOLUNTARY EUTHANASIA- Euthanasia is performed without the consent of the patient. The patient is killed against his wish, and it amounts to an offence.[13]

NON-VOLUNTARY EUTHANASIA- In non-voluntary euthanasia, the deceased or the patient is not competent to inform someone about his request to die or request to live. In addition to this, the patient also neither made a living will nor he has given any advance directives. The euthanasia is performed with the consent of his family members and their decision is respected.

CONFLICTING CONCEPTS ON EUTHANASIA

In several texts of Hindus and even ancient Greeks instances have been found where the killing of a person suffering from an incurable disease is favored. In epic pieces of literature like Mahabharata and Ramayana, there are several instances of religious suicides. The natural law thinker, Plato in his book 'The Republic of Plato' has stated that if a man has a sickly constitution and temperate habits, if his practices are nothing worth, then he should not be cured. According to Hindu texts, ending a life of a person suffering from a painful disease, then you are performing a good deed. But on the other hand, there are some other Hindu texts which believe that by ending the life of a person, even a deceased person, one is disturbing the cycle of death and rebirth. So, it can be said that Hindus too carry different views on euthanasia.

Further, Muslims were against euthanasia. They considered life to be sacred and believed that no one has a right to interfere with the health of a person. Because life is given to a person by Allah. Similarly, Christians were also against euthanasia. They believed that life is a gift from God. Only God has the power to take away someone’s life and end it.[14] Sikhs were also not in favor of euthanasia as they considered it to be an interruption in God’s plan.

It has been found that opinions of people also differ on euthanasia on factors like religion, age, sex, education or status. It is the findings of many piece of research that people who are more religious as compared to others are often against euthanasia. Because they consider life as a gift of God. A college student will favor euthanasia more as compared to a non-educated person. Also, people with low income and women are likely to go against euthanasia as compared to the others.[15]

Several authors all across the world have written their opinions and views on euthanasia. A famous author, Stanley Leo in his article'Dying with Dignity: Case for legalizing Physician-assisted Suicide' says that life is not only about surviving but also living a life with good health.[16]Different countries have different ideologies regarding euthanasia. India has legalized only passive euthanasia while active euthanasia is still illegal in the country.

There have always been deliberations on this subject for a few decades. Some people were against euthanasia, and some wanted to legalize it. There was a time when a layman used to consider suicide and euthanasia on the same footing and used them interchangeably. Later Supreme Court through judgments gave clear definitions of the terms and established a clear-cut difference between the two. Suicide is an act performed by the person himself to end his life but some other person performs euthanasia with the consent of the deceased person.

HISTORY OF EUTHANASIA

Indian Constitution has been made by referring to the various constitution of the other countries. While giving any judgment, the judges of a court take reference from many foreign decisions. There are only a few provisions and Articles in the Constitutions of India that have experienced the same level of judicial activism as Article 21.[17] Since the Maneka Gandhi[18] case, such activism has widened the scope of this Article. Inclusion of ‘right to die’ under this provision is yet another addition to the cap of Article 21.[19]The Supreme Court of India has passed a plethora of judgments before the legalization of Passive Euthanasia in the country. There have been an evolution and differences in the legality of euthanasia from one judgment to others.

Euthanasia is a dilemma due to the presence of more than one course of conduct justified on various grounds.[20]There are myriads of question which existed in India before the judgement of 2018. The Indian Constitution under Article 21[21] empowers citizens to enjoy right to life and personal liberty bringing within ambit the right to privacy, right of self-determination and right of autonomy.[22] The right to die is a negative right of right to life and have a subject of dispute since a long time in Indian judiciary. The legal barrier in recognizing the right to die are Section 306 and 309 of IPC.

The first judgement which dealt with the issue that whether the right to die is included under Article 21 of the constitution was Maruti Shripati Dubalv. State of Maharashtra.[23] The court in the case pronounced that the right to life under Article 21 could also be interpreted as the right not to live a forced life and Section 306[24] and Section 309[25]of Indian Penal Code should be held unconstitutional. Subsequently, the Apex Court in P Rathinam v Union of India[26]held that under Article 21, the right to life does not include the right to die. It coincided with the judgment of the Bombay High Court in the case Maruti Shripati Dubal v. State of Maharashtra and held that Section 306 and 309 are unconstitutional, on the grounds of being violative of Art. 21, which includes the right to die. Thus, Section 309 of IPC was struck down. But the precedent set forth by of P Rathinam did not hold good for a long time. The Supreme Court in 1996 in Gian Kaur v. the State of Punjab,[27] pronounced the judgment that both active and passive euthanasia and assisted suicide is unlawful in India. It was also challenged that as the court in the P Rathinam case has invalidated Section 309 of IPC, therefore the Section 306 which penalizes abetment of suicide should also be held unconstitutional ipso facto. But the court rejected this argument and held that both Section 306 and 309 of IPC are valid and constitutional. Further in the year 2011, the Apex Court in Aruna Shanbaug v. Union of India[28]relying on the above judgment, held that passive euthanasia is legally valid in the country under exceptional circumstances which means the removal of life-supporting medical instruments and causing natural death of a person.

The Law Commission of India, in its 196th report, gave a clear definition and clarified the meaning of the terms related to euthanasia. Further, the report also recommended passive euthanasia in cases where the deceased is both capable and incapable of deciding things and are in critical condition. In a case where a person is not capable of determining or is not conscious, the medical practitioner who is operating him will take opinions of three medical experts and after that will inform the patient and his family members.

COMMON CAUSE V. UNION OF INDIA

Finally, the Supreme Court on 9th March 2018 in the case Common Cause v. Union of India[29]gave a landmark verdict by giving legal recognition to passive euthanasia and permitting the execution of a living will or advanced medical directives. This case is synonymous with different names like 'passive euthanasia case', 'euthanasia case' or 'living will case'. A 'living will' is a document which is executed by a patient who is of sound mind and is capable of knowing the consequences. It must be made willingly by a patient and without any force or coercion.

The Court in this judgment concluded that it is inhumane to force a person to live with such unbearable condition and he should have a right to decide whether medical treatment should be given or not. Finally, there was a legal stand of India on this long battle of euthanasia. It was held that 'right to die' is a part of Article 21,[30] and a person has a right to live with dignity until his death. The Apex Court has introduced guidelines to be followed while performing euthanasia, and there are set of the procedure involved when a patient wants to execute a living will. They gave a vigorous interpretation of the on-going debate of ‘right to life’ including ‘right to die’. The judgement is constitutionally valid and favors the dignified end to human life. In cases of passive euthanasia, death of a person is certainly expected and by keeping such a person alive with the help of life-sustaining devices, it will not prolong his life but will prolong his death. [31]

In this judgment, the verdict of the judges revolved around the basics of morality, ethics, religion and legality. The judgment includes a reference from various other national and international cases. The judgment is a perfect example that nobody has authority over someone. A person is a master of his own rules. It must be on the discretion of the deceased whether he wants medical treatment for prolonging his life span or not. The case of Common Cause v. Union of India includes religious text, reference from schools of jurisprudence, scholarly literature and the same suggests that ending a life of the terminally ill patient is a good deed. Keeping a person on a ventilator and providing him oxygen is just an artificial method of increasing life span which cases both pains, suffering and burden to the family. Now in India, in cases of passive euthanasia consent by a spouse, children and patient is sufficient but it requires approval from High Court if consented by any friend, near relative or doctor.[32]

In a nutshell, the judgment pronounced sets out to be a good legal precedent as it has given relief to an infinite number of people who were struggling with their stagnant health with no hopes for improvement. It is better to give a person a natural death rather than making his life span shorter and painful by delivering high doses of medicine and medical treatment. An adult human being with mental capacity has complete right to take decisions including refusal to medical treatment or complete withdrawal from a life-saving device.[33]

Even though the judgment was praised by the majority of the population but still it faced many criticisms. There was a bombardment of questions challenging the constitutionality of euthanasia. The inclusion of 'Right to die' as a part of Fundamental Right protected under Article 21 was being questioned on the grounds of religion, ethics, morals, societal norms and values. People were considering passive euthanasia as a form of suicide and an act of killing a person. Some people considered it as an inhumane act.

The legalization of Passive euthanasia is one of the landmark decisions taken by the Court as life is not just about surviving but living with excellent and wholesome health. The Court has considered multiple aspects while legalizing euthanasia, ranging from the possibility of abuse of euthanasia to its effect on the fabrics of society. Giving a medical treatment or keeping a patient on the ventilator for years only prolongs pain and sufferings.The right to avoid unbearable pain is seen as a legitimate argument in favor of preserving dignity.[34] So, a patient must have a right to request for extinguishing his life.

PRESENT SCENARIO AND LIABILITY OF DOCTORS

In the last century, with the improvement and progress in science and technology, the surge in the economy of the country and with the change in present lifestyle of people, the concepts of life and death has been completely evolved. Now a person who is in critical condition or is in a permanent vegetative state can be kept alive by keeping on a ventilator for years. At the same time if there are no hopes for a patient's recovery, then the life-supporting system can be stopped. But here the question arises that whether by doing this, can the medical practitioner be held guilty of abetment to suicide or murder? This issue has been a matter of concern in many countries. But the 'withdrawal of life-supporting device' is different from active euthanasia. Many countries have either legalized passive euthanasia, active euthanasia or both. Some have permitted the use of passive euthanasia but only on exceptional cases.

There is a principle at common law called principle of self-determination. This principle states that a patient has a complete right to refuse or accept medical treatment. Lord Goff of Chieveley in Airedale[35]stated that "it is established that the principle of self-determination requires respect must be given to the wishes of the patient, so that if any adult patient of sound mind refuses, however unreasonably, to consent to treatment or care by which his life would or might be prolonged," it shall be obeyed. The medical practitioner must take a decision which is in the best interest of the patient. If a competent patient who wants a life-supporting device to be removed, then the doctor is bind to do so.

On the other hand, if the patient is insane or is not competent, then a doctor can stop the medication if he considers it to be in the best interest for the patient. It is incredibly crucial to know the exact meaning of terms like 'competent', 'incompetent' and 'best interest'. So, the Law Commission of India in its 196th report annexed the drafted Bill named "Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2006"[36] which emphasized on the laws that related to a deceased who wants a natural death, not through the consumption of lethal drugs or from life-supporting devices.

It was a matter of concern that can a patient be held liable under Section 309 of IPC if he is an adult, competent enough and refuses treatment. Section 309 of IPC talks about 'attempt to commit suicide'. The Court held that a competent patient has every right to decide what is good for him and what is wrong. A patient can decide for himself whether he wants medical treatment or allow the disease to continue. Many countries that are governed by common law do not consider this act of patient as any offence. Also, in Airedale[37]the House of Lords held that it is not suicide. Supreme Court had also declared that this is not an offence under Section 309 of IPC.

Similarly, if a doctor obeys the instruction of the patient of not giving him the medicines or medical treatment, then he is not committing any offence. There was another issue that if a doctor obeys his patient and removes the life-supporting devices, then whether he will be guilty of 'abetment of suicide' under Section 306 of IPC. The act of not giving the medicines is based on the patient's direction, and hence, the doctor is not guilty under Section 306 of IPC.

There were disputes related to the doctors being guilty under Section 299 of IPC[38], which talks about 'culpable homicide'. When a doctor is performing any act, which is with the consent of the patient, then he should not be held guilty. Further, the main requirement of Section 299 is the intention to cause death or bodily injury, which is lacking in this case. Hence the doctors are not guilty under Section 299 of IPC.

Technology is progressing at a high rate all over the world. India is also making progress in medical science as in the rest of the world. There are devices and instruments which can artificially prolong the life span of a patient.[39] There is no doubt that medical treatment is way too expensive and is not easily affordable. But in the last decade, India has witnessed a sizeable portion of upliftment in terms of economy. And this is one of the main reasons why people are relying on and using such expensive medical treatment. But not everyone in the country belongs to a wealthy family and so they are not able to afford it. Hence, end-of-life issues are becoming primary ethical considerations in the modern-day medical science in India.[40]

Today in our society, the main concern for clinicians has become the quality of life of people suffering from critical diseases like AIDS and cancer. And on the parallel lines, the issue of euthanasia has also become a matter of concern. Euthanasia is an incredibly disputable issue in a country like India, where even attempting to commit suicide is an offence.

It was a subject of discussion about whether a person has a right to die. Courts have pondered upon this issue in many judgments. In earlier judgment Courts believed that under Article 21, the right to life does not include the right to die with dignity. Because life is a different concept and death is contrary to ethics and values. Life is a gift of God and one should take all possible measures to save it. But in later years, perception of people changed and they started accepting that life is something which includes both enjoying life and living with dignity till death. The Court in further judgments held that Article 21 includes both right to die with dignity and right to life. At this juncture of life, they started believing that the ‘liberty to die’ should not be studied in isolation rather it must be the part of Article 21 of the constitution.

So far as the India position on euthanasia is concerned, the Judiciaryhas taken an applaudable step by legalizing passive euthanasia and making illegal the active euthanasia. After profoundly studying and analyzing various aspects of euthanasia in detail, it can be concluded that passive euthanasia is constitutionally valid. Neither it is going against any fundamental right, nor it can be considered as an offence under the Indian Penal Code. Passive euthanasia is based on the consent and the will of a patient. It is only performed in a case where the person is suffering from an incurable disease, and there are no hopes of improvement. It is a way of causing natural death and reduce pain, suffering and burden on the family. Concludingly it can be said that passive euthanasia is constitutionally valid, and the strict guidelines attached to it is protecting its misuse.

[1] Niraj Kumar & Akhilendra Pratab Singh, Favouring a Dignified End to Human Life: Common Cause v. Union of India, Journal of National Law University Delhi(2018).
[2] Rateesh Sareen, India Decides on Euthanasia: Is the debate over?, Health Care Current Reviews, June 2019.
[3] Dillman RJM&Legemaate J. Euthanasia in the Netherland: The state of the debate, Eur Health Law (1994).
[4] Caesar Roy, Position of Euthanasia in India- An Analytical Study, Research Gate, July 2011.
[5] Josef Kure, Everything Under Control: How and When to Die- A Critical Analysis of the Arguments for Euthanasia, IntechOpen, Sept. 15, 2011.
[6] Margaret A. Somerville, Legalising Euthanasia: Why Now?,theaustralian quarterly, Vol. 68, No. 3, pp. 1-14.
[7] Euthanasia, Black's Law Dictionary (8th ed. 2004).
[8] supra note 3.
[9] Dr. Parikh, Parikh’s Textbook Of Medical Jurisprudences, Forensic Medicine And Toxicology (6th ed. 2006).
[10] Brody And Baruch, Life And Death Decision Making, (Oxford University Press) (1998).
[11] supra note 3.
[12] Aruna Ramchandra Shanbaug v. Union of India, (2011) 4 S.C.C. 454.
[13] Chao DV et al., Euthanasia revisited, Fam Pract.(2002, 4:45).
[14] Religion and Euthanasia, BBC available at: http://www.bbc.co.uk/ethics/euthanasia/religion/religion.shtml
[15] Patricia K. Jennings & Clarence R. Talley, A Good Death?: White Privilege and Public Opinion,JEAN AIT BELKHIR, RACE, GENDER AND CLASS JOURNAL, (2003, 2:45), https://www.jstor.org/stable/41675087.
[16] Stanley Yeo, Dying with Dignity: Case for Legalizing Physician- Assisted Suicide, INDIAN LAW INSTITUTES, (2008, 4:56), https://www.jstor.org/stable/43952159.
[17] India Const. art. 21.
[18] Maneka Gandhi v. Union of India, (1978) 1 S.C.C. 248.
[19] Jamie Cassels, Judicial Activism and Public Interest Litigation in India: Attempting the Impossible?, The American Journal of Comparitive Law (1989).
[20] Rateesh Sareen, India Decides on Euthanasia: Is the debate over?,Health Care Current Reviews, June 2019.
[21] India Const. art. 21.
[22] M.P. Jain, INDIAN CONSTITUTION Law 1180 (6thed. 2010).
[23]1986 SCC Online Bom 278.
[24] Section 306 of IPC, Abetment of Suicide- If any person commits suicide, whoever abets the commission of such suicide, shall be punished with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine.
[25] Section 309 of IPC, Attempt to commit Suicide- Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year or with fine, or with both.
[26] (1994) 3 S.C.C. 394.
[27] (1996) 2 S.C.C. 648.
[28] (2011) 4 S.C.C. 454.
[29](2018) 5 S.C.C. 1
[30]Article 21 “ No person shall be deprived of his life or personal liberty except according to procedure established by law.”
[31]Carson Strong, The Neonatologist’s duty to patients & parents, Hastings Centre Report, 8 10-16(1984)
[32]Rateesh Sareen, India Decides on Euthanasia: Is the Debate Over?, Health Care: Current Reviews, Vol. 7 Iss. 3 (2018).
[33]supra note 1.
[34]Geetha Mani et al., Euthanasia: Right to Die with Dignity, Journal of Family Medicine and Primary Care (2014).
[35]1993 (1) All. E.R. 821 (HL).
[37]Available at: http://lawcommissionofindia.nic.in/reports/rep196.pdf (accessed on May 17, 2020)
[38]Section 299 of IPC, Culpable Homicide- Whoever causes death by doing an act with the intention of causing death, or with the intention of causing such bodily injury as is likely to cause death, or with the knowledge that he is likely by such act to cause death, commits the offence of culpable homicide.
[39]George Zdenkowski, Human Rights and Euthanasia, Occasional Paper of the Human Rights and Equal Opportunity Commission (1996).
[40] Vinod K Sinha, Euthanasia: An Indian perspective, indian journal of psychiatry, 27th Feb, 2014.

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Passive Euthanasia Now a Legal Reality in India

Recognising “living wills” made by terminally-ill patients, the Supreme Court has held that the right to die with dignity is a fundamental right.

A view of Supreme Court of India in New Delhi. Credit: PTI/Atul Yadav

New Delhi: Declaring the right to die with dignity as a fundamental right, the Supreme Court in a landmark judgment on Friday, passed an order allowing passive euthanasia in the country.

According to an Indian Express report , a five-judge bench of the apex court headed by the Chief Justice of India Dipak Misra and comprising Justices A.K. Sikri, A.M. Khanwilkar, D.Y. Chandrachud and Ashok Bhushan, issued guidelines in recognition of “living will” made by terminally-ill patients.

These guidelines include who can execute the will and under what conditions can the medical board endorse passive euthanasia. The apex court further stated that its guidelines and directives shall remain in force till a legislation is brought to deal with the issue, Firstpost reported .

The court was issuing its verdict on a PIL filed by NGO Common Cause in 2005. According to LiveLaw , noted lawyer Prashant Bhushan had argued in the case that when a medical expert suggests that a patient suffering from a terminal disease has reached a point of no return, she should have the right to refuse artificial life support – medically referred to as passive euthanasia – to avoid prolonged agony.

Justice Chandrachud today held:

“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.”

The bench had earlier reserved its judgment on October 11, 2017 while observing that the right to die in peace could not be separated from Right to Life under Article 21 of the constitution.

A five-judge bench, headed by Justice J. S. Verma, in Gian Kaur vs State of Punjab in 1994 had held that both assisted suicide and euthanasia were unlawful. The bench stated that the right to life did not include the right to die, hence overruling the two-judge bench decision in P. Rathinam vs Union of India which struck down section 309 of Indian Penal Code (attempt to suicide) as unconstitutional.

In the Gian Kaur case, the apex court held that Article 21 speaks of life with dignity, and only aspects of life which make it more dignified could be read into this Article, thereby pointing out that the right to die was inconsistent with it.

However, later in Aruna Ramchandra Shanbaug vs Union Of India, the Supreme Court in March 2011 held that passive euthanasia could be given a nod in case of exceptional circumstances and under strict monitoring of the apex court.

Aruna Shanbaug had been in a vegetative state for since 1973, and on her behalf, Pinki Virani, a social activist, journalist and writer, had filed a writ petition claiming that her right to life guaranteed by the constitution had been violated.

Aruna Shanbaug, who spent 42 years in a vegetative state after a brutal sexual assault.

The SC opined that such a decision regarding the death of an individual could not be solely left to the discretion of the patient’s relatives or the ‘next friend’ – like the nursing staff in the case of the Shanbaug case. The Centre at the time opposed recognition of ‘living will’ and said consent for removal of artificial support system given by a patient may not be an informed choice. The decision could stem from a lack of awareness medical advancements.

How active euthanasia differers from passive euthanasia is that in the former, death is brought about by an act – for example, a person is killed by being given an overdose of pain killers. In passive euthanasia, death is brought by omission. In other words, by not carrying out any medical intervention to save the person’s life.

Euthanasia is regarded as the only viable option when all life care interventions fall short of ensuring a better life for terminally ill patient or one who is in a vegetative state.

A living will is a written document allowing a patient to give instructions in advance about the medical treatment to be administered when he/she is terminally ill or no longer able to express informed consent, including withdrawing life support if a medical board declares that all life saving medical options have been exhausted .

The Centre had opposed the concept of a living will, stating that there was risk of misusing such a provision. And that it may not be viable as a part of public policy.

Global euthanasia and assisted suicide laws

Netherlands was the first country to legalise euthanasia and assisted suicide in April 2002. According to a Guardian report , the country had issued strict guidelines and conditions, including that “the patient must be suffering unbearable pain, their illness must be incurable and the demand must be made in “full consciousness” by the patient.”

Belgium soon followed with a law legalising euthanasia in the same year. While assisted suicide is not mentioned in the law, “doctors can help patients to end their lives when they freely express a wish to die because they are suffering intractable and unbearable pain,” the Guardian reported.

While euthanasia remains illegal in the US, in five states in the country, doctors are allowed to prescribe lethal doses of medicine to terminally ill. In 2013, roughly 300 terminally ill Americans were prescribed lethal medications, and around 230 people died as a result of taking them.

(With PTI inputs)

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Why Euthanasia should be Legalised

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Physician-assisted Suicide Debate

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Euthanasia defined as an intentionally ending of the life of the terminally ill person in order to relieve pain or suffering, done by a physician, legally. This is not to be confused with the similar physician assisted suicide, the suicide of patient suffering from an incurable disease, effected by the taking of lethal drug by a doctor for this purpose. It is legal in only a few places of the world, and the laws vary by the places. That means […]

Essays on Euthanasia

Euthanasia is a subject of debate in many countries including the United States. Without any doubt, there are many pros and cons of so-called mercy killing. Some people claim pain suffering as the worst experience that people could experience. But, you can also find argumentative essays about euthanasia for students that do not support ... approach. If you plan to write an essay about this topic, it is essential to outline all the facts and details. For instance, there has to be a “for and against” section, an interactive introduction, and a strong conclusion based on facts. Samples of research papers of this type usually analyze the cause and effect of this issue before making conclusions. These essay topics are tough to talk about, so we suggest you analyze essay examples on euthanasia before starting your work.

Pro Euthanasia Argument

“If I had terminal cancer, I had a few weeks to live, I was in a tremendous amount of pain — if they just effectively wanted to turn off the switch and legalize that by legalizing euthanasia, I’d want that,” -John Key. Euthanasia is the intentional termination of a life (Frederic). It is used to end a patient from suffering a painful, and incurable disease. Legalizing euthanasia should be allowed to help people who want to make their death more […]

Proposals for Reform of the Law Regarding Euthanasia and Assisted Suicide

Introduction: As part of my Law Reform Project module, we have been asked to select a topic of our choice to examine and make proposals on for reform. The topic I have chosen to discuss is Euthanasia and Assisted Suicide in Ireland. This topic has been in the spot light recently as Dublin woman Gail O’Rorke has been in court charged with attempting to assist the suicide of her friend Bernadette Forde by making travel arrangements to Zurich for her […]

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Physician-Assisted Suicide: the Law and Professional Ethics

The discussion to make physician-assisted suicide legal has created mixed reactions among the US citizens. Despite its ethical prohibitions, some people continue to express their interest in the act. People have increasingly shown their concerns and fears regarding how their lives will end. Some people have voiced out their opinions on euthanasia, and surprisingly, a section of them continue to advocate for the legalization of the process. Others have expressed their disgrace in the debate surrounding legalization of the process […]

Physician Assisted Suicide should be Legal in the United States

The United States, a place where freedom runs through the blood of its citizens and where we all have the ability to make choices without interference. We fight to protect these liberties and right to personal freedom given to us by the constitution. The United States government allows it citizens to make choices everyday about one’s own life in hopes we all make good utilitarian like decisions. Citizens make choices every day such as where we want to live, what […]

The Case for and against Assisted Dying

In homes across the world, millions of victims are suffering from fatal and terminal illnesses.With death knocking on their door, should these people have to endure pain and misery knowing what is to come? The answers to these questions are very controversial. Furthermore, there is a greater question to be answered”should these people have the right and option to end the relentless pain and agony through physician assisted death? Physician-Assisted Suicide PAS is highly contentious because it induces conflict of […]

Against Euthanasia

Euthanasia is the act of causing or permitting the death of someone who may be suffering from a terminal illness that cannot be cured , often as a way to end the pain of that individual. Some people prefer the meaning of Euthanasia means the good and gentle way of death. Euthanasia should not be allowed because people need more help, it’s murder, and it is against the bible. Instead of giving up the doctors should help them. When a […]

The Euthanasia Debate

Euthanasia, or mercy killing, has been a human issue for millennia. It was common for the ancient Greeks and has continued to the present. The debate surrounding it has changed over the course of civilization; both religion and the natural changes of human culture, but still exists. The major difference between 300 BC and the present are the ways our treatments have evolved to encompass cures for illnesses that were formerly death sentences. The difference between justified and unjustified killing […]

What Opinions do People have on Euthanasia

Introduction This research report will investigate the topic euthanasia. Euthanasia is an act or practice were a doctor, that is allowed by law, kills a terminally ill person in a painless way so that the sick person gets peace. Euthanasia is only done by the terminally ill persons request. I choose euthanasia because I find this topic very interesting because there is so many pros and cons about it and it’s a topic that you can find out alot about […]

The Ethics of Physician-Assisted Suicide

Abstract Physician-assisted suicide is a highly controversial topic around the world and is only legal in seven countries as a whole and seven states in the US along with the District of Columbia. The controversy stems from the debate on whether the patient has a right to end their own life. Historically, suicide was seen as a sin since only God had the right to determine when a person was to die, and since many western countries practiced Christianity which […]

History of Medical Ethics

To have a complete understanding of a present situation one must have a complete understanding of the past. Human innovation has made more leaps in the past hundred years than ever before in human history, but many of the ideas and values western society runs on have fundamental roots in much earlier societies. The roots that extended into the modernity of medical ethics laws were articulated in Ancient Greece in the form of the Hippocratic Oath. Unfortunately, it was not […]

Ethics and the Legalization of Physician-Assisted Suicide

The debate over physician assisted suicide often leaves many on the fence, with names like death with dignity and describing it as a personal, selfless act, it leaves the wrong idea. These terms are very misleading when itr’s taken into account who is affected by the actions of one person. Physician assisted suicide is more specifically when a physician gives the proper information and/or means for a patient to conduct suicide. Life is the very basic right to have and […]

The Argument for the Legalization of Euthanasia

Regard to the way that Cruzan’s folks were as it were thinking about her best advantages. Marking these occasions as “”murder””, legitimately or verbally, clashes with our natural sensitivity towards the family’s battle since the word conveys a strongly negative undertone that should reference just genuine reprobates. Popular assessment concurs with this; seventy-two percent of respondents to a 2003 Gallup survey trust that “”when a man has an infection that can’t be relieved… specialists ought to be permitted to end […]

“Mice and Mercy Killing” Analysis

In the 1930s, the one thing most Americans strived to achieve was the American Dream. This included owning your own land and being independent but in order to do it, Americans needed to work. In the book, Of Mice and men, the two main characters try to achieve the American dream and look for work. The main characters Lennie and George find work on a farm. The two-characters make an interesting duo because Lennie is mentally challenged and big while […]

Passive Euthanasia Essay

Pope John Paul II once said, “ A man, even if seriously sick or prevented in the exercise of its higher functions, is and will be always a man … [he] will never become a ‘vegetable’ or an ‘animal’. The intrinsic value and personal dignity of every human being does not change depending on their circumstances.” This quote signifies that no matter what one is going through, they will always have the same value and should have the same reason […]

Legalizing Assisted Suicide

If someone wanted to end their life should they be allowed to do so with the aid of a doctor? Would those with depression be allowed to end their life? If a person is in so much pain that nothing will relieve it, should they be given the means to end it? In Oregon, which had the Death with Dignity Act since 1997, people with terminal illnesses can get lethal prescriptions from their doctors to take their own lives. In […]

Role for Physician-assisted Suicide in Cancer

A woman suffering from terminal cancer became the first person to die under the law of physician-assisted suicide in Oregon in 1998. The New England Journal of Medicine states that more than 4,000 doctors have approved of the physician assisted suicide law (The Anguish n.pag.). In just the United States, forty-two percent of people have had a friend or relative suffer from a terminal illness (The right n.pag.). Although cancer is the leading cause of death in terminally ill patients, […]

Assisted Suicide by Physician for the Terminally Ill Moral or not

The notion of the right to assisted suicide is oftentimes a controversial topic surrounding the medical industry in the United States. One side of the spectrum will argue that assisted suicide is unjustifiable because by definition, death in itself is an inevitability, not a right. On the contrary, the other side of the spectrum claims that assisted suicide by aid of physician is an ethical right to a patients free exercise of autonomy. Therer’s a multitude of factors that play […]

We have a Right to Die with Dignity

A very controversial topic discussed in recent years is physician assisted suicide. The discussion is if it the patient actually has the right to die with the assistance of a physician. Many of the people who oppose physician assisted suicide have arguments based off of religious, moral, and ethical standards. Those who support physician assisted suicide have beliefs that it ends suffering of those who are already dying and they respect one’s choice of death. Even physicians are split on […]

Euthanasia and Death Penalty

he difference between killing and letting die is killing would be ideal in the medical field such as giving a person a medication to rush or conclude their existence gently to put them out of suffering or torment. Letting die would be letting a god take direction and just give them a drug to have a person content until they take their last breath and die. Reasons why killing is morally defective than letting someone pass away would be society […]

Debate Problem of Assisted Suicide

Arguably nothing in life is more intimate and private than the manner in which one dies. Despite this the idea of a consenting adult willingly taking one’s own life when few other options remain stirs up significant controversy in our society. In this paper I will discuss physician assisted suicide, its history, its current legal standing in the United States, and how it exemplifies societal discipline by enforcing moral standards regarding suicide and death, even in cases where it goes […]

Euthanasia should be Illegal in Health Care

Euthanasia is a highly controversial topic that elicits two sides of the debate- in favor of intentional termination of life versus counteract death by euthanasia. The importance of having this discussion is to display the ramifications death by euthanasia presents. Various regions of the world changed society’s view on human life. On the surface, euthanasia appears to be an easy one step task that includes a lethal dosage of medication administered by a physician to patients living with terminal illnesses […]

Should Euthanasia be Legal

Bob Dent, who lives in Darwin, Australia, was the first person to ever participate in euthanasia. He was able to do this because of the Terminally Ill Act, which had become law in the northern territory of Australia on July 1st, 1996 (Fraser and Walter). Bob’s case is important because of he was the first to go through with it and his attitude towards it. He had more than a few words to say regarding the topic. He pleaded that […]

Physician Asisted Suicide

Chapter 1: Biology Part 1: Introduction to Biology Biology is the study of living things and their natural processes. (Kara Rogers Edna R. Green Susan Heyner Joshi) Biology is divided into multiple different branches but all are interrelated through their basic principles. (Kara Rogers Edna R. Green Susan Heyner Joshi) These include branches like botany, zoology, morphology, physiology, and cell biology. (Kara Rogers Edna R. Green Susan Heyner Joshi) Botany is the study of plants while zoology is a different […]

Detaching Criminality from Assisted Suicide

Criminality is defined as a behavior and/or action that is contrary to or forbidden by criminal law, according to Merriam-Websterr’s Dictionary. Wherein murder is defined as a criminal act due to the intention of killing an individual out of hatred or insanity, assisted suicide performed by a physician is legal in several states and is being contemplated in others. Many have been arguing for years whether-or-not physician-assisted suicide should be legal, however most do not separate the ethical point of […]

Is Assisted Suicide Morally Acceptable?

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What Assisted Suicide Is?

In Dictionary.com, retrieved November 20th, 2018, The definition of Assisted Suicide is suicide facilitated by another person, especially a physician, who organizes the logistics of the suicide, as by providing the necessary quantities of a poison. Assisted Suicide is for someone who has a terminal illness with six months or less to live. They have less aggressive ways to say assisted suicide like physician assisted death, aid in dying, euthanasia (good death), death with dignity, DNR (do not resuscitate), and […]

The Choice of Assisted Suicide

There are very few things that we as humans have complete control over. Our bodies should be one of them. Why should a terminally ill patient and their family suffer for a longer period of time when they already made the mental decision that they are over it? There probably isnt one person that can say that they havent watched somebody they love suffer from and ultimately die from some sort of unfortunate disease. Assisted suicide is a choice that […]

The Complications of Physician-Assisted Suicide

There is a heavy debate on the legality, morality, and ethics surrounding physician-assisted suicide because itr’s difficult to determine what qualifies a person for assisted suicide because there has not been enough thorough research. There are many aspects, both beneficial and detrimental, that have not been adequately explored. This should be a cause for concern for both doctors and patients. The controversy surrounding physician-assisted suicide and voluntary euthanasia is rooted in the lack of knowledge about the regulations, demand, qualifications, […]

Assisted Suicide: a Right or a Wrong?

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Physician-Assisted Death

Life itself is something that is a journey and therefore that journey leads you to something that is guaranteed which is death. In actuality we are only living to die, so why not make the most of the time that we are here, why because this is a statement that corresponds to us as human beings, we are only living to die. However, the question remains how do you want to live, what are you remembered for, what did your […]

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Indian J Psychiatry
v.54(2); Apr-Jun 2012

Euthanasia: An Indian perspective

Vinod k. sinha.

Department of Child and Adolescent Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India

1 Consultant Psychiatrist, Victoria, Australia

2 Department of Psychiatry, Kolkata, West Bengal, India

In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or “mercy –killing” of terminally ill patients. Proponents of physician-assisted suicide (PAS) feel that an individual's right to autonomy automatically entitles him to choose a painless death. The opponents feel that a physician's role in the death of an individual violates the central tenet of the medical profession. Moreover, undiagnosed depression and possibility of social ‘coercion’ in people asking for euthanasia put a further question mark on the ethical principles underlying such an act. These concerns have led to strict guidelines for implementing PAS. Assessment of the mental state of the person consenting to PAS becomes mandatory and here, the role of the psychiatrist becomes pivotal. Although considered illegal in our country, PAS has several advocates in the form of voluntary organizations like “death with dignity” foundation. This has got a fillip in the recent Honourable Supreme Court Judgment in the Aruna Shaunbag case. What remains to be seen is how long it takes before this sensitive issue rattles the Indian legislature.

INTRODUCTION

The phenomenal advances in medical science and technology have not been without a significant impact on society. They have brought into forefront issues that are altering the pattern of human living and societal values. Pari passu with these changes is the upsurge of affirmation of human rights, autonomy, and freedom of choice. These issues compel us to re-evaluate our concepts of societal and medical ethics and value systems.

Amongst these issues, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and acquired immune deficiency syndrome (AIDS) have become an important area of clinical care and investigation. Significant progress has been made in extending a palliative care/quality of life research agenda to the clinical problems of patients with cancer, including efforts that focus on mental health related issues such as neuropsychiatric syndromes and psychological symptoms in patients with terminal medical illness. However, perhaps the most compelling and clinically relevant mental health issues in palliative care today concern the desire for death and physician-assisted suicide (PAS) and their relationship to depression.

Desire for death has been postulated as a construct that is central to a number of related issues or phenomena, including suicide and suicidal ideation, interest in PAS/euthanasia, and request for PAS/euthanasia. This construct, which was initially proposed by Brown and colleagues[ 1 ] and further developed by Chochinov et al .[ 2 ] focuses on the degree to which an individual wishes his or her life could end sooner. It ranges from suicidal intent (i.e., a desire to end one's life immediately) to a complete absence of any desire to die.

Advocates demanding autonomy for patients regarding how and when they die have been increasingly vocal during recent years, sparked by the highly publicized cases of Drs Jack Kevorkian, Timothy Quill, and Aruna Shanbaug . These cases have centered on the plight of dying patients with terminal illnesses.

What has often been overlooked, however, in the political and legal machinations, is the importance of medical, social, and psychological factors (e.g., depression) that may contribute to suicidal ideation, desire for hastened death, or requests for PAS by terminally ill patients.

DEFINITION OF EUTHANASIA AND PAS

The English philosopher Sir Francis Bacon coined the phrase “euthanasia” early in the 17 th century. Euthanasia is derived from the Greek word eu, meaning “good” and thanatos meaning “death,” and early on signified a “good” or “easy” death.[ 3 ] Euthanasia is defined as the administration of a lethal agent by another person to a patient for the purpose of relieving the patient's intolerable and incurable suffering.[ 4 ] Typically, the physician's motive is merciful and intended to end suffering. Euthanasia is performed by physicians and has been further defined as “active” or “passive.” Active euthanasia refers to a physician deliberately acting in a way to end a patient's life. Passive euthanasia pertains to withholding or withdrawing treatment necessary to maintain life. There are three types of active euthanasia. Voluntary euthanasia is one form of active euthanasia which is performed at the request of the patient. Involuntary euthanasia, also known as “mercy killing,” involves taking the life of a patient who has not requested for it, with the intent of relieving his pain and suffering. In nonvoluntary euthanasia, the process is carried out even though the patient is not in a position to give consent.[ 5 ]

PAS, on the other hand, involves a physician providing medications or advice to enable the patient to end his or her own life. While theoretical and/or ethical distinctions between euthanasia and PAS may be subtle to some, the practical distinctions may be significant. Many terminally ill patients have access to potentially lethal medications, at times even upon request from their physicians, yet do not use these medications to end their own lives.

Both euthanasia and PAS have been distinguished, legally and ethically, from the administration of high-dose pain medication meant to relieve a patient's pain that may hasten death (often referred to as the rule of double effect) or even the withdrawal of life support.[ 6 , 7 ] The distinction between euthanasia/PAS and the administration of high-dose pain medications that may hasten death is premised on the intent behind the act. In euthanasia/PAS, the intent is to end the patient's life, while in the administration of pain medications that may also hasten death; the intent is to relieve suffering.

Distinctions between withdrawal of life support and euthanasia/PAS are, in many ways, considerably clearer. Long-standing civil case law has supported the rights of patients to refuse any unwanted treatment, even though such treatment refusals may cause death.[ 8 ] On the other hand, patients have not had the converse right to demand treatments or interventions that they desire. This distinction has had the effect of allowing a patient on life support the ability to end his or her life on request, yet a patient who is not dependent on life support does not have such a right.

LEGALIZATION OF PAS AND EUTHANASIA

Arguments supporting legalization of pas/euthanasia.

The arguments supporting legalization of euthanasia/PAS are substantial. Proponents perceive PAS as an act of humanity toward the terminally ill patient. They believe the patient and family should not be forced to suffer through a long and painful death, even if the only way to alleviate the suffering is through suicide. According to the proponents of PAS, it becomes ethical and justified when the quality of life of the terminally ill patient becomes so low that death remains the only justifiable means to relieve suffering. Lack of any justifiable means of recovery and the dying patient himself making the choice to end his life are conditions which make euthanasia more justifiable.[ 9 ] To the advocate for PAS, legalization of PAS is a natural extension of patient's autonomy and the right to determine what treatments are accepted or refused. Arguments in favor of legalization of PAS are typically premised on the assumption that requests for PAS are “rational” decision, given the circumstances of terminal illness, pain, increased disability, and fears of becoming (or continuing to be) a burden to family and friends. Given the possibility that these symptoms and circumstances may not be relieved, even with aggressive palliative care and social services, the decision to hasten one's death may seem rational.[ 10 ] Proponents of euthanasia also criticize the “artificial and impractical” demarcation drawn by the court and the religious organizations between active and passive euthanasia. Withdrawal of life support, the classical form of “passive” euthanasia, actually involves taking an “active” step to hasten the death of a terminally ill patient and it is the patient's consent which lends legitimacy to the act. If, following consent of a similar nature, a physician administers a lethal dose of injection, there is no reason why this act should be considered as illegal or immoral.[ 11 ] Moreover, the desire to include one's physician in carrying out a decision to end one's life can be viewed as an extension of the natural reliance of terminally ill patients on their physicians for help with most aspects of their illness, as well as reasonable mechanism to ensure that they do not become more disabled and burdensome to their family or friends by attempting suicide unsuccessfully (causing a persistent vegetative state or increased disability).

Another argument raised by proponents of legalization is that merely knowing that one can control the timing and manner of death serves as a form of “psychologic insurance” for dying patients. In other words, knowing there can be an escape from the suffering of illness may alleviate some of the stress associated with the dying processes. It may be (as argued by some proponents of PAS) that many individuals with a terminal illness desire the option to end their lives if certain possible conditions arise, even though the likelihood that they will utilize this option is small.[ 9 ]

Arguments opposing legalization of PAS/euthanasia

Opposition to legalization of PAS and/or euthanasia has come from numerous different perspectives. As frequently noted in the editorial pages of various medical journals, the medical profession is guided by a desire to heal and extend life. This guideline is best exemplified in the Hippocratic Oath which states, “I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice that may cause his death.” Thus, the possibility that a physician may directly hasten the death of a patient – one whom the physician has been presumably treating in an effort to extend and improve life – contradicts the central tenet of the medical profession.

From a mental health perspective, professional psychiatric and psychological training reinforces the view that suicide should be prevented at all costs. Several studies have supported this connection between mental disorder (e.g., depression) and interest in PAS, suggesting that suicidal ideation in terminally ill patients is a manifestation of undiagnosed, untreated mental illness.[ 3 , 4 , 12 ] Consequently, physician compliance with a suffering patient's stated wish for PAS may circumvent the provision of appropriate psychiatric care. Similar arguments have been made regarding pain and physical symptoms, suggesting that requests for PAS may be evidence of inadequate palliative care.[ 13 ] In spite of the fact that improperly managed physical and/or psychiatric symptoms may underlie a patient's wish for hastened death, physicians may unknowingly participate in PAS designed to alleviate precisely these symptoms that possibly could be managed with better palliative care, as opposed to providing proper medical management, if PAS is legalized.

Opponents of PAS additionally posit that individuals of lower socioeconomic classes or other disenfranchised groups will be “coerced,” either directly or indirectly, into requesting PAS as a means of resolving the difficulties posed by their illness. Family members may subtly suggest that death, since inevitable, would be preferable if it occurred sooner rather than later because of the social and financial burdens involved in caring for terminally ill family members. Physicians may view PAS, perhaps because of their own unrecognized feelings (countertransference), as the appropriate and preferable response to a terminal illness and resulting disability. Thus, physicians may be particularly poor at recognizing “irrational” requests for PAS because of their belief that they would not want to live in a condition similar to that of their patients. An even more frightening possibility is that physicians or other health care providers might recommend PAS as an option because the alternative – providing adequate palliative care – is too expensive or difficult to obtain. Thus, patients with poor health insurance or limited financial resources may be “coerced” into requesting PAS by poorly managed or untreated physical and psychological symptoms, perceiving their only options to be either continued suffering or death. Several studies have demonstrated inadequate recognition and treatment of both psychological and physical symptoms,[ 14 ] with symptoms such as depression and anxiety going largely unrecognized in many medically ill patients.[ 15 ] According to a recent review of palliative care in Canada, only 5% of dying patients in Canada receive adequate palliative care.[ 16 ] These and related studies are often cited by opponents of legalization for PAS/euthanasia as evidence that legalization is premature until all dying patients and their families have access to skilled and effective palliative care service.

In response to these concerns, legislators proposing guidelines for PAS have incorporated several mechanisms to minimize the risk that PAS, if legalized, will be misused. These guidelines include (1) a voluntarily request for assistance in dying on the part of the patient, (2) evidence of a terminal illness, and (3) documentation by the primary physician of the reason for the request and efforts made to optimize the patient's care. Opponents, however, suggest that these limitations are more arbitrary than scientific, and they argue that the legal and medical communities will eventually end up on a “slippery slope,” where euthanasia is ultimately legalized as an acceptable practice for a wider patient population, including non-terminal, nonvoluntary patients.[ 17 ] Opponents point to a similar evolution of euthanasia use in The Netherlands where regulations regarding PAS have gradually weakened over the 13 years since this practice was decriminalized. For example, in 1994, the Dutch Supreme Court accepted the argument that a chronic disease is an acceptable basis for euthanasia, even if not terminal, and more recent cases have extended this “right” even to patients without a physical illness.

ATTITUDES TOWARD HASTENED DEATH AND PAS: IMPORTANCE OF PSYCHIATRIC ISSUES

Public interest has been spurred by media attention devoted to Drs. Kevorkian, Quill, Aruna Shanbaug, and others, as well as legal decision, state referenda, and the growing availability of life-extending medical treatments. As a result, both the public and the medical community have openly debated ethical issues relating to end-of-life options. While the US Supreme Court upheld the rights of individual states to prohibit PAS, its decision simultaneously opened the door for professionals to “experiment” with legalization of PAS,[ 9 , 10 ] as has recently occurred in the state of Oregon.[ 18 ] In part spurred by this increased attention, a number of researchers have surveyed attitudes toward euthanasia and PAS among the lay public, medical professionals, and medically ill patients.[ 19 – 31 ] These surveys have demonstrated high rates of public support for legalization of PAS, as well as relatively significant rates of endorsement and even performance of PAS among medical professionals. The proposed guidelines offered to date have all suggested that psychiatric evaluation must comprise critical components of any assessment of a patient's request for PAS.[ 32 – 34 ] Clearly, if PAS is legalized, mental health professionals must play an important role in the evaluation of patients at the end of life who request PAS.[ 16 , 35 – 38 ] Despite the apparent importance of a mental professional's evaluation in assessing requests for PAS, little research has been conducted that has focused on the basis for patients′ interest in hastened death. In their study of physician response to request for PAS/euthanasia, Meier et al .[ 28 ] found that physicians sought mental health consultation for only 2% of their patients who requested PAS or euthanasia. Furthermore, a study by Ganzini et al .[ 25 ] indicated that only 6% of Oregon psychiatrists felt “confident” in their ability to assess whether a psychiatric disorder was impairing the judgment of a patient requesting PAS, despite overwhelming support from psychiatrists for legalization.

EUTHANASIA AND PAS IN CLINICAL PRACTICE

A number of surveys have been published documenting the practice of euthanasia and PAS among health care professionals. For example, an anonymous survey of Washington physicians conducted in 1995 found that 26% of responding physicians had received at least one request for PAS and two-thirds of those physicians had granted such requests.[ 20 ] These statistics suggest that PAS is not a rare event, despite the illegal status (it is also possible that despite the anonymous nature of the survey, some physicians who had in fact carried out these requests were unwilling to acknowledge their actions for fear of repercussions). Even more striking results were reported in a survey of San Francisco area physicians looking after AIDS patients. Slome et al .[ 39 ] found that 98% of respondents had received requests for PAS and that more than half of all responding physicians reported having granted requests for PAS, with some physicians fulfilling dozens of such requests. Moreover, in response to a hypothetical vignette, nearly half of the sample (48%) indicated that they would be likely to grant a hypothetical patient's initial request for PAS.

Perhaps the most striking research to date regarding the use of PAS and euthanasia was a study of critical care nurses conducted by Asch.[ 19 ] This study, based on the results of an anonymous survey, found that 17% of respondents reported having received at least one request for PAS and 11% had granted such a request. Approximately 5% responding nurses acknowledged having hastened a patient's death at the request of the physician, but without the request of the patient or the family (termed “nonvoluntary euthanasia” by some writers). Moreover, 4.7% of the sample indicated that they had hastened a patient's death without the knowledge of or request by the physician. Respondents described having stopped oxygen therapy or increased pain medication in order to hasten death.[ 19 ] Asch suggested that based on the reports of respondent nurses, these actions were done in order to ease the suffering of the patients. The traditional role of nursing in palliative care was cited as the basis for these results. It should also be noted that Asch's controversial study generated considerable response, including many suggestions that methodological issues such as vague wording of questions may make these data unreliable.[ 40 ] Nevertheless, while these data may not accurately indicate the true prevalence of PAS or euthanasia, requests for assistance in dying are clearly not rare events and physicians occasionally grant such requests despite legal prohibitions. Furthermore, because legal restrictions limit the ability of physicians to consult with colleagues regarding how to react to a request for PAS, the appropriateness of patient requests and physician responses is unknown.

In The Netherlands, however, where PAS and euthanasia have been practiced regularly for more than 20 years, data are available regarding the frequency of requests for assistance in dying and the proportion of terminally ill patients whose lives end in this manner. Euthanasia was granted its current status in 1984 after a Dutch Supreme Court decision authorized this practice, provided a number of conditions were met. Specifically, the patient's request for PAS must be considered free, conscious, explicit, and persistent. Both the physician and patient must agree that the patient's suffering is intolerable, and other measures for relief must have been exhausted. A second physician must be consulted and must concur with the decision to assist in ending the patient's life. Finally, all of these conditions must be adequately documented and reported to the governmental body supervising the practice of euthanasia. Because of the availability of such records, several studies have documented the proportion of deaths in The Netherlands in which euthanasia and PAS are implicated (these estimates were adjusted to account for underreporting of euthanasia acknowledged by many Dutch physicians). While reporting on euthanasia and PAS practices in The Netherlands from 1990 to 1995, van der Maas et al .[ 41 ] incorporated both official reports of euthanasia as well as responses to anonymous surveys to estimate the rates of euthanasia and PAS. They concluded that euthanasia and PAS were involved in roughly 4.7% of all deaths in The Netherlands during 1995, a substantial increase over the 2.7% of deaths involving medical assistance reported in a 1991 study.[ 31 ]

Supporters of PAS point to data from The Netherlands as evidence that legalization has not led to widespread abuse or overuse of euthanasia or PAS. However, critics suggest that the 75% increase in deaths involving euthanasia or PAS (from 2.7 to 4.7%) demonstrates a growing tendency toward their more frequent use and thus a greater number of potentially inappropriate cases of euthanasia. Such concerns are clearly reflected in a 1994 Dutch Supreme Court decision in which the right to euthanasia/PAS was extended to include patients′ suffering from chronic illnesses that are not terminal, including mental disorders such as depression, provided the illness is refractory to treatment and causes intolerable suffering. Although the vast majority of requests for PAS from mentally ill individuals have been denied, isolated cases have occurred in which mentally ill Dutch adults have been allowed to receive PAS or euthanasia as a result of this court ruling. This experience has been identified as evidence of the “slippery slope” argument,[ 17 ] in which legalization of PAS is presumed to lead to a gradual widening of the group of patients eligible for this “intervention,” many of whom may not be appropriate candidates (e.g., physically healthy but clinically depressed individuals).

REASONS FOR SEEKING HASTENED DEATH/PAS

A growing body of literature has emerged indicating the types of physical and psychological concerns that may give rise to a desire for hastened death and requests for PAS. Although this literature has not always been consistent, a growing consensus has supported many of the assumptions put forth by the initial advocates and opponents of legalization. Specifically, the issues that have received the broadest empirical support are pain, depression, social support, and cognitive dysfunction.

SUICIDE AMONG THE MEDICALLY ILL

Not all patients who seek a hastened death request assistance from their physicians. Rates of suicide among medically ill populations have been a topic of clinical concern and empirical research for many years prior to the emergence of the PAS debate. This research has generally concluded that depression and suicide among patients with medical illnesses are not particularly common but rather occur more often than in physically healthy populations.[ 12 , 42 , 43 ] These suicide vulnerability factors in cancer and AIDS patients include poor prognosis and advanced disease, depression, hopelessness, loss of control, a sense of helplessness, delirium, fatigue and exhaustion of resources, pre-existing psychopathology, and previous suicide attempts. The role of psychiatric and psychosocial assessment and intervention has been well accepted as a critically important aspect of the care of patients with advanced cancer or AIDS.[ 12 , 42 , 43 ]

HINDUISM – SUICIDE, EUTHANASIA, AND PAS

It has been pointed out that in Hinduism, the word for suicide, atma-gatha, has also the elements of intentionality.[ 44 ]

The intention to voluntarily kill oneself for selfish motives was condemned in Hinduism.[ 45 ] Subjectively, the evil sprang from a product of ignorance and passion; objectively, the evil encompassed the karmic consequences which impeded the progress of liberation. It was in this context that the Dharmasutras vehemently prohibited suicide.[ 45 ]

Nevertheless, Hinduism venerated enlightened people who voluntarily decided their mode of death. Thus, the Pandavas eulogized “Mahaparasthana” or the great journey through their Himalayan sojourn when they walked in pilgrimage, thriving on air and water till they left their bodies one after another.[ 44 ] Crawford[ 45 ] lists fasting, self-immolation, and drowning at holy places as other examples of such venerated deaths. Such deaths by enlightened persons have never been equated with the popular notion of suicide in the Indian tradition. It has been always considered that suicide increases the difficulties in subsequent lives.

Can the Hindu stance as mentioned above be extended to the question of euthanasia? Here, the Indian attitude toward life and death needs special mention.

In the Hindu tradition, death acts as a prefiguration and model, through which the ties that bind man's self or soul to cosmic impermanence can be completely broken and through which ultimate goals of immortality and freedom can be finally and definitely attained.[ 44 ] Crawford[ 45 ] considers “spiritual death” in the Indian context to be synonymous with a “good death,” i.e., the individual must be in a state of calm and equipoise. Crawford[ 45 ] surmises that to ensure such a noble death, the concept of active euthanasia would not be unacceptable to the Indian psyche. However, this view has been criticized by authors[ 46 ] who claim that “spiritual death” or “iccha mrtu” can only be possible when the evolved soul chooses to abandon the body at will. It is also claimed that the evolving soul cannot be equated with mental tranquility as it is at a higher level of consciousness. Thus, though less dogmatic than other religions, Hindus would traditionally remain skeptic in their view about euthanasia. It has been proposed that a strong objection to euthanasia might arise from the Indian concept of Ahimsa. However, even in the Gandhian framework of Ahimsa, violence that is inevitable is not considered as sin.[ 46 ] This emphasizes flexibility of the Indian mind. Hence, though a little skeptic, the Indian mind would not consider the thought of euthanasia and PAS as a sacrilege.

ATTITUDES OF PSYCHIATRISTS TOWARD VOLUNTARY EUTHANASIA IN INDIA

A major concern that has been expressed is that the wish of the terminally ill patient requesting PAS may be colored by depression. Hence, psychiatrist's role becomes important for assessing depression in these patients. It is in fact a legal requirement in some places that psychiatric assessment should be mandatory before a patient is granted the permission to undergo PAS.[ 26 ] It is claimed that after being allotted this crucial role, the psychiatrists would act as a gatekeeper in this highly controversial issue. It has also been proposed that since very few psychiatrists would feel confident in detecting depression in the terminally ill, their attitude might color their judgment.[ 25 ]

Though legalization of PAS is still not a very important prerogative for the Indian legislature, we designed a study at the Central Institute of Psychiatry, Ranchi, to see the attitude of Indian psychiatrists about euthanasia, as they might have to act as gatekeepers in PAS issues in the future. Certain interesting findings emerged in this study. Out of the 165 psychiatrists who participated in the study, 99 completed the questionnaire. More than 55% of the subjects favored PAS and believed that it should be legalized, whereas only 28% opposed the idea. The major factors that determined the attitude included deeply held moral values like role of physician is to preserve life, PAS would pressurize for improved palliative care, religious beliefs, and diversion of resources from palliative care. 60% believed that they would consider PAS on themselves in case of terminal suffering. The factors determining their decision to consider PAS would be pain in 70% cases, no hope of recovery in 50% cases, loss of mental faculties in 49% cases, inability to take care of self and poor quality of life in 35% cases each. 60% of the respondents believed that they would not be confident in diagnosing depression in the terminally ill patients during a single interview with the patients if they were called for giving an expert opinion. This is a surprising finding as it implies that more than expert knowledge, the moral principles and previous attitude regarding PAS may influence the judgments of the psychiatrists if they were act as a gatekeeper in the future.

Another sample survey of 200 doctors carried out by the Society for the Right to Die with Dignity in Bombay[ 47 ] also gave a glimpse of what views health professionals in our country held regarding euthanasia and PAS: Ninety percent stated they had the topic in mind and were concerned, while 78% argued that patients should have the right to choose in case of terminal illness; 74% believed that artificial life supports should not be extended when death is imminent, but only 65% stated that they would withdraw life supports; 41% argued that Living Will should be respected, and 31% had reservations about the issue.

THE INDIAN REALITY

It can be argued that in a country where the basic human rights of individuals are often left unaddressed, illiteracy is rampant, more than half the population is not having access to potable water, people die every day due to infections, and where medical assistance and care is less, for the few people, issues related to euthanasia and PAS are irrelevant. However, India is a country of diversities across religious groups, educational status, and cultures. In this background, the debate on euthanasia in India is more confusing as there is also a law in this land that punishes individuals who even try to commit suicide.

The Medical Council of India, in a meeting of its ethics committee in February 2008 in relation to euthanasia opined: Practicing euthanasia shall constitute unethical conduct. However, on specific occasions, the question of withdrawing supporting devices to sustain cardio-pulmonary function even after brain death shall be decided only by a team of doctors and not merely by the treating physician alone. A team of doctors shall declare withdrawal of support system. Such team shall consist of the doctor in-charge of the patient, Chief Medical Officer / Medical Officer in-charge of the hospital, and a doctor nominated by the in-charge of the hospital from the hospital staff or in accordance with the provisions of the Transplantation of Human Organ Act, 1994.[ 48 ]

In India, euthanasia is a crime. Section 309 of the Indian Penal Code (IPC) deals with the attempt to commit suicide and Section 306 of the IPC deals with abetment of suicide – both actions are punishable. Only those who are brain dead can be taken off life support with the help of family members. Likewise, the Honorable Supreme Court is also of the view that that the right to life guaranteed by Article 21 of the constitution does not include the right to die. The court held that Article 21 is a provision guaranteeing protection of life and personal liberty and by no stretch of imagination can extinction of life be read into it. However, various pro-euthanasia organizations, the most prominent among them being the Death with Dignity Foundation, keep on fighting for legalization of an individual's right to choose his own death.

A major development took place in this field on 7 March 2011. The Supreme Court, in a landmark judgment, allowed passive euthanasia. Refusing mercy killing of Aruna Shaunbag, lying in a vegetative state in a Mumbai Hospital for 37 years, a two-judge bench laid down a set of tough guidelines under which passive euthanasia can be legalized through a high-court monitored mechanism. The court further stated that parents, spouses, or close relatives of the patient can make such a plea to the high court. The chief justices of the high courts, on receipt of such a plea, would constitute a bench to decide it. The bench in turn would appoint a committee of at least three renowned doctors to advise them on the matter.[ 49 ]

Medical science is progressing in India as in the rest of the world, and hence currently we are having devises that can prolong life by artificial means. This may indirectly prolong terminal suffering and may also prove to be very costly for the families of the subject in question. Hence, end-of-life issues are becoming major ethical considerations in the modern-day medical science in India. The proponents and the opponents of euthanasia and PAS are as active in India as in the rest of the world. However, the Indian legislature does not seem to be sensitive to these. The landmark Supreme Court judgment has provided a major boost to pro-euthanasia activists though it is a long way to go before it becomes a law in the parliament. Moreover, concerns for its misuse remain a major issue which ought to be addressed before it becomes a law in our country.

Source of Support: Nil

Conflict of Interest: None declared.

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