1. Introduction
Euthanasia, the practice of ending a life to terminate suffering, remains a complex and often controversial issue in India. While the right to a dignified death resonates with many, a legislative void and strong social and religious convictions create a tangled web of considerations. Exploring the nuances of euthanasia in India requires investigating its legal landscape, ethical complexities, and societal perspectives.
The arguments supporting the legalization of euthanasia/PAS (physician-assisted suicide) are substantial. They believe the patient and family should not be forced to suffer through a long and painful death, even if the only way to terminate 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. [1][2]
Lack of any justifiable means of recovery and the dying patient himself choosing to end his life are conditions that make euthanasia more justifiable. Some believe that the legalization of PAS is a natural extension of the patient's autonomy as well as the right to accept or refuse treatment.
2. Aruna Shanbaug case
The Supreme Court in 2018, in the landmark Aruna Shanbaug case, recognized the right to die with dignity as part of the fundamental right to life under Article 21 of the Constitution which states "No person shall be deprived of his life or personal liberty except according to procedure established by law". The Court laid down specific guidelines for passive euthanasia allowing the withdrawal of life support in terminal cases with informed consent. However, active euthanasia administering a lethal substance to end suffering remains in legal limbo. This creates uncertainty for patients and practitioners, hindering access to a potential pathway for a peaceful death. [3]
This writ petition, filed under Article 32 of the Constitution of India, raises profound questions concerning the right to die with dignity, passive euthanasia, and the legal framework governing end-of-life care in India. The petitioner, Pinki Virani, acting as a next friend of Aruna Ramachandra Shanbaug, seeks permission for the withdrawal of life-support measures from Ms Shanbaug, who has been in a persistent vegetative state since 1973.
The facts, though tragic, are straightforward. On November 27, 1973, Ms. Shanbaug, a young nurse at King Edward Memorial Hospital in Mumbai, was brutally assaulted, resulting in severe brain damage and PVS. Medical reports confirm the irreversible nature of her condition, highlighting the absence of any conscious awareness or possibility of recovery. [4]
The central legal issue before the Court revolves around the interpretation of the right to life under Article 21 of the Constitution. The petitioner argues that Article 21 encompasses not only the right to live but also the right to die with dignity, free from unnecessary suffering. In the context of Ms Shanbaug's PVS, continuing life-support measures, the petitioner contends, is tantamount to an indignity, causing an extension of an existence devoid of any conscious experience.
The Court acknowledges the sanctity of life as a fundamental right but emphasizes that it cannot be interpreted in a narrow or absolute manner. Article 21, in its holistic interpretation, encompasses aspects of individual autonomy and the right to make informed choices regarding one's body and well-being. This includes the right to refuse medical treatment, even if such refusal may lead to one's death.
However, recognizing the potential for misuse and the need for safeguards, the Court refrains from granting permission for passive euthanasia in Ms. Shanbaug's specific case. Concerns regarding informed consent, the vulnerability of certain groups, and the lack of a robust regulatory framework necessitate a cautious approach.
Nonetheless, the Court takes a landmark step by laying down guidelines for passive euthanasia in India. In exceptional circumstances, where strict conditions are met, including a high medical certainty of irreversible PVS, a terminal illness with unbearable suffering, and the presence of a living will or unequivocal family consent, withdrawal of life-support measures may be permissible.
The Court further recognizes the legal sanctity of living wills, empowering individuals to document their wishes regarding end-of-life care. This document, duly witnessed and authenticated, will serve as a testament to an individual's informed and conscious choice regarding the termination of life-support measures in the event of PVS or terminal illness. [5]
3. State of Euthanasia around the world
While India grapples with a complex legal landscape surrounding euthanasia, other countries have adopted diverse approaches, offering valuable insights for further consideration.
3.1 Europe: The Netherlands, Belgium, and Luxembourg stand at the forefront, legalizing both active and passive euthanasia with stringent safeguards, including informed consent, medical assessments, and independent oversight. Switzerland and Germany allow physician-assisted suicide under specific conditions. These frameworks offer India a glimpse into potential models for balancing patient autonomy with ethical considerations and societal concerns. [6]
3.2 North America: In Canada, physician-assisted suicide is legal for terminally ill adults with informed consent and a doctor's certification. Oregon and Washington in the US have similar laws, demonstrating nuanced regional policies within a federal framework. These examples highlight the potential for state-level legislation within India's diverse context. [7]
3.3 Asia and Beyond: While euthanasia remains illegal in most Asian countries, Japan's recent legal recognition of "living wills" offers a potential direction for India. New Zealand and Australia's ongoing legislative debates reflect the evolving global conversation on this sensitive issue. [8]
4. Conclusion
In conclusion, euthanasia in India presents a complex challenge, navigating legal, ethical, and societal dimensions. The Aruna Shanbaug case marked a crucial moment in recognizing the right to die with dignity, particularly through passive euthanasia. The Supreme Court's guidelines, while acknowledging individual autonomy, also underscore the need for caution, safeguards, and a comprehensive legal framework.
The global landscape of euthanasia reveals diverse approaches, with European countries adopting comprehensive models and North American jurisdictions showcasing nuanced regional policies. As India contemplates its stance, there is an opportunity to draw insights from these international experiences, exploring a balanced approach that upholds patient autonomy while addressing ethical concerns.
5. Citations
[1] Euthanasia in India. Available at: https://en.wikipedia.org/wiki/Euthanasia_in_India (last visited on January 3, 2024)
[2] National Center for Biotechnology Information. Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440914/(last visited on January 3, 2024)
[3] Supreme Court of India. Common Cause (A Regd. Society) vs Union of India and Others. Writ Petition (civil) NO. 215 OF 2005. Available at:https://indiankanoon.org/doc/1911130/(last visited on January 3, 2024)
[4] Supreme Court of India. Aruna Ramachandra Shanbaug vs Union Of India Ors. Writ Petition No. 115 OF 2009. Available at:https://indiankanoon.org/doc/1670523/(last visited on January 4, 2024)
[5] Supreme Court of India. Common Cause (A Regd. Society) vs Union of India and Others. Writ Petition (civil) NO. 215 OF 2005. Available at:https://indiankanoon.org/doc/1911130/(last visited on January 5, 2024)
[6] Euthanasia and the Law in Europe by Suzanne Ost, available at: https://academic.oup.com/medlaw/article-abstract/17/1/118/937488?redirectedFrom=fulltext(last visited on January 5, 2024)
[7] Medical Assistance in Dying on Health Canada, available at: https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html (last visited on January 5, 2024).
[8] Assisted Suicide and Euthanasia: A Comparative Analysis of Dutch and Japanese Law, available at: https://www.tandfonline.com/doi/pdf/10.1080/15265161.2021.2013986 (last visited on January 5, 2024).
