Euthanasia – Relief from Suffering or Assisted Suicide

Miss Stuti Ladia, Mumbai University

“Death is not the greatest loss in life. Greatest loss is what dies inside us while we live.” – Norman Cousins

Euthanasia, commonly known as Mercy Killing, has been derived from Greek words ‘Eu’ which means good and ‘Thanotos’ which means death hence the word literally means good death. It is medically and legally defined as an act of terminating one’s life to relieve him from his suffering, a terminal illness, an incurable disease and his situation is painful. Euthanasia is adhered to aid the patient die peacefully rather than live painfully.

Euthanasia can be branched into two main categories namely Active and Passive Euthanasia on the basis of the methods in which it can be performed.

Active Euthanasia – It is a process which is conducted out of mercy. The procedure is undertaken (by the third party) like the administration of a mortal/lethal drug. There are countries that have passed legislation permitting assisted suicide and active euthanasia. The only difference between them is in the former, the patient administers lethal medications on his own, and in the latter doctor or some other medical practitioner does it.

The Netherlands was the first country to legalize the passage of the “Termination of Life on Request and Assisted Suicide (Review Procedures) Act” 2002 providing well-defined guidelines for Euthanasia. Belgium was the second nation to do the same. Also, in Switzerland assisted suicide can be performed by non-physicians. Both Active Euthanasia and Assisted Suicide are legal in Luxembourg 2008.

Passive Euthanasia It involves withdrawal from the life support system or withholding medical treatment for continuance of life. Therefore, in passive euthanasia death is administered by an act of omission. Euthanasia can be further classified as ‘voluntary’ where euthanasia is carried out at the request of the patient and ‘non-voluntary’ where the person is unable to ask for euthanasia.

On the basis of consent it can further be divided into three categories

1. Voluntary Euthanasia:  This is when consent has been provided by the sufferer. However in India it is interpreted as an act of attempting to commit suicide under section 309 of the Indian Penal Code. In the judgment of Gian Kaur vs. State of Punjab (1996) 2 SCC 648 the court to provide clarity with regards to section 309 held that right to life guaranteed by Article 21 of the Constitution does not include the right to die. Justice J.S Verma had observed that under Article 21 of the Indian Constitution right to life was a natural and fundamental right however suicide or termination of life that is right to die is inconsistent and incompatible. 2. Involuntary Euthanasia: this is when the person is in coma or is brain dead and is not in the condition to provide consent.3. Non – Voluntary Euthanasia: to someone else making the decision to end one’s life. A person from close proximity or a close family member usually makes the decision. This is usually done when someone is permanently incapacitated or in a vegetative state for a very long period of time.

According to The Medical Treatment of Terminally ill Patients (Protection of Patients and Medical Practitioners) Bill 2006, ‘terminal illness’ under section 2(m) is defined as:

i. Such illness, injury or degeneration of physical or mental condition which is causing extreme pain and suffering to the patients and which, according to reasonable medical opinion, will inevitably cause the untimely death of the patient concerned, orii. Which has caused a ‘persistent and irreversible vegetative’ condition under which no meaningful existence of life is possible for the patient.

Therefore, the patient must be suffering from some ailment causing extreme pain and suffering, which according to medical opinion, would ultimately lead to his death. The second condition is when the patient is in a “Persistent and Irreversible” Vegetative State. These patients without active lifesaving procedures would die a natural death. Hence, one would be reasonable to simply not keep the patient alive if he is suffering from intractable pain, psychological and emotional distress.

Legally in India Section 306 of the Indian Penal Code deals with Abetment of suicide and Section 309 defines attempt to commit suicide. As both the sections are punishable hence they result in making Euthanasia illegal in nature in India. Only those whose brains have stopped working or are dead can be taken off life support with the consent of family members.

In the Landmark Judgement of Aruna Ramchandra Shanbaug v. Union of India the Supreme Court in 2011 recognized passive euthanasia in this case by permitting withdrawal of life-support treatment from patients not in a position to make a voluntary decision.

Following are the facts of the case:

Aruna was a nurse in the King Edwards Memorial Hospital in Mumbai. In 1973, she was assaulted by a ward boy of the same hospital in the hospital basement. The ward boy tried to choke her by strangulating Aruna with a dog chain around her neck.

The attack shunned off the oxygen supply to her brain leaving her blind, deaf, paralyzed, and in a vegetative state for 42 years.

Aruna would only survive on boiled food. She was unable to move her hands or legs or perform the basic and meagrefunctions of a normal human being.

In 2015, Shanbaug, who was then 66 years old, died of severe pneumonia. She was on life support in KEM’s acute care unit.

Followed by this, Supreme Court laid down certain guidelines for passive euthanasia. This verdict made passive euthanasia a possibility in India by the virtue of the decision by the High Court.

To make Passive Euthanasia applicable in a particular case itis compulsory to take High Court’s permission before every case. Execution of the directive in presence of two witnesses, authentication by a Judicial Magistrate, permission from two Medical Boards, and a jurisdictional collector are some of the measures to be taken into consideration before any case.

In State of Maharashtra v. Maruti Sripati Dubal the court had held that section 309 of the Indian Penal Code is ultra virus to the Constitution of India. The Bombay High Court in this case stated that the Right to life under Article 21 includes the Right to die. It was accepted that Section 309 of IPC (attempt to commit suicide) is unconstitutional for it being violative of Article 21 of the Constitution. Court clearly stated in this judgment that the Right to die is just uncommon not unnatural.

In P. Rathinam v. Union of India it was held that section 309 of IPC was violative of Article 21 of the Constitution of India. The court stated that the section was irrational as it was it was punishing the person who had already suffered pain and agony. The person would be going through humiliation and disgrace due to his failed attempt of committing suicide. The court further added that his act cannot be considered to be going against any religion or culture as the act of killing himself does not have a baneful effect on the society thereby not causing harm to others hence interference of the state in the persons liberty was unwarranted in the present matter.

In Gian Kaur v. State of Punjab the constitutional bench of the supreme court however overruled the above judgement which stated that right to life and right to die is inherently inconsistent The Supreme Court stated that the Right to life does not include the Right to die but at the same time court also stated that the Right to life will include live with human dignity and the right to die with dignity. The court held that the right to die with dignity should always be distinguished from the Right to die.

In Common Cause v. Union of India the Supreme Court in 2018 recognized the right to die with dignity in this case and passive euthanasia was legalized and the permit was given to withdraw the life support system of those who are terminally ill and are in life-long comatose.  Subsequently, The Court also propounded the concept of “living wills”.

They differentiated between Living will and Advance Medical Directive. The court expressed that instead of the word living will Advance medical directive should be used and to justify it they gave the definition provided by Black’s law dictionary for the respective words. Living will through the dictionary meant “a document prescribing a person’s wishes regarding the medical treatment the person would want if he was unable to share his wishes with the health care provider.” However the word advance medical directive was defined as “a legal document explaining one’s wishes about medical treatment if one becomes incompetent or unable to communicate.”

Through this case law it was concluded that it is considered to be a fundamental right if a person chooses his right to die with dignity. They court had also added that a sound, adult human being in his conscious state of mind has the right to take a decision regarding his medical treatment and has a right to withdraw from taking one which includes withdrawal from devices which would save his life. The person also has a right to advance medical directives if in accordance to the safeguards and lastly in absence of advance medical directives the principle of persons best interest has to be taken into consideration and applied by the experts while taking a decision. The court however concluded that until a legislation regarding euthanasia is made by the legislature advance medical directives and their safeguards were to be in force.

Conclusion:

After going through the cases and studies we knowunderstand that euthanasia as a topic has strong arguments from both the sides. There does not seem to be any cut and dry reasoning behind whether euthanasia should be practiced legally or should be a punishable offence. You can either see it as a way of releasing someone’s painful life painlessly or use an unnatural course of action to commit a crime and go on with life.  

“Euthanasia…is simply to be able to die with dignity at a moment when life is devoid of it.” –Mary Mannes

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