UNDERSTANDING EUTHANASIA

-Written By Khushi Sheikh

1. INTRODUCTION

Euthanasia involves the deliberate ending of a patient's life to alleviate their suffering, often in cases of terminal illness or intense pain. The term originates from the Greek words "eu" (meaning good) and "thanatos" (meaning death), implying a humane approach to avoid a prolonged, agonizing, or undignified demise[1].The concept revolves around providing individuals with the option of a more dignified and less painful passing, as opposed to subjecting them to a protracted ordeal.

2. TYPES OF EUTHANASIA

Various practices fall under the umbrella term "euthanasia," each delineated by distinct characteristics:

1. Active Euthanasia: Involves actively causing a patient's death, such as administering a lethal dose of medication, sometimes termed "aggressive" euthanasia.

2. Passive Euthanasia: Intentionally allowing a patient to die by withholding artificial life support, which may include ventilators or feeding tubes. Ethicists differentiate between withholding and withdrawing life support.

3. Voluntary Euthanasia: Carried out with the explicit consent of the patient.

4. Involuntary Euthanasia: Performed without the patient's consent, often when the patient is unconscious, and their wishes are unknown. Ethicists further distinguish between "involuntary" (against known wishes) and "nonvoluntary" (without known consent) forms.

5. Self-administered Euthanasia: The patient independently administers the means of death.

6. Other-administered Euthanasia: A person, other than the patient, administers the means of death.

7. Assisted Euthanasia: The patient self-administers the means of death with the assistance of another person, typically a physician.

These categories can combine in various ways, and many forms of euthanasia remain morally contentious. Some, like assisted voluntary euthanasia, are legally sanctioned in certain countries.

Additionally, there are specific terms associated with euthanasia:

- Mercy-Killing: Primarily refers to active, involuntary, or nonvoluntary, other-administered euthanasia, where someone ends a patient's suffering without explicit consent.

- Physician-assisted Suicide: Involves active, voluntary, assisted euthanasia, where a physician aids the patient in ending their life, typically by providing the means, such as medication.

The ethical considerations surrounding these practices vary, with physician-assisted suicide and certain forms of euthanasia legal in some jurisdictions.

3. WHAT ARE THE KEY DISPUTES OVER THE CONTROVERSY REGARDING EUTHANASIA?

Advocates of active euthanasia often contend that causing the death of suffering patients is no worse than allowing them to perish. Supporters of voluntary euthanasia assert that individuals should have autonomy over their lives. Advocates of mercy killing argue that for those in vegetative states with no recovery prospects, allowing a natural death prevents futile treatment and unnecessary suffering.

Proponents of physician-assisted suicide argue that aiding terminally ill patients aligns with the pursuit of a dignified death.

Critics of euthanasia argue that killing is inherently wrong, that nonvoluntary or involuntary euthanasia infringes on patient rights, or that physician-assisted suicide contradicts the duty to avoid harm.

The ethical debate extends to the distinction between killing and letting die. Common morality often deems letting a person die less severe than actively killing. Examples, such as neglecting to call an ambulance for a neighbor versus not preventing deaths in distant impoverished areas, illustrate varying moral judgments.

In healthcare, controversy surrounds the distinction, as critics claim it lacks a solid moral foundation, insisting that the outcome is the same regardless of the means. Others argue that the nature of killing differs morally from letting die.

The debate also encompasses ordinary vs. extraordinary treatment. While some consider using a ventilator as extraordinary, allowing a patient to die by withholding or withdrawing treatment is a contentious issue. The distinction's validity is disputed, with some viewing it as artificial and subject to change with evolving technology.

Another ethical consideration involves death intended vs. anticipated, where some ethicists argue that the intent behind a patient's death matters, invoking the principle of double effect. Intentionally causing death with pain-relieving medications may be viewed differently from anticipating death as a side effect.

Overall, these nuanced ethical discussions highlight the complexity and ongoing controversy surrounding euthanasia and end-of-life care.

4. IS EUTHANASIA LEGAL?

The ethics and legality of euthanasia and physician-assisted suicide (PAS) have been subjects of debate for centuries. Presently, laws governing these practices vary widely across states and countries.

In the United States, PAS is legally allowed in Washington, Oregon, California, Colorado, Montana, Vermont, Washington, D.C., and Hawaii (since 2019). However, each jurisdiction has distinct legal requirements, and not all cases of PAS are permissible. Furthermore, ongoing legislative discussions in many states may expand the list of jurisdictions permitting PAS.

Internationally, PAS is legal in Switzerland, Germany, and Japan. Euthanasia, encompassing PAS, is sanctioned in several countries, including the Netherlands, Belgium, Luxembourg, Colombia, and Canada. The legal landscape surrounding end-of-life choices continues to evolve globally.

5. VIEWS AGAINST EUTHANASIA

The legal status of euthanasia continues to be a contentious issue, prompting discussions among intellectuals to establish a consistent policy. Life is widely regarded as a sacred gift, and the prevailing universal viewpoint asserts that no one possesses the right to intentionally end their own or another person's life. Religious doctrines uniformly condemn the unnatural termination of life.

The humanitarian approach emphasizes the duty to assist individuals facing difficulties and rejects leaving anyone helpless in times of trouble. Throughout the evolution of civilized society, the principle has been established that one should not yield to adversaries like disease or pain. The familial concept reinforces the values of support and unity during challenging circumstances.

Governments bear the responsibility of working for the welfare of all citizens, and the sanctity of life should be upheld in every scenario. Adequate means and measures must be developed to ensure that even the economically disadvantaged can receive assistance. The law, guided by humanitarian, constitutional, legal, and religious principles, prohibits individuals from taking another person's life.

In societies like India, where familial ties are strong, euthanasia cannot be permitted solely based on the wishes of relatives, as their motivations might be influenced by an interest in inheriting the patient's property.

6. REASONS TO SUPPORT EUTHANASIA

In ancient India, within the Hindu religious context, there are instances where monks support the renunciation of the body (kaya) for eternal spiritual gains in the pursuit of God. The concept of seeking death is endorsed when a person, facing unbearable pain, makes a demand for it. The right to claim death arises from the broader right to choose one's own path. Every individual is endowed with the right to self-determination, allowing them the freedom to choose their way of life.

It is asserted that everyone should possess the right to end their own life, particularly when living becomes more distressing than dying due to insurmountable pain or incurable diseases. This perspective sees death as a form of healthcare, providing relief from a life deemed unworthy to endure. Euthanasia, as a practice, has historical roots, with residents of Athens having the option to obtain official permission for a dose of poison to choose death over prolonged suffering.

The controversy surrounding euthanasia varies across countries and cultures, reflecting diverse perspectives on the ethical and moral dimensions of this practice.

7. EUTHANASIA IN INDIA AND THE JUDICIAL RESPONSE

There is currently no legislation in India that explicitly allows or declares the legitimacy of mercy killing. The Law Commission of India's 241st Report, titled "Passive Euthanasia A Relook,"[2] proposed legislation on passive euthanasia. The report led to the drafting of The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill. The bill underwent scrutiny by the Ministry of Health and Family Welfare's technical wing in June 2014. Expert committees, chaired by officials from the health services, convened to review the bill, ultimately recommending the formulation of legislation on passive euthanasia.

The topic of mercy killing, or euthanasia, has long been a subject of legal and social concern due to various distressing situations. The right to die has been intermittently argued to fall under the purview of the right to life with dignity under Article 21 of the Constitution of India. Proponents argue that when the dying process causes prolonged suffering, individuals should be allowed to choose death to alleviate distress and agony, asserting that the right to die is inseparable from the right to life with dignity.

While there is no specific law enacted by the Indian Parliament regarding euthanasia, judicial interpretations by the apex court have shaped the concept over time. The Supreme Court, in various cases, has discussed the right to life and the criminalization of suicide attempts. Notably, due to judicial decisions, passive euthanasia has been legalized in India.

Historically, challenges to the constitutional validity of Section 309 of the Indian Penal Code, which criminalizes attempted suicide, have been raised. The court, in a landmark decision, declared Section 309 as cruel, irrational, and deserving removal from the statute book. The court acknowledged that punishing individuals attempting suicide is counterproductive and causes additional harm to those already suffering.

In the case of Airedale N.H.S. Trust v. Bland[3], the House of Lords emphasized that mercy killing is not legal under common law and should only be permissible through legislation. The case dealt with the withdrawal of life-saving measures for a patient in a persistent vegetative state.

Gian Kaur[4] challenged the constitutional validity of Section 306 of the Indian Penal Code, which penalizes abetment of suicide. The constitutional bench held that the right to life under Article 21 does not include the right to die. The court emphasized the dissimilarity and unjustifiability of comparing the right to life with the right to die.

In Aruna Ramachandra Shanbaug's case[5], the court addressed the concept of passive euthanasia, stating that it could be legalized through legislation. However, the court did not allow the withdrawal of life-saving measures for the victim in that particular case.

In the recent case of Common Cause Society v. Union of India[6], the petitioner sought the declaration of the right to die with dignity as a fundamental right under Article 21. The court acknowledged the need for suitable procedures and the possibility of executing documents like "My Living Will and Attorney Authorization." The court reiterated that euthanasia should be allowed only through legislation.

The legal landscape of euthanasia in India has been shaped through judicial interpretations and discussions, leading to the acceptance of passive euthanasia under specific circumstances. The judiciary emphasizes the importance of legislation to regulate euthanasia, and discussions continue regarding the right to die with dignity as an integral part of the right to life.

8. CONCLUSION AND SUGGESTIONS

As society advances, the need for legal evolution becomes imperative, leading to the continuous codification of laws. The emergence of new rights in tandem with societal changes prompts the establishment of fresh dimensions of law. While customs once formed the basis of many legal aspects, the due process of law has seen the codification of such practices. Scientific and technological advancements introduce novel mechanisms and techniques, giving rise to new statutory rights. In instances lacking legislation, judicial decisions set precedents, exemplified by the recognition of passive euthanasia as a right through a landmark judgment.

Welcoming the apex court's decision on passive euthanasia, it is essential to consider the pressures faced by physicians and doctors who may conduct euthanasia. Striking a balance between preserving the sanctity of life, a sacred aspect of human existence, and addressing the complexities of contemporary life becomes crucial. While the state is obligated to provide a secure and healthy life, the intricate nature of modern existence brings forth various diseases and sufferings.

Scientific advancements, particularly in medical science, offer both life-saving treatments and the prolonged preservation of life. However, individuals, endowed with the right to lead a dignified life, including the right to self-determination, should be empowered to make choices about their treatment, especially in cases where recovery is unlikely. The right to die with dignity should be protected, considering it an integral part of human rights within the purview of Article 21 of the Constitution.

To prevent misuse, safeguards should be implemented, and patients opting for passive euthanasia should be treated with proper care and attention. While active euthanasia may not be advisable in the current Indian societal context due to educational limitations and high crime rates, the grant of passive euthanasia aligns with the principles of human rights.

In the Indian social fabric, where property disputes often arise, authorities must conduct thorough inquiries to confirm the motives behind decisions related to euthanasia, considering the potential influence of inheritance interests. Property disputes are recurrent causes of crime and fraud, necessitating a holistic analysis of socio-legal conditions by lawmakers.

The Supreme Court's decision to allow passive euthanasia, define its boundaries, and propose a supervisory committee is commendable. It sheds light on the patient's agony and advocates for a peaceful exit from life. This judicial stance positively expands the right to life within the ambit of Article 21 of the Constitution. The responsibility now lies with the Parliament to enact laws and provide clear guidelines for the implementation of passive euthanasia, fostering a more transparent and compassionate legal landscape.