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The struggle of Euthanasia in India

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:
  1. the brain-dead for whom there is no scope of returning to the normal state and the ventilator can be turned down.
  2. (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 and referred 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 Rajya Sabha.

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.

Arguments

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 ordinary and extraordinary 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 also).

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.

Should the 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.

A 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 be.

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 self-dignity.

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 unbearable intrusion.

(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.
  1. 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.
     
  2. 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.
     
  3. 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 in theory.

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.

If 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 applications.

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.

In 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 practice.

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 and just.

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.

The 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.

They 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 women.

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 enough.

(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 prematurely.

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.

For example:
Larue 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 its revival.

(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 to survive.

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.

As 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:
  1. 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.
     
  2. 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.

The court 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 observed:

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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