Author: Apoorva Gopal Katti, IV year of B.A.,LL.B(Hons.) From CHRIST (Deemed to be University).
Co-author: Neha Venkatesh, IV year of B.A.,LL.B(Hons.) From CHRIST (Deemed to be University).
Euthanasia or mercy killing is legally and medically defined as ‘an act of terminating or ending the life of an individual who suffers from an incurable disease or situation especially painful’. It can be classified into active and passive euthanasia. The former refers to the employment of lethal substances to terminate one’s life, whereas the latter refers to withholding essential medical treatment. Based on consent, it may be classified into voluntary euthanasia, where the patient is competent to decide for themselves and involuntary euthanasia, where the patient’s consent cannot be taken, for example, a patient in a state of coma. The constitutional validity of this practice has been fervently debated upon due to the conflict between the ideals of the sanctity of life and an individual’s autonomy.
Article 21 of the Constitution states that “No person shall be deprived of his life or personal liberty except according to procedure established by law”. The right to live with dignity, privacy, and quality of life have been recognised as an extension of this Fundamental Right. In essence, it includes all aspects essential to living a meaningful and wholesome life. Unnatural death may be caused by the action of the individual himself or a third party. Under normal circumstances, this is illegal as well as immoral. However, the distinction is not as clear when the individual seeks to terminate their own life if they are suffering from terminal diseases and seek medical assistance for the same. The right to withhold life-saving treatment is another facet of the Right to die with dignity. It is rooted in the belief that a person of sound mind is competent to decide what happens to their body. A medical professional cannot perform surgery on a patient without their consent. Similarly, they cannot continue treatment once the patient has expressed their wish to withdraw from it. This creates a conflict between the individual’s Right to life and the state’s duty to protect the sanctity of life. However, in cases where the potential for life diminishes, the state’s interest also diminishes.
a. Judicial Interpretations
Over the years, the Right to life has been interpreted and expanded by the judiciary. In the case of State of Maharashtra v. Maruti Sripati Dubal, the petitioner was schizophrenic and was charged under Section 309 of the Indian Penal Code for attempting to commit suicide. The Bombay High Court stated that Article 21 includes the Right to die and though atypical, it is not unnatural or unconstitutional. It further stated that the ‘right to not live a forced life’ is an extension of the Right to live one’s life with dignity. Section 309 of the IPC was then invalidated on the grounds of being in contravention of Articles 14 and 21. Subsequently, the Supreme Court, in the case of P. Rathinam v. Union of India added that Section 309 creates an unwarranted interference and held the provision to be irrational and inhumane since it sought to punish a person who was in a state of suffering.
However, this was overruled in the case of Gian Kaur v. State of Punjab wherein the defendants had abetted their daughter-in-law’s suicide. The Court opined that the Right to life is not inclusive of the Right to die, but the Right to live and die with dignity is an extension of the same. The difference between the two is that the former is the unnatural and premature termination of one’s life, whereas the latter ends the suffering of a person suffering from an ailment. The Court clarified that the Right to die cannot be an extension of the Right to live because they are inconsistent and dissonant concepts and that the Right to die with dignity cannot be interpreted to mean the unnatural termination of one’s life.
In 2011, in the case of Aruna Ramachandra Shanbaug v. Union of India and Ors., a petition was filed on behalf of the petitioner, a nurse who had been in a vegetative state for over thirty years. The Apex Court relied on international legislations and judicial precedents and observed that the petitioner was in fact, not brain dead according to the meaning set out in the Transplantation of Human Organs Act, 1994. A person was to be considered dead only if their brain was dead, and since the petitioner was able to breathe independently, express emotions and interact with her surroundings, the petition was rejected. The Court also highlighted the difference between voluntary and non-voluntary euthanasia. This was a case of non-voluntary passive euthanasia. This case simultaneously provided guidelines to be followed to prevent the premature termination of one’s life.
In the case of Common Cause v Union of India, a writ petition was filed seeking the extension of Article 21 to include the Right to die with dignity and issue guidelines allowing terminally ill patients to execute a living will. It also sought the appointment of medical professionals, legal experts and social scientists to an expert committee to aid in the execution of these living wills. The Supreme Court relied on the judgements mentioned above and held that the Right to die with dignity is a fundamental right and that a legislation is not essential to assert one’s Right to bodily integrity. It stated that denying patients with chronic diseases the Right to die prolongs their suffering and violates the Right to die in a dignified manner. It further clarified that executing advance medical directives is an assertion of one’s Right to live with dignity.
a. Analysis of the Medical Treatment for Terminally Ill Patients Bill, 2016
The Medical Treatment for Terminally Ill Patients Bill, 2016 was introduced by the Ministry of Health and Family Welfare, on the suggestions made by the Supreme Court in the Aruna Shanbaug Case and on the recommendations made by the Law Commission Report in 2012. It put forth a procedure for the relatives or doctors of the patient to approach the High Court to seek permission for the same. This legislation legalises passive euthanasia and allows terminally ill patients to refrain from receiving medical treatment, but only if they are of sound mind and capable of making an informed decision. The legislation aims to realise the Right to die with dignity by providing a mechanism to prevent misuse of the same. The principle of ‘parens patriae’ was upheld since the power to allow the same would lie with the High Court after following an established procedure which would involve the Constitution of a Bench of at least two judges acting on the opinion of a committee of three reputed medical professionals. The Court is also required to issue a notice and provide a copy of the report to the state as well as the family and friends of the petitioner. This procedure is to be followed until a legislation governing the same is passed.
b. Arguments for and against the legalisation of the practice
The most widely accepted contention supporting the legalisation of euthanasia is that a person must have the Right to live without suffering caused by painful medical treatment and to end that suffering. Recognising passive euthanasia in cases of terminally ill patients would reduce the emotional, financial and physical stress on the patient and their families. Further, it would lead to better utilisation of scarce state funds and medical resources since it would be diverted to cases with a better chance of recovery. Lastly, the organs of these patients may still be fit to be donated before the illness runs its full course.
Alternatively, it is contended that the practice is immoral, diminishes the value of human life and is against the Hippocratic oath. The decision to terminate one’s life may also be a manifestation of an undiagnosed mental illness like depression or anxiety. These suicidal tendencies may not be the true desires of the patient. There is scope for misuse of the practice when the consent of the patient cannot be obtained. The procedural requirements would also burden the already clogged legal system. It could also pave the way for unethical practices like organ trafficking or commercialisation of the practice. Further, it could be used as a last resort by economically weaker sections to avoid medical expenses. Lastly, it would make sick and disabled persons vulnerable.
Euthanasia is a relatively new legal concept and has been met with a mound of support as well as dissent. There is a conflict between religious beliefs and ethical standards and rationality and secular ideologies. It is also important to note that models used to legalise this practice in countries like the Netherlands or Switzerland would not be apt or effective in a country like India since they are welfare states that guarantee social security and medical care. It is essential to design a mechanism applicable to India's social and economic standards.