Passive Euthanasia: Right to Die with Dignity a Fundamental Right
In this post, the author has explored the concept of "Euthanasia" and its legality in India under the aegis of the Right to die as a fundamental right.
The word Euthanasia came from the Greek word, “Euthanatos”, meaning “good death”. It is the painless termination of the life of a patient by medical personnel when he suffers from an illness that is incurable or is in a vegetative state or a coma. It is of two types- active and passive. Active Euthanasia is caused when the life of the patient is terminated by an act of the doctors, for example, by giving him a drug to stop bodily functions. Passive Euthanasia, on the other hand, is caused by an omission, i.e., by switching off the life support machinery keeping the patient alive, and no efforts to resuscitate him are made. Voluntary Euthanasia is when the patient himself requests the doctors to terminate his life, as opposed to Non-voluntary Euthanasia, when the patient is incompetent to make a decision for himself and a close family member takes a call on his behalf. Involuntary Euthanasia is caused when the life of the patient is terminated against his wish. Since a long time, there has been a debate in the legal, as well as the medical field, as to whether it is correct to take the life of a person when the Constitution of India gives the Right to Life as a fundamental right to every individual under the Article 21. Shouldn’t the patient be allowed to live for as long as possible with the assistance of all the ways and equipment available? Also, aren’t the doctors, who take the Hippocratic Oath to save the life of the patient in any way possible, doing just the opposite of their duty by terminating a patient’s life?
Position of "Euthanasia" over the years as decided by the Judiciary
The Indian Judiciary has not always been in favor of Euthanasia. In fact, for many years, there was no discussion on it by the Honorable courts. But the judiciary made it clear that taking the life of a person in any way is an offense in the case of Gian Kaur v. State of Punjab in 1996. The 5-judge constitutional bench of the Honorable Supreme Court, in this case, observed that “Right to Life” does not include “Right to Die”, and any attempt to end the life of a person before his natural death would be unnatural ebbing of life, which is impermissible under the Article 21 of the Constitution, and would come under the offense of abetment to suicide, murder, or culpable homicide not amounting to murder under the IPC. Hence, euthanasia, of any kind, was a criminal offense. But the case of Gian Kaur was related to attempted suicide and not euthanasia. In case of suicide, a person himself commits an act to terminate his life, so his condition cannot be compared to that of a terminally ill patient, or one in a permanent vegetative state, where only the acceleration of the process of dying takes place so as to end the suffering of the patient. Hence, the Right to die with dignity cannot be applied in the former case but can be applied in the latter.
Later, in 2011, in a landmark judgment in the case of Aruna Ramchandra Shanbaug v. Union of India, the issue of Euthanasia was first talked about, and the Honorable Supreme Court held that Passive Euthanasia can be allowed in certain cases when the courts allow the doctors to do so for the best interest of the patient. It invoked the principle of Parens Patriae (Guardian of the nation), and held that the courts would be the decision-makers in such cases, and guidelines related to the same were laid down. Then, later in 2018, in the case of Common Cause (a registered society) v. Union of India, the Honorable Supreme Court held that Passive Euthanasia should be permissible, since Right to Life also encompasses the right to die with dignity, and a decision or directive can be made by the patient beforehand, for the steps to be undertaken if he is unable to take a decision during the course of the medical treatment. The patient also has the right to deny medical treatment at any point of time before or during the treatment, if he is of a sound and competent mind.
The rationale behind allowing passive euthanasia but not active euthanasia is because it is morally wrong to “kill someone” by an “act”, but may not be so by “allowing nature to do its work” by an “omission”. The doctors here are not killing the patient, but are just not saving him, and speeding up the process of death. Since Right to life includes right to die with dignity, a life should not be prolonged just for the sake of keeping the person alive, even if there is left no scope of improvement and the measures taken are not actually curative but are just to artificially maintain the life of the person. It is better to let go of a dying person with love rather than try and postpone the inevitable death. Looking at it through a utilitarian perspective, ending the life, and the misery of a terminally ill patient would decrease his pain and suffering, and that of his family members, who stand beside his bed day and night, for years sometimes, hoping against hope that maybe the person gets better.
However, there is a moral paradox as to how it is better and kind to withhold treatment and let a patient suffer insufferable pain for a period of time before he finally dies. Will it not be better to allow the patient to die a quick and painless death through the administration of drugs, i.e., Active Euthanasia? Will it not quicken the death of the patient and the suffering of his family who would otherwise have to watch him die a slow death in front of their eyes?
Also, the family members may feel that they did not fulfill their duty of taking care of the patient, and gave up on him by agreeing to terminate his life. Their own individual guilt and social stigma may prevent them from assenting to passive euthanasia. There is a dilemma for the doctors as well, who have a duty to alleviate the suffering of the patient and save his life due to the oath they are bound to. Euthanasia relieves the patient from suffering and excruciating pain, but it ends his life, so as to force the doctor to break his oath by terminating a patient’s life. But although we cannot expect a doctor to voluntarily kill a person through an act of his, we also cannot expect him to fight for the patient’s life forever. There comes a time when doctors can do nothing to cure the patient. It would then be unreasonable to expect the doctor to keep the patient alive forever when the life of the patient will never have the same human value. At that point, it would be better to terminate the patient’s life rather than keeping his vitals stable when the doctors clearly know that the patient would never wake, and would not even live if not for the machines keeping him alive.
The judgement in the Common Cause v. Union of India case states that withdrawing of treatment when it is known that the treatment has no purpose is different from not attending or treating the patient. Secondly, since the person has a right to die with dignity, the social stigma and beliefs, the oath of the doctors, and the individual guilt of the family comes secondary. Primacy is to be given to the patient’s fundamental right and it should be protected. If a patient is made to, or rather, forced to undergo pain and suffering when there is no hope of recovery, in order to fulfill his right to live with dignity, the meaning of dignity itself is lost due to the indignity of the patient has to go through.
To conclude, our judiciary has taken a great step to legalize Passive Euthanasia, but this should be governed very closely, and several precautions should be taken, so that people don’t misuse it. What starts as a measure to end the suffering of a terminally ill patient may end up terminating the lives of patients who aren’t even suffering excruciating pain, but keeping them alive becomes a burden for their family, or maybe life is terminated to use scarce medical resources somewhere else, where they are needed more. To prevent this from happening, appropriate criteria should be decided upon, and a patient wanting to terminate his life should be made subject to those criteria, so that the law is put to wise use.
References:  Gian Kaur v. State of Punjab, (1996) 2 SCC 648.  Aruna Ramchandra Shanbaug v. Union of India, (2011) 15 SCC 48.  Common Cause (a registered society) v. Union of India, (2018) 5 SCC 1.  Glanville Williams, Text Book of Criminal Law, Stevens & Sons, London, 1978, p236.  Supra note 3.
Rajiv Gandhi National University of Law, Punjab
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