euthanasia

Abstract:

Every constitutional right is balanced with its opposite in the Indian Constitution, such as it is right to remain silent for the right to freedom of speech; the only exception here is the right to die which has no mention in the Constitution. Whether the right to life also includes the right to die has been a hot topic for debate for a long time.

The intentional taking of one’s own life is known as suicide, and the crime of killing a person illegally and on purpose is called murder, but to end the life of a person by others though on the request of the deceased, is called ‘euthanasia’ or ‘mercy killing’.

This study seeks to examine what euthanasia is and its various dimensions, from active to passive. It has been a subject of debate over a long period of time. Euthanasia is considered a merciful response to end the suffering of patients but it can be perceived as immoral as it includes violating someone’s right to life.

The laws on euthanasia in India are very vogue in the Indian Penal Code and thus arguments are put for and against legalizing euthanasia. It has been concluded in favour of legalizing passive euthanasia in India.

Introduction:

The Indian Constitution has included the right to life as the most important right in the Chapter of Fundamental Rights. According to this right, “No person should be deprived of his life or personal liberty except according to the procedure established by law.”

This Fundamental Right confers an obligation on the state to ensure good quality of life, livelihood, liberty, and dignified life to the people, both citizens and otherwise.

It took a few landmark judgments to transform the right to life into the right to life with human dignity. Article 21 which gives us the fundamental right to life and personal liberty has expanded its horizons by including human dignity. In Maneka Gandhi vs. Union of India[1] held that right to life embodied in Article 21 of the Indian Constitution is not merely a physical right but it also includes within its ambit, the right to live with human dignity.

The Supreme Court elaborated on the same view in Francis Coralie vs. Union Territory of Delhi[2]. In this case, the court observed that “The right to life includes the right to live with dignity and all that goes along with it, i.e. the bare necessities of life such as adequate nutrition, clothing, and shelter over the head and facilities for reading, writing and expressing oneself in diverse forms, freely mixing and mingling with fellow human beings and must include the right to basic necessities of life and also the right to carry on functions and activities as constituting the bare minimum expression of the human self.”

Another expression of this theme is given in Bandhua Mukti Morcha vs. Union of India[3], where Bhagwati J. observed:

“It is the fundamental right of everyone in this country… to live with human dignity free from exploitation. This right to live with human dignity enshrined in Article 21 derives its life breath from the Directive Principles of State Policy and particularly clauses (e) and (f) of Article 39 and Article 41 and 42 and at least, therefore, it must include protection of health and strength of workers, men and women, and of the tender age of children against abuse, opportunities and facilities for children to develop in a healthy manner and in conditions of freedom and dignity, educational facilities, just and humane conditions of work and maternity relief.

These are the minimum requirements that must exist in order to enable a person to live with human dignity and, no State; neither the Central Government nor any State Government has the right to take any action which will deprive a person of the enjoyment of these basic essentials.”

In a succession of these above-stated cases, the Supreme Court in Peoples Union for Democratic Rights vs. Union of India[4] held that non-payment of minimum wages to the workers employed in various Asiad Projects in Delhi was a denial to them, their right to live with basic human dignity and violative of Article 21 of the Constitution.

Bhagwati J. held that rights and benefits conferred on workmen employed by a contractor under various labour laws are clearly intended to ensure basic human dignity to workmen. He held that the non-implementation by the private contractors engaged for constructing a building for holding Asian Games in Delhi, and non-enforcement of these laws by the state authorities of the provisions of these laws was held to be violative of the fundamental right of workers to live with human dignity contained in Article 21.

No Right to Die

The concept of the right to die is based on the opinion that an individual is at liberty to take all major decisions of his life, which also includes their right to avail death, this also includes voluntary euthanasia. According to this right, a person with a terminal illness, or without the will to continue living, should be allowed to end their own life or to decline lifelong treatment. The question arising now is whether people are capable enough of taking away their own lives and is it morally right to do so, also what may be the principles justifying such right.

There are two variations of death

  • Natural and,
  • Unnatural

Causing the termination of a life unnaturally by the action of oneself over himself or over someone else is morally wrong as well as legally punishable.

For a common man, when life becomes far more painful and unbearable than death and there is no human dignity left in their lives, then it is normal for them to desire death.

Analysis of Right to Die

The scope of the right to die in India extends to only allowing terminally ill patients or their families to decide when to withdraw life support and to let the person die with dignity.

Section 309 of the Indian Penal Code, 1860, which discusses the abetment of suicide, was recently held to be arbitrary, as well as the state withdrew the prior punishment for persons who attempted suicide. The state merely abstains from criminalizing it as it is a matter of mental health.

The question regarding the right to die arose for the first time in State of Maharashtra vs. Maruty Sripati Dubal[5]. In this case, the Bombay High Court held that the right to life guaranteed under Article 21 includes the right to die, and the Hon’ble High Court declared Section 309 unconstitutional. Hence, there was no punishment for an attempt to commit suicide.

Similarly, in P. Rathinam vs. Union of India[6] a two-division judge bench of the Supreme Court, took cognizance of the contradiction between Section 309 Indian Penal Code, 1860, and Article 21. The decision of Bombay High Court in the case of State of Maharashtra vs. Maruty Sripati Dubal was supported by the apex Court and it was held that the right to life embodied in Article 21 also incorporated in it the right to not live a forced life, to his disliking.

The Court concluded that the right to life was also followed by the right to not live a forced life. It further emphasized that “attempt to commit suicide is, in reality, a cry for help and not for punishment.”

However, the Supreme Court in Gian Kaur vs. State of Punjab [7] held that the right to life doesn’t include the right to die. It was argued that if the right to die was included in Article 21 and Section 309 was made to be unconstitutional, then any individual instigating the commission of suicide by another is merely assisting in the enforcement of his fundamental right under Article 21.

The Court overrode the decision by the Division Bench, thus bringing an end to the controversy and ruled that Article 21 guaranteed only the protection of life and it can never be extended to include termination of life in an unnatural manner. It also observed:

“Right to Life is a natural right embodied in Article 21 but suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of the right to life.”

Hence an attempt to suicide was a punishable offence under Section 309 of Indian Penal Code, 1860 and it is not unconstitutional to the Indian Constitution.

Euthanasia

Euthanasia is a term derived from Greek, ‘Eu’ meaning good, and ‘Thanatos’ meaning death.

It normally implies an intentional termination of life by another at an explicit request of the person who wishes to die.

According to Black’s Law Dictionary, euthanasia means the act or practise of killing or bringing about the death of a person who suffers from an incurable disease or condition especially, a painful one, for reasons of mercy. This is the reason why it is called ‘mercy death.’

It is outlined as hastening of death by the administration of drugs with the explicit intention of ending the patient’s life, at the patient’s request.

In the contemporary context, euthanasia is limited to freeing patients from excruciating pain or terminal illness by the doctors at the request of the patient.

Euthanasia can be classified as given below:

  1. Active euthanasia
  2. Passive euthanasia
  3. Voluntary euthanasia
  4. Non-voluntary euthanasia

Active Euthanasia

Active euthanasia is when death is brought by some positive steps taken to terminate life, such as the administration of any toxic substance or injection of an air bubble in the bloodstream.

Passive Euthanasia

Euthanasia is considered to be passive when death is caused due to a treatment sustaining the life of the patient is held off and the patient dies as a result. It includes withdrawing life support devices such as a ventilator from any serious patient.

In this version of euthanasia, doctors aren’t killing anyone they are simply not saving them.

Voluntary Euthanasia

Voluntary euthanasia is practised when the desire of death is expressed and there is consent by the patient. It is primarily concerned with the right to choice of the terminally ill who decides to end his or her life, choice which serves the best for everyone.

Non-Voluntary Euthanasia

It refers to ending the life of a patient who is in a vegetative state and is not exactly in a position to make consent for death. Here it is usually the family members who make the decision of administering euthanasia.

Historical Background of Euthanasia

There have been many references to euthanasia or ‘mercy killing’ in ancient times too.

This practice was largely advocated by Greek philosophers. Socrates and Plato justified the elimination of severely disabled children and asserted that no elaborate attempt should be made to keep invalids alive when there was no hope for recovery.

In the Republic, Aristotle has also mentioned that in the Ideal State, those suffering from unbearable pain and incurable disease must be endorsed an easy death.

There also existed a Greek colony, where it was a custom to make available a death potion for those who justified their reasons in front of the Senate.

In the Cure for Incurables by the Honorable Lionel A. Tollemache; Tollemache, a British philosopher not only discussed the pros and cons of euthanasia but also gave strong support to the idea that laws must now be supportive of it.

In the ‘Essay on Suicide’, an article published in 1777, the author had held that a person who retires from worldly duties or life is not doing any harm to the society, instead, he has stopped doing good for the society. He said that if a person cannot promote the interests of society and instead be a burden on society, his resignation from life is laudable.

In regard to suicide in the Hindu faith, the Hindu scriptures have said little related to it or its consequences. The Isha Upanishad contains the following controversial verse: “All who kill the self, go after death to demonic worlds that are cloaked in blind darkness.[8] This appears to be a straight forward condemnation of suicide and also asserts that their rebirth will be hellish.

However, other Hindu writings make a distinction between a ‘dishonourable’ suicide and ‘honourable’ giving up of one’s atman or their soul.

When on one hand, suicide undertaken out of passion is condemned by Manu as, “No ritual of libation should be poured out for those who… have taken their own lives.[9] While on the other hand, the same text commends giving up of one’s life after attaining the highest spiritual state, “When he has gradually abandoned all attachments in this way and is freed from all duality, he is absorbed directly into the ultimate reality.”[10]

Countries Where Euthanasia is Legal

There are some countries all over the world where euthanasia is legal. Some of them are:

  1. NETHERLANDS: Euthanasia is legal in the Netherlands if the patient is suffering from unbearable pain and there is no chance of improving. Also, there is no age restriction and hence children as young as twelve years old can also ask for the permission of euthanasia. However, it is administered only under parental discretion for those under sixteen years of age.
  2. BELGIUM: Here also euthanasia is an option for those who are terminally ill, but those who don’t have to wait for a month before this process can be performed.
  3. CANADA: Canada allows euthanasia for adults suffering from ‘grievous and irremediable conditions’ whose death is reasonably ‘foreseeable.’
  4. AUSTRALIA: Only the state of Victoria has passed voluntary euthanasia in this country. To qualify for this process, one needs to be a decision making adult and have intolerable suffering due to any illness that gives life expectancy of fewer than 6 months.
  5. UNITED STATES OF AMERICA: Many states of the USA now offer euthanasia. Doctors can write patients a prescription for fatal drugs, but a healthcare professional must be present at that time.

Discussion

Schools of thoughts regarding Euthanasia

  1. Life is God’s gift, hence only he is entitled to take it

There are people who are against euthanasia as they consider it to be murder. Pain and suffering are part and parcel of life and death is an inevitable end and if euthanasia is legalized it devalues human life. It proclaims that being terminally ill somehow affects the value and purpose of life and thus this life should be ended.

Euthanasia opposers also argue that if ‘right to die with dignity’ is embraced then people will be disposed of from our society just because they are terminally ill.

Moreover, doctors and medical staff will also get excessive power in decision making for the invalids. They will be able to justify their murders and disguise it as euthanasia. Euthanasia also violates medical ethics which specifies that a doctor is prohibited from helping their patients die, instead, they are supposed to save their lives in any way possible.

If euthanasia will be legalized then the patients can be pressured by their family members because they may seem as ‘burdens’ on the family. Individuals of lower socioeconomic strata will be ‘coerced’ to take this step, either directly or indirectly.

Also, euthanasia inevitably leads people to commit suicide as those suffering from mental illness or depression may find it as a solution without even fighting their illness. They will lose hope as soon as the disease becomes even a little bit unbearable. If it is permitted without the necessity to abide by government rules and regulations, people will start using it as a means to get out of small troubles too.

From the religious point of view, it is believed that life is a gift given to us by God almighty and if we terminate it unnaturally we are dishonouring God himself.

  1. My death, my decision

The main question before supporters of euthanasia is that whether this practice is ethical? The answer rests on one moral value, which is mercy. Many healthcare professionals also consider that euthanasia is far better and far ethical than suffering from unbearable pain and terminal illness.

It should be allowed to keep in the knowledge that it is administered only on the consent of the sufferer. According to the advocates of euthanasia, the consent and decision of the patient must be valued.

Euthanasia also provides a way to relieve the victim suffering from intolerable pain and lingering death. The aim of passive euthanasia is altruistic and beneficial as it is an act of administering death painlessly.

Article 21 includes living with human dignity to the right to life. The right to life with dignity means when a person is enjoying their life in a dignified manner and not in a vegetative state. But a person, who can not eat with his own hands, can not stand or complete his basic essential daily tasks then he can’t be said to be living with dignity.

Also, medical aid is very expensive in the contemporary world. Not every patient can bear the huge burden of medical bills including hefty hospital bills as well as medicines. These patients just cause a financial burden on their family members and an end to their life seems like the only right option.

Medical professionals have a responsibility not only for the patient but also for their family members. No one can see their loved ones in such agony or pain and thus to relieve them of their mental pain euthanasia should be legalized.

Case studies in India

  1. Aruna Ramchandra Shaunbaug vs. Union Of India & Ors.

Aruna Shaunbaug was working as a nurse at a hospital in Mumbai. On the night of November 27, 1973, she was strangled with a dog leash and sodomized by a janitor. This attack left her oxygen-deprived and caused hypoxic damage to her brain cells, leaving her paralyzed and in a vegetative state as she was brain dead.

On behalf of Aruna, a petition was filed by Pinki Virani arguing that the ‘continued existence of Aruna is in violation of her right to live with dignity.’ On 7 March 2011, the apex court passed its landmark judgment on legalizing passive euthanasia but rejected the appeal of mercy killing in her case.

  1. Anamika Mishra: A woman from Kanpur wrote to PM Modi seeking mercy death for her daughter suffering from Muscular Dystrophy Disease. Because of her poor financial condition, her mother asked for euthanasia for her daughter.
  2. A. Thomas Master vs. Union Of India[11]: The petitioner approached the Kerala High Court for permission to end his life and to donate his organs. According to him, he had lived his life to the fullest and was now willing to do social service by donating his organs. His plea was rejected on the grounds that,

In our view, no distinction can be made between suicide committed by a person defeated and frustrated by life. The question as to whether the suicide was committed impulsively or after a lot of deliberation, is totally irrelevant. Similarly, the decisions taken by persons like the petitioners to voluntarily put an end to one’s life on the footing that one has led a successful life, and the mission of his life was completed, would, in our view, amount to suicide.

What the petitioner has overlooked is the probable loss to the society, when a person is otherwise bodily and mentally healthy, wants to exercise his right to voluntarily put an end to his life. It may be that his family members or the society at large may gain by his rich experience in life. The possibility of misuse, or abuse, of such a right and exploitation on that count, cannot be ruled out.

Guidelines for Euthanasia

Mahatma Gandhi is deemed as an advocate of euthanasia. In a response to the anger and outrage expressed by some people to the killing of an ailing calf in Sabarmati Ashram, at his instance, he had said “Some days back a calf having been maimed lay in agony in the ashram. Finally, in all humility but with the clearest of convictions I got in my presence a doctor kindly to administer the calf a quietus by means of a poison injection. The whole thing was ever in less than two minutes…

The question may legitimately be put to me: would I apply to human beings the principle I have enunciated in connection with a calf? Would I like it to be applied in my own case? My reply is ‘Yes’; the same law holds good in both cases.

Just as a surgeon does not commit himsa but practices the purest form of ahimsa when he wields his knife, one may find it necessary, under certain imperative circumstances, to go a step further and sever life from the body in the interest of the sufferer. ”

The Supreme Court of India legalized passive euthanasia in a landmark judgment in the case of Aruna Ramchandra Shaunbaug vs. Union of India. The court also recommended the decriminalization of attempt to suicide by declaring Section 309 of the Indian Penal Code, 1860 as unconstitutional.

Some guidelines issued by the Court in the administering of passive euthanasia are as follows:

  1. The decision to discontinue the life support of the patient must be only taken by either parents or spouse or any close relatives. The doctors are also free to take such a decision but in any case, it should only be in the bona fide interest of the patient.
  2. Even if the consent is provided by the close relative or doctor, it still needs to be approved by the High Court concerned.
  3. The High Court is entitled to allow the removal of life support for the administration of passive euthanasia under Article 226 of the Constitution. Article 226 not only empowers the High Court to issue writs but also to issue directions or orders.
  4. High Court should forthwith constitute a Bench of at least two judges who should decide if the approval should be granted or not.
  5. The Bench should nominate three medical practitioners. Preferably, constituting of a psychiatrist, a neurologist, and a physician. They should thoroughly examine the patient and take views by the hospital staff and the report should be submitted to the High Court.
  6. After in-depth scrutiny of the report, the High Court should take the necessary decision which is in the best interest of the patient.
  7. This procedure must be followed all over India before the Parliament makes any decision on this issue.

Suggestions

Coming back to the argument presented by those opposing euthanasia that if voluntary euthanasia is legalized then this will lead to various misuses of the provision, this study wants to suggest a scheme to minimize the misuse to its lowest possible extent.

  1. The physician after getting a voluntary request from the patient must make sure that:
  2. The request is voluntary, well contemplated, and lasting or final.
  3. The patient is suffering from a terminal or chronic disease and there is no scope of its cure.
  • The practitioner must inform the patient about his situation and further prospects.
  1. The practitioner has reached the firm conclusion that there is no alternative solution left for the patient.
  2. The person who is going to die must:
  3. Be fully aware of the results of his action.
  4. Must know about other treatments available.
  • Must be determined about his wish to die.
  1. A quasi-judicial officer must be appointed to supervise all cases of euthanasia in a particular territory.

Conclusion

Quoting Dr Jack Kevorkian

For those who are facing a terminal illness, who are in irremediable pain and suffering, and wish to exercise their right to die with dignity, a system should be available to them.

The importance and value of human life don’t mean that there is a need for forced continuation of existence in pain and suffering. Everybody has a right to live with dignity, but in very severe cases where a person who has been self-dependent their entire life is suddenly crippled and has to now depend on someone, then their human dignity is lost.

The right to privacy is also fundamental right now, but when it is such a case that the patient can not even change their own clothes then there is no question of privacy. Hence he can not be made to live in detriment. If the patient is suffering from intolerable pain, it will be inhumane to compel them to more pain or to such pain till they get a natural death. Instead, it would be better to relieve them by administering passive euthanasia and thus end their burden as well as the financial burden on their family too.

No law can be guaranteed with a hundred per cent assurance to be free of any abuse or violation. Every law has some loophole, here or there and thus the legalizing of euthanasia will also administer some violations. It will be dangerous in one more aspect that it will never be revealed if the death was actually voluntary euthanasia or culpable homicide amounting to murder.

Hence even if mercy killing seems ethically warranted, its practical implementation without any breach is unfeasible.

The medical field has progressed a lot in our country, and hence we have techniques to prolong the lives of ill or suffering. Hence it is necessary to maintain the passive euthanasia exclusively for the terminally ill.

In view of all the facts and the suggestions made above, the researcher believes that there is a need for legalizing voluntary euthanasia too in India. The recommendations made by the Law Commission as well as the guidelines laid down by the court must be carefully dispensed before framing any law regards to euthanasia.


Author:

amisha srivastava Amisha Srivastava


References

  1. Position of euthanasia in India – An analytical study by Caesar Roy, Midnapore Law College, West Bengal.
  2. researchgate.net
  3. org
  4. Euthanasia: An Indian perspective by Vinod K. Sinha, S. Basu, S. Sarkhel
  5. academia.edu
  6. Euthanasia: Right to die with dignity by Kalaivani A., Raja D., Geetha M.
  7. Euthanasia: Right to life vs. Right to die by Suresh B. Math, Santosh K. Chaturvedi
  8. Legalizing euthanasia in India: A Need For Constitutional Correction and Legislative response
  9. Right to life with dignity also includes right to die with dignity:- Time to amend article 21 of Indian Constitution and law of euthanasia by Pyali Chatterjee
  10. Euthanasia: Indian Scenario Post 07/03/2011 by Dr. M.K. Jha, Prof. Dr. Ranabir Pal, Dr. Promukh B., Dr. S.S. Oberoi, Dr. Anil Garg
  11. Article 21 of the Constitution of India – Right to life and personal liberty by Riya Jain
  12. lawctopus.com
  13. https://shodhganga.inflibnet.ac.in
  14. Historical Background of euthanasia and Legality of Euthanasia Legal and ethical issues of euthanasia: Argumentative essay by Bilal S.H. Badr Naga, Majd T. Mrayyan

[1] 1978 AIR 597, 1978 SCR (2) 621

[2] 1981 AIR 746, 1981 SCR (2) 516

[3] 1984 AIR 802,1984 SCR (2) 67

[4] 1982 AIR 1473, 1983 SCR (1) 456

[5] 1987 Cri LJ 743

[6] 1994 AIR 1844, 1994 SCC (3) 394

[7] 1996 SCC (2) 648

[8] Isha Upanishad verse 3

[9] Manusmriti, Chapter 5, Verse 89

[10] Manusmriti, Chapter 6, Verse 81

[11] 2000 CRL LJ 2729

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