The debate over euthanasia in India has intensified since March 2018. In the
ruling given by the Hon'ble Supreme Court of India in a case involving Aruna
Shanbaug, who was in a continuous vegetative state (PVS) legalizing passive
euthanasia under strict guidelines which permits only the use of withdrawal of
life support unit to a patient who may be suffering in a continuous vegetative
state or permanent vegetative state (PVS). Under the guidelines, the patient
must agree through a living will, and be either in a sick or vegetative state.
The decision was made as part of a ruling in a case involving Aruna Shanbag, who
was in a continuous vegetative state (PVS) until she died in 2015.
On 9 March 2018, the Hon'ble Supreme Court of India passed a landmark
judgment-law allowing passive euthanasia in the country. This decision was given
in wake of Pinki Virani's plea in December 2009 to advocate in the Supreme Court
under the constitutional provision Next Friend
. It was a historical step,
which transfers the power of choice previously exercised by the government,
medical or religious control in the hands of the individual, who has been
suffering as destiny
In its ruling the Hon'ble Supreme Court of India specified two irreversible
conditions to allow passive euthanasia:
- the brain-dead for whom there is no scope of returning to the normal
state and the ventilator can be turned down.
- (II) For those who are in a continuous or persistent Vegetative State (PVS)
In which, tapes are added and pain-management palliatives are added, as per the
prescribed international specifications for which feeds may occur.
In the same ruling, the Hon'ble Supreme Court of India was inclined toward the
scrapping of 309, which punishes survivors for suicide attempts. Similarly, the
Government of India promulgates its intention to do so. However, on 25 February
2014, a three-judge bench of the Hon'ble Supreme Court of India translated its
decision in the case of Aruna Shanbag as inconsistent in itself
the same issue to its five-judge constitution bench.
As a result, the Government of India on 23 December 2014 stated in a press
release in the Rajya Sabha, that the passive euthanasia decision-law was
endorsed and re-validated as follows: The Hon'ble Supreme Court of India in its
decision delivered on 01-2013. [WP (Criminal) No. 2009] 115], while dismissing
the petition for mercy killing in a particular case, gave broad guidelines for
cases amounting to passive euthanasia.
Subsequently, the cases amounting to
passive euthanasia was investigated in consultation with the Ministry of Law and
Justice and it was held that since the Hon'ble Supreme Court has already given
its strict guidelines which permit only the use of withdrawal of life support
unit to a patient who may be suffering in a continuous vegetative state or
permanent vegetative state (PVS), these should be followed and the form of law
in such cases needed.
At present, there is no legislation on this subject and
the ruling of the Hon'ble Supreme Court will be acting as a precedent and is
binding on all. Health Minister JP Nadda said this as a written reply in the
The Hon'ble Supreme Court dismissed the petition for active euthanasia by using
lethal injection. Since then there is no law which may regulate the exercise of
euthanasia in India, the court held that its decision becomes a precedent and is
binding on all until the Indian Parliament makes a suitable law.
Active euthanasia, including the administration of chronically deadly compounds
to end life, is still illegal in India and most countries.
However, In 2018, through a five-judge constitution bench of the Hon'ble Supreme
Court announced that, if strict guidelines are followed properly with all the
utmost care and due diligence, the government would have to consider the
living, so that consenting patients with passive euthanasia can be allowed, if
the patient is suffering ailment incurable enough or is in
passive vegetative condition.
Aruna Shanbaug's case
Aruna Shanbaug used to be a working nurse at the famous King Edward Memorial
Hospital, Parel, Mumbai. On 27 November 1973, she was attacked and sodomized by
Sohanlal Walmiki, a sweeper from the same King Edward Memorial Hospital, Mumbai.
The attack was so severe that she went in a coma ever since. It was reported
during the investigation that she was strangled with the help of a chain, as a
result, she was shocked and went in a vegetative state ever since. She had been
treated at same KEM Hospital where the incident took place and she was kept
alive by feeding tubes.
Regarding the cases, Aruna's friend Pinki Virani, a social activist, filed a
petition in the Supreme Court stating that Aruna's continued existence is a
violation of her right to live with dignity. on 7 March 2011 the Hon'ble
Supreme Court of India rejected Pinki Virani's Next friend plea to stop life
support but issued broad guidelines to legalize passive euthanasia in India.
The Hon'ble Supreme Court of India decided not to conduct withdrawal of Aruna's
life support based on the fact that the hospital staff who treated and cared for
her for 42 long years did not support her euthanasia. On 18th May 2015, She died
from pneumonia after spending a longing period of 42 years of immovability.
Aruna's death about euthanasia intensified the argument, transforming into a
controversy of social ethics. Aruna's death undermined the idea that accepting
the practice of passive euthanasia as part of palliative care could provide an
opportunity to end the patient's suffering. The idea is having harsh but logical
ground anyway, which can permit even if there is reported evidence in support.
A breach of philosophy
The Arguments on and about the moral acceptability and applicability of
euthanasia holds several conventional philosophical elements.
Many conventional concepts needed to be carefully examined
and particularly expressed to ensure that logical essence does not vanish
between the ambiguity and the equation. The primary requisite of careful
delimitation includes the definition of death, the analytical aspects of
measures in medical treatment, and the difference
between the active and passive killing of patients seeking euthanasia, and the
critical examination of murder and death to procure some good and prevent some
injustice solely based on just medical and ethnicity of procedural aspect only.
This important elusive work has been already addressed extensively elsewhere and
I have very little to add here.
However, I would like to draw the classification of acts of dying, to help the
distribution of these categories. Regarding this explicit function, we have to
consider several different categories of 'individuals' (to use the term more
vividly to curtail 'former persons' and post-individuals
For whom the application of euthanasia has been
considered or proposed. These include individuals who have been descended to a
persistent vegetative state, perhaps through injury or pharmacological
deterioration, which can be kept alive by medical technology. And for those rare
cases where individuals have entered a state of satisfied symptoms of cognitive
decline, perhaps as a result of an accident in which individuals may manifest no
significant personal interaction.
Assuming such a person, when their faculties were intact, first, a survivor
person would be requested to seek treatment in such a situation.
earlier decision become decisive?
It is certainly not taken as a decisive using medical practice. At a medical
conference, it was reported that 66 per cent of physicians interviewed felt
there was nothing wrong with overriding the patient's advanced direction, even
if that instruction clearly stated the conditions for withdrawal and withdrawal
of medical treatment.
Thirdly, there are problematic cases of defective newborns. Cases of anaesthesia,
or children with Down syndrome with Down's syndrome atresia (intestinal
obstruction), are textbook clinical examples that raise unpleasant problems
regarding permissive treatment, and permissible neglect.
For present purposes, there are cases where a life is one of suffering and
unbelievable pain. This is perhaps the strongest category of claimants of 'right
to die' and one that was claimed by Pinki Virani.
Types of euthanasia
Euthanasia can be classified based on it procedural conducts such as active and
passive and voluntary, non-voluntary and involuntary. These terms are often
confusing because of its similarities and are often regarded as a source of
misconception. Because of this, they raise various issues in the
conceptualization of euthanasia, it is important to note them carefully for
those individuals who are unable to indicate priorities or even those who are
not capable of giving priorities.
Permissible procedures or conducts and
effective neglect-ion for those who fall in this category and differentiate
them from those who have indicated a prior preference for procedures and
treatments in regards to both the categories.
There is a broad consensus among some categorical procedures like in passive
voluntary euthanasia, the right to refuse treatment is almost universally
accepted and in cases regarding the use of active Involuntary euthanasia,
unanimously condemned because of the ability of its notorious consequences.
major argument often raised by the opponents is that sanctioning euthanasia in
any form would be in the form of acceptance of acts in the unforgivable
category. The most strongly contested category is active voluntary euthanasia.
The category in which Aruna Shanbag did not fall.
Arguments for active euthanasia
(a) The right to shape their own lives
The strongest argument in favour of active voluntary euthanasia is based on the
notion of respect for an individual's freedom to exercise his/her body or
individuals right to the body. The logic beneath it is based on the claim that
everyone has the right to shape their lives through their choices and it should
Certainly, in the adverse circumstances of incurable pain or permanent
disability are concerned; some will argue on its extensions like the right to
choose the time and conditions of death. On this view, the right to make
decisions about our own lives and the circumstances of our deaths is a matter of
It is essentially a manifestation of the Kant's philosophy that
what is paramount to my life is that it is my own choice, for good or ill. For
Kant, notoriously, it is never acceptable to treat individuals as an instrument
rather than an end in itself, even if it involves attempting to use them as an
instrument for their own good.
Treating someone as an instrument of one's own
well-being leads to questionable paternalistic defects that may be better known
to someone other than the person who may be involved in this well-being.
J.S. Mill was as resolute a defender as Kant of the right to autonomously
determine its own fate and to be free from heretical determinations by others.
This right is rooted in Mill's famous harm
principle: The only purpose for
which power can be properly exercised against the will of any member of a
civilized community to harm others. His own good, either physical or moral, is
not a sufficient warrant. Mankind benefits more and more to torment each other
as the rest of the people force each person to live as they wish.
To take autonomy (literally 'self-rule') seriously means accepting individual
sovereignty for all perceived acts. According to this theory, one must determine
the circumstances of one's own death, provided that it is a self concerning the
act, and if so it should be free from the interference of others concerning its
own acts. Mill, like Kant, believed that taking control of one's life was an
(b) Beneficence and fairness
There are at least three other important and related, supporting arguments used
to support the right to determine the circumstances of one's death.
- The first
golden rule, do as you shall do, requires that we provide assistance to the
people in distress and provide appropriate relief, especially from suffering. In
cases where palliation is ineffective, again in the case of Aruna Shanbag it is
clarified that it would be unfair (many would call it unconscionable) to deprive
anyone of their right to make their suffering a dignified end.
- Secondly, a relation of the harm principle is that the denial of the right to
die is unfair and cruel; No one should be forced to endure unbearable pain.
Those who deny the rational choice of someone to end their suffering, their
absence is the major concern of Pinki Virani.
- Thirdly, the imposition of a 'duty
to live' denies the right to death - no matter what the abusive situation of
that life may be. It is presumptuous and unbearable.
Arguments against legalizing euthanasia
Not everyone opposes the practice of euthanasia as opposed to the legalization
of euthanasia: Therefore, we must separate the argument against the practice of
euthanasia from arguments directed against the legalization of euthanasia. Those
who theoretically oppose euthanasia will certainly oppose its legalization; But
others have made mistakes about its institutionalization, supporting euthanasia
Thus some defend the right of people to choose the time and
circumstances of their deaths but who find the need to satisfy a medical
bureaucracy that their decision is both sound and aggressive.
On this view,
End-of-life decisions should be a personal affair between the patient and the
physician. In fact, in India, a belief in euthanasia in medical practice is that
termination of life by a person's personal arrangement with a physician is far
more widespread than is commonly believed. A significant number of physicians
are willing to illegally assist patients to end their lives.
According to the opinion of doctors towards euthanasia in India, and practice
of, euthanasia, about half of the doctors had been asked by a patient to hasten
their death and about a third wanted to assist patients to end their lives.
Medical practitioners have included themselves in favour of a minority of
doctors who wanted to assist patients to die sooner than they might have.
However, there are problems in tolerating euthanasia as a diagnostic procedure
that is allowed to operate outside the law. The argument that advocating
something in private is social hypocrisy is dismissed as public policy.
Furthermore, it is an unjust policy because its benefits are not equally
accessible to all, but depend to a large extent on personal resources, or
resourcefulness, or luck.
Arguments against the practice of euthanasia
Moving away from the arguments directed against the legalization of euthanasia
only, the doctrine only has objections to the practice of euthanasia, there are
three lines of objection that are pre-determined with many supporting arguments.
There are three main objections: first, the so-called 'slippery slope' or
'wedge' argument, second, there is concern that excessive practice of euthanasia
will change the culture of medicine, and third, a conviction based on
deputation. The decision to end one's life is purely self-regarding.
Supporting arguments include the claim that procrastination provides
considerable relief from pain and pain, uncertain arguments about the
possibility of miraculous treatment, suggesting that people in temporary
physical or psychological distress end up having a mindless end to their lives.
And can make irreplaceable choices. The claim that all human life is sacred, and
in the end, an attempt to kill who commits an act of murder, is justified
through the principle of double effect
(a) Thin end of the profession
The most obvious concern is that if euthanasia is admitted for worthy reasons,
such as Aruna Shanbaug, it will lead to the admission of less qualified or
substantially unreasonable cases. In time the doctrine will be progressively
enhanced while security measures will be diluted and weakened. Soon a policy
inspired by compassion will become a vehicle for abuse and demonic injustice.
we allow a case like that of Aruna Shanbag, it is suggested, then we are on the
slippery slope. This sinister rhetoric is one-sided. Any practice of euthanasia
will attract scrutiny and for this reason, it is very difficult to imagine
safeguards without public protest.
The logic of the wedge is in general
uncertainty in any case, and it is no better here than in its other
It is worth citing a commonly considered assessment of F. M. Cornford's wedge
arguments: the principle of the theory is that you should still not take action
for fear of raising expectations that you are still more prudent in future
expectations Act in a manner.
Can not dare to be satisfied with what you are
afraid of. A little reflection will make it clear that entry into the keel
argument means that those who use it cannot prove that the action is simply not.
If they cannot do this and that is the only and sufficient reason for not doing
so, and this argument would be exaggerated.
The answer to the argument, here as elsewhere, is not simply to forbid practices
but to take careful steps to ensure that proper regulation is maintained so that
standards do not erode. In particular, the line expressing the most fear about
the crossing is the line between voluntary and non-voluntary.
If it is true that abuses have occurred where the practice has been permitted,
this does not indicate the need for complete prohibition. An obvious alternative
is to ensure that adequate safeguards are put in place to prevent misuse.
particular, the purpose of safeguards is to ensure that the ultimate
responsibility for the decision and its execution depends on the class with the
patient and not with the physician or any other party. It would be important to
ensure that regulations and safeguards were developed to ensure that the line
between voluntary and non-voluntary actions of euthanasia would not be shifted.
(b) Culture of medicine
Another argument used by opponents of euthanasia is that it changes the culture
of medicine. Instead of maintaining and nurturing life, medical practice will
involve the intentional killing of patients. Doctors said that it should be the
healer, not the killer. One response to this is to first point out that
compassion-induced murder has become a surprisingly common part of medical
What needs to be done is to turn on an uncontrolled process, the
benefit of which is now capitalized, in a pattern of practice that is both safe
In the era of sophisticated life-sustaining techniques, certain elements of the
Hippocratic oath, such as injunctions to preserve life at all costs, have passed
through the date of their use. Contemporary medical terms demand that the
physician's duty to care and benefits is primary and to subordinate life to this
basic purpose. Regarding maintaining life as a primary and paramount concern of
medical practice, regardless of its quality, is not reliable.
(c) Social limits of autonomy
One of the strongest objections to euthanasia is that autonomy must respect is
not liked by all. Even if it is assumed that respect for individual autonomy is
paramount, it only applies to socially empowered individuals or groups within
society. There can be serious problems with the application of this principle to
marginalized groups, and especially to individuals who may be exploited.
Legalizing euthanasia, according to some, ignores the social reality of
marginalized groups, and individuals who may be exploited by unscrupulous
relatives, or unscrupulous doctors.
It is an essentially utilitarian argument
that draws attention to the social consequences of legitimizing the practice. A
basic conflict of conflicts arises here. On the one hand, it is claimed by
personally inclined liberals that no one has the right to determine the duty to
live. Against this, it is argued by those who reject the individualist notion of
society that liberal individuals have no right to harm the social fabric of
society, thereby reducing the value of life within society. can do.
difference between these fundamental contradictions depends on the extent to
which the acts of self-destruction are self-sufficient or that they are
important social or political. We can distinguish individual acts, which
primarily affect the agent and those that affect others only minimally, from
social acts that significantly affect, and possibly harm others.
Mill's harm principle explicitly restrain permits a person's freedom to act in
cases where his acts disturb others. Opponents of euthanasia may claim that
individual acts of self-destruction, and medical assistance for such acts,
actually affect others and are therefore not purely self-relationships.
adversely affect the value of community life and reduce the culture of medicine,
to the detriment of all. Aruna Shanbag's right to die reduces the right of
others to live. Attitudes towards life are degraded and its serious value is
disregarded. The death of Aruna Shanbag, on this point of view, is not just
Pinky Virani's business, and we cannot appeal Mill's theory to privilege his
views on the matter.
At this point, the controversy about euthanasia is similar to another that comes
up in discussions of pornography and prostitution. Some women claim the right to
make professional use of their bodies as a matter of personal freedom. To that
end, it is answered that such choices do not affect them alone, but help shape
community attitudes about how women are perceived. In allowing themselves to be
seen or used as a sex object, they are promoting abusive attitudes towards all
Whether pornography and prostitution involve purely self-regarding options, and
how to balance competing views, is not noticeable here. I only want to note the
analogy and point out its consequences: especially to those who claim that
allowing euthanasia to be legalized has adverse social consequences, stressing
that Aruna Shanbag was supposed to live for the greater social good, no matter
how serious her situation may be.
(d) Palliative care and physician-assisted death
A helpful and helpful argument often used by opponents of euthanasia is the
claim that the practice is unnecessary because the relief sought by patients can
provide adequate palliative care. Perhaps in some cases, quality of life can be
improved by the efficient deployment of palliative care, but settlement is not
effective in all cases, as far as Aruna Shanbag was concerned, it was not good
(e) Ignorance and uncertainty objections
Another objection to allowing euthanasia is that this irreversible step should
be avoided as a miracle cure or spontaneous relaxation therapy can reverse the
misfortune. It cannot be for those who have chosen to end their lives
This suggestion is largely ineffective when investigating actual
clinical cases such as Aruna Shanbag. For Pinky Virani, nothing was more certain
that Aruna was in the worst position and could not be harmed further. In her
opinion, if she was able to speak for herself, one might share a strong desire
not to be remembered as a wreck of pain-severe incontinence.
(f) Virtue of life
The final objection to euthanasia is based on the claim that all human life is
sacred. As a simple unqualified claim, it is too strong to be taken seriously.
If it was accepted it would provide a powerful objection to passive as well as
active acts of euthanasia, and this result has been widely rejected. It is
generally believed that there is no serious moral objection to deteriorating
further medical treatment. In general, arguments about holiness and holiness
need to proceed with more ethical reasoning.
The related suggestion that termination of life is the prerogative of the deity
is equally irrefutable because divine demerits are conceived by various
religious authorities. It is not useful to be told that a verb transfers the
deities of the deity until we know what these prefixes are.
has recorded a large variety of religious opinions among Christian and
non-Christian denominations regarding the acceptability of euthanasia or
physician-assisted suicide. In general, there is no unified Christian, Jewish or
other denomination on the issue. The major problem with claims based on the
'holiness' or 'role of God' in life is that they serve as rhetorical devices for
rhetoric, rather than illuminating discussion.
(g) Double effect
Some opponents of euthanasia still allow it to be treated as a hasty death,
which would turn death into haste. It is popular, although not unanimous, that
aggressive doses of morphine are believed to shorten life in many cases. In a
scene when a patient's condition is sufficiently distressing, a doctor is
permitted to end the misery with a fatal overdose of the painkiller, but this
should be administered with the intent to relieving the pain. Although it is
also not intended to kill the patient.
Still, there is the foreseen unintended
consequence of killing the patient. The theory behind this idea is the doctrine
of double effect, which draws a sharp moral line between intention and which is
not only predictable but has no intention.
Those who apply the theory generally have strong confidence in its application.
It is a belief that is not universally shared. This particularly rests on an
ambiguous assumption that in analyzing a complex task with multiple consequences
(such as death and reducing pain) we can identify which of these outcomes are
intended and which are not intended but only predictions.
But how can we differentiate any task with complex or multiple consequences
(pain relief and killing a patient) that are not intended? While the doctrine of
double effect provides plausible reasons for distinguishing certain cases, there
are many others where it delivers without any clear or unanswered answer.
Ethically relevant differential operations in cases in which the doctrine of
double effect provides guidance.
There is a distinct difference between negative
duties that do not harm others and no less rigid positive duty to help others.
In general, people do not have the same duty to help as the other refrains from
injuring them. In fact, between intention and mere foreboding, the doctrine of
dual-effect appeal ruthlessly teased by Pascal in his brutal attack on some
conflicting uses of casuistry.
Pascal's attack on casuistical methods (moral reasoning through the use of
cases) as an instrument of moral reasoning is an intellectual tour de force of
such magnitude, which took more than three centuries for a serious attempt at
(h) The issue of power
An important issue that is important and embedded in the debate is the
empowerment of patients. According to which it took the form of power from the
medical profession to the patient, and the medical profession does not welcome
any change of power. There is a clear suggestion that physicians are inclined to
help their patients to end their suffering, but the time for fatal overdoses is
to remain square in medical hands. The nature of the medical profession itself
is evidence that reluctance to give strength to patients is a widespread feature
of medical practice.
Numerous claims indicate a tendency by physicians to
disregard patients' advance directives, indicating a reluctance of physicians to
assert power over their patients. In general, physicians indicated that they
would follow a patient's advance directive only if it conformed to their
clinical judgment and indicated that they would be able to diagnose treatment
regardless of the patient's request. Wanted to take a decision.
Nevertheless, sometimes it does not appear that the autonomous physician does
not have a case for exercising sovereignty over a dissatisfied patient because a
physician is the victim of too many social and cultural circumstances in which
the patient is subject to medical treatment. This appears to be the case for
example in the relief reported by a specialist, who failed to address the
objections of family members to futile surgery, which he proposed because he
felt that in the absence of such objections moral he was obliged to proceed.
This suggests that there may be cases in which physicians are acting against
both their wishes and against the wishes of patients and their relatives because
the parties are too reticent to express their preferences and too prepared to
submit to what they take to be the conventional expectation.
Perhaps such cases are examples of so-called defensive medicine
which are the excessive or
excessive provision of medical treatment to prevent any possible (moral or
legal) allegations of negligence. Whatever the reason, the complex and still
unresolved issues surrounding the euthanasia debate once again give paramount
importance to health professionals who provide their medical care for effective
communication of the hopes, values, and aspirations of patients.
Supreme Court decision
Dismissing Pinki Virani's plea for Aruna Shanbag's euthanasia, the court gave
guidelines for passive euthanasia. According to these guidelines, passive
euthanasia involves treatment or withdrawal of food that will allow the patient
Forms of active euthanasia, including the administration of lethal
compounds, are legal in many countries and jurisdictions including Luxembourg,
Belgium and the Netherlands, as well as the US states of Washington and Oregon,
are still illegal in India. Active euthanasia is almost always illegal anywhere
in the world. On the other hand, the legal status of passive euthanasia,
including nutrition or water withdrawal, varies among countries in the world.
India had no law regarding euthanasia, the Supreme Court has guidelines and laws
until Parliament passes the law. India's Minister of Law and Justice, Veerappa
Moily, called for serious political debate on the issue.
The following guidelines were set:
- The decision to discontinue life support should be made by parents or
spouses or other close relatives or in the absence of any of them, such a
decision is also taken by a body of individuals acting as one person or the
next friend can go. This patient can also be taken by the attending doctors.
However, the decision should be taken in the best interest of the patient.
- Even if a decision is made to withdraw life support by a relative or
doctor or next friend, such a decision requires the presence of two
witnesses and a count of a first-class judicial magistrate and also be
approved by a medical board Want a hospital.
Reference to Constitution Bench
On 25 February 2014, while hearing a PIL filed by the non-governmental
organization Common Cause, a three-judge bench of the Supreme Court of India
observed that the decision in the Aruna Shanbag case was based on a
misinterpretation of the judgment of Gian Kaur v. the State of Punjab
observed that the decision is inconsistent in itself, however, observing that
euthanasia can only be allowed by the legislature, yet it tends to meet the
guidelines. Therefore, the court has referred the issue to a constitution bench
which shall be heard with the strength of at least five judges. The Court
Because of the inconsistent opinions rendered in Aruna Shanbaug (supra) and also
considering the important question of law involved which needs to be reflected
in the light of social, legal, medical and constitutional perspective, it
becomes extremely important to have a clear enunciation of law. Thus, in our
cogent opinion, the question of law involved requires careful consideration by a
Constitution Bench of this Court for the benefit of humanity as a whole.
The Five-judge bench of the Supreme Court was tasked with deciding whether
Article 21 of the Constitution included in its ambit the right to die with
dignity through the implementation of the living wills/advance directives.
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