More than six years after sanctioning passive euthanasia as a legitimate option to end lives of people in a permanent vegetative state, the Supreme Court has decided to examine the more complex concept of a “living will” where removal of life support is authorised in case of an irreversible coma.
SC was hearing a plea by NGO Common Cause to declare ‘right to die with dignity’ as a fundamental right within the fold of right to live with dignity, which is guaranteed under Article 21 of the Constitution.
A “living will” is a document prepared by a person in a healthy state of mind specifying that if s/he slides into a vegetative state because of an irreversible terminal illness, the debilitated existence should not be prolonged with the help of life support systems or other medical interventions.
In such a case, relatives will be spared the agonising decision of removing life support and doctors will be guided solely by the “living will”. In several cases, the reluctance to pull the plug on a loved one even when s/he is in a vegetative state prolongs the pain of the patient.
Active and passive euthanasia:
Active euthanasia, the intentional act of causing the death of a patient in great suffering, is illegal in India. It entails deliberately causing the patient’s death through injections or overdose.
But passive euthanasia, the withdrawal of medical treatment with the deliberate intention to hasten a terminally ill patient’s death is “partially” allowed.
The patient, family, friends and legal guardians can’t take the decision on their own, but need a high court’s approval bill for stopping treatment.
Euthanasia in law:
The government told the court on Tuesday there was already a law on passive euthanasia and it had drafted a ‘management of patients with terminal illness-withdrawal of medical life support bill’.
The issue of euthanasia was first examined by the health ministry in consultation with the experts in 2006, based on the 196th Law Commission of India report. However, it was decided to not make any laws on euthanasia.
Aruna Shanbaug case:
In 2011, the Supreme Court, while hearing the case of Aruna Shanbaug, who was in a vegetative state for nearly 30 years, had legalised passive euthanasia partially.
A nurse at KEM Hospital in Mumbai, Shanbaug was in a vegetative state since 1973 after a brutal sodomisation and strangling with a dog-chain during a sexual assault. She died in 2015 while on a ventilator for several days after suffering from pneumonia.
SC gave patients living in a vegetative state the right to have treatment or food withdrawn, and laid down guidelines to process passive euthanasia in the case of incompetent patients. The guidelines include seeking a declaration from a high court, after getting clearance from a medical board and state government.
Medical experts on euthanasia:
Doctors have a mixed reaction to legalising euthanasia. They say the government needs to take a careful approach before legalising passive euthanasia when the measures to prolong the life of the patient are withdrawn.
Most doctors, however, agree that euthanasia should be made legal in cases where there is no scope of a patient recovering. But many feel that India is not yet ready for a decision like this which requires a mix of sensitivity and maturity.
A major concern is the misuse of the law. If it is legal to passively allow or actively hasten death, what’s to say an aged parent won’t be hastened in favour of an inheritance, or a spouse have treatment withdrawn for the sake of a hefty insurance payout?
Euthanasia in other countries:
Euthanasia and physician-assisted suicide have been legal in The Netherlands and Belgium since 2001 and 2002. In the US, Switzerland and Germany, euthanasia is illegal but physician-assisted suicide is legal. Euthanasia remains illegal in the UK, France, Canada and Australia.