Life and death are inseparable. Every moment our bodies undergo change…
life is not disconnected from death. Dying is a part of the process of living.
- Justice D.Y Chandrachud
The word Euthanasia means a good death. Today there is growing debate
over the contention, whether people possessing similar rights such as the 'right
to life' and also 'right to die'. There is a divided opinion over this issue, as
some argue that life is to be continued in every manner possible - be it in a
natural or artificial one. The rest believe that it being a matter of individual
liberty, all of us are entitled to live and end our lives as and when we deem
According to these people, suicide like euthanasia should be morally
permissible. Due regard must be given to every cases of euthanasia before a
person's right to live and die a pain free life is denied. Whereas, it is
equally necessary that the state takes interest in the preservation and
protection of life, otherwise human life shall have no value.
According to the historian N.D.A Kemp, the origin of the contemporary debate on
euthanasia started in 1870. Euthanasia is known to have been debated and
practiced long before that date. Euthanasia was practiced in Ancient Greece and
Rome: for example, hemlock was employed as a means of hastening death on the
island of Kea, a technique also employed in Marseilles.
Euthanasia, in the sense of deliberate hastening of person's death, was
supported by Socrates, Plato and Seneca the Elder in the ancient world, although
Hippocrates appears to have spoken against the practice, writing I'll not
prescribe a deadly drug to please someone, nor give advice that may cause his
death (noting there is some debate in the literature about whether or not this
was intended to encompass euthanasia).
Early modern period
The term Euthanasia in the earlier sense of supporting someone as they
died was used for the first time by Francis Bacon (1561-1626). In his work,
Euthanasia medica, he chooses this ancient Greek work and, in doing so,
distinguished between Euthanasia interior, the preparation of the soul of death,
and euthanasia exterior, which was intended to make the end of life easier and
painless, in exceptional circumstances by shortening life.
That the ancient meaning of an easy death came to the fore again in the early
modern period can be seen from its definition in the 18th century Zedlers
Universal lexicon: Euthanasia: a very gentle and quiet death, which happens
without painful convulsions.
Forms of euthanasia
Euthanasia comes in several different forms each of which bring a different set
of rights and wrongs.
Active and Passive euthanasia In active euthanasia a person directly and deliberately causes the patient's
death. In passive euthanasia they don't directly take the patient's life,
they just allow them to die.
This is morally unsatisfactory distinction, since even though a person
doesn't 'actively kill' the patient.
Active euthanasia is when death is brought about by an act - for example
when a person is killed by being given an overdose of pain-killers.
Passive euthanasia is when death is brought about by an omission - i.e. when
someone lets the person die.
This can be by withdrawing or withholding treatment:
- Withdrawing treatment:
for example, switching off a machine that is keeping
a person alive, so that they die of their disease.
for example, nit carrying out surgery that will extend life for a short
Traditionally, passive euthanasia is thought of as less bad than active
euthanasia. But some people think active euthanasia is morally better.
Voluntary and involuntary euthanasiaVoluntary euthanasia occurs at the request of the person who dies.
Non-voluntary euthanasia occurs when the person is unconscious or otherwise
unable (for example, a very young baby or a person of extremely low
intelligence) to make a meaningful choice between living and dying and an
appropriate person takes the decision on their behalf.
Non-voluntary euthanasia also includes cases where the person is a child who
is mentally and emotionally able to take the decision, but is not regarded
in the law as old enough to take such a decision, so someone else must take
it on their behalf in the eyes of the law.
Involuntary euthanasia occurs when the person who dies chooses life and is
killed anyway this is usually called murder, but it is possible to imagine
cases where the killing would count as being for the benefit of the person
Indirect euthanasia This means providing treatment (Usually to reduce pain) that has side effect
of speeding the patient's death.
Since the primary intention is not to kill, this is seen by some people (but
not all) as morally acceptable.
A justification along these lines is formally called the 'doctrine of double
Euthanasia in India
Passive euthanasia is legal in India, on 7 March 2011 the Supreme Court of India
legalized passive euthanasia by means of the withdrawal of life support to
patients in a permanent vegetative state. The decision was made as part of the
verdict in a case involving Aruna Shanbaug, who had been in a President
Vegetative State (PVS) until her death in 2015.
In March 2011, the Supreme Court of India, passed a historic judgment-law
permitting Passive Euthanasia in the Country. This judgment was passed in wake
of 'Pinki Virani' plea to the highest court in December 2009 under the
Constitutional provision of Next Friend. It's a landmark law which places
the power of choice in the hands of the individual, over government, medical or
religious control which sees all suffering as Destiny.
The Supreme Court
specified two irreversible conditions to permit Passive Euthanasia Law in its
- The brain-dead for whom the ventilator can be switched off
- Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered
out and pain-managing palliative be added, according to laid-down international
The same judgment-law also asked for the scrapping of 309, the code which
penalizes those who survive suicide-attempts. In December 2014, government of
India declared its intention to do so.
However, on 25 February 2014, a three-judge bench of Supreme Court of India had
termed the judgment in the Aruna Shanbaug case to be inconsistent in itself
and has referred the issue of euthanasia to its five-judge Constitutional bench.
And on December 23, 2014, Government of India endorsed and re-validated the
Passive Euthanasia Judgment-law in a press release, after stating in the Rajya
Sabha as follows:
that The Hon'ble Supreme Court of India in its judgment dated
7.3.2011, while dismissing the plea for mercy killing in a particular case, laid
down comprehensive guidelines to process cases relating to passive euthanasia.
Thereafter, the matter of mercy killing was examined in consultation with the
Ministry of Law and Justice and it has been decided that since the Hon'ble
Supreme Court has already laid down the guidelines, these should be followed and
treated as law in such cases.
A big change is came as in year 2015 when Supreme Court of India has held that
right to die with dignity is a fundamental right. The Bench also held that
passive euthanasia and a living will also legally valid. The Court has issued
detailed guidelines in this regard. The right to life and liberty as envisaged
under Article 21 of the Constitution is meaningless unless it encompasses within
its sphere individual dignity. With the passage of time, this Court has expanded
the spectrum of Article 21 to include within it the right to live with dignity
as component of right to life and liberty.
The Bench also held that the right to live with dignity also includes the
smoothening of the process of dying in case of a terminally ill patient or a
person in Persistent vegetative state with no hope of recovery.
A failure to legally recognize advance medical directives may amount to
non-facilitation of the right to smoothen the dying process and the right to
live with dignity. Further, a study of the position in other jurisdictions shows
that Advance Directives have gained lawful recognition in several jurisdictions
by way of legislation and in certain countries through judicial pronouncements.
What is a living will?
A living will is a written document by way of which a patient can give his
explicit instructions in advance about the medical treatment to be administered
when he or she is terminally ill or no longer able to express informed consent.
Passive euthanasia, meanwhile, is a condition where there is withdrawal of
medical treatment with the deliberate intention to hasten the death of a
The very first case before the court on the issue of right to die was P.
Rathinam v. Union of India, AIR 1994 SC 1844, wherein the court stated that
right to life includes right to die, broadening the scope of article 21. Also,
section 309 that criminalizes suicide was held as a violation of article 21.
This case created hue and cry amongst the government which was against the idea
of decriminalizing suicide.
Aruna Shanbaug Case:
Marte hai aarzoo mein marne ki, Maut aati hai par aati nhi – Markandey Katju
Aruna Shanbaug was a nurse working at the King Edward Memorial Hospital, Parel,
Mumbai. On 27 November 1973 when she was strangled and sodomized by Sohanlal Walmiki, a sweeper. During the attack she was strangled with a chain, and the
deprivation of oxygen has left in a vegetative state ever since. She has been
treated at KEM since the incident and is kept alive by feeding tube.
of Aruna, her friend Pinki Virani, a social activist, filed a petition in the
Supreme Court arguing that the continued existence of Aruna is in violation of
her right to live in dignity. The Supreme Court made its decision on 7 March
2011. The court rejected the plea to discontinue Aruna's life support but issued
a set of board guidelines legalizing Passive Euthanasia in India. The Supreme
Court's decision to reject the discontinuation of Aruna's life support was based
on the fact that the hospital staff who treat and take care of her did not
support euthanizing her. She died from pneumonia on 18 May 2015, after being in
a coma for 42 years.
A five Judge Bench of Supreme Court in Gian Kaur v. State of Punjab, held both
euthanasia and assisted suicide not lawful in India and overruled the two Judge
Bench decision in P. Rathinam v. Union of India. The Court held that the right
to life under Article 21 of the Constitution does not include the right to die.
But later in Aruna Ramchandra Shanbaug v. Union of India & Ors. on 7 March, 2011
the Supreme Court held that passive euthanasia can be allowed under exceptional
circumstances under the strict monitoring of the Court.
The difference between
active and passive euthanasia is that in active euthanasia something is done
to end the patient's life while in passive euthanasia, something is not done
that would have preserved the patient's life. The difference between 'active'
and passive' euthanasia is that in active euthanasia something is done to end
the patient's life while in passive euthanasia, something is not done that would
have preserved the patient's life.
A five-judge bench, headed by Justice J. S. Verma, in Gian Kaur v. State of
Punjab (1996) 2 SCC 648 in 1994 had held that both assisted suicide and
euthanasia were unlawful. The bench stated that the right to life did not
include the right to die, hence overruling the two-judge bench decision in P. Rathinam vs. Union of India which struck down section 309 of Indian Penal Code
(attempt to suicide) as unconstitutional.
In the Gian Kaur case, the apex court held that Article 21 speaks of life with
dignity, and only aspects of life which make it more dignified could be read
into this Article, thereby pointing out that the right to die was inconsistent
In 2011, the top court had recognized passive euthanasia in Aruna Shanbaug's
case by which it had permitted withdrawal of life-sustaining treatment from
patients not in a position to make an informed decision. The Centre had opposed
recognition of 'living will' and said the consent for removal of artificial
support system given by a patient may not be an informed one and without being
aware of medical advancements. It had cited examples of various countries in
disallowing creation of living will by patients.
Since March 2018, passive euthanasia is legal in India under strict guidelines.
Patients must consent through a living will, and must be either terminally ill
or in a vegetative state.
Arguments against euthanasia
Eliminating the invalid:Euthanasia oppsers argue that if we embrace 'the right to death with dignity',
people with incurable and debilitating illness will be disposed from our
civilized society. The practice of palliative care counters this view, as
palliative care would provide relief from distressing symptoms and pains, and
support to the patient as well as the care giver. Palliative care is an active,
compassionate and creative care for the dying.
Constitution of India:'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 'right to life'. It is the duty of state to
protect life and the physician's duty to provide care and not to harm patient.
If euthanasia is legalized, then there is a grave apprehension that the State
may refuse to invest in health (working toward right to life). Legalized
euthanasia has led to a severe decline in the quality of care for terminally-ill
patients. Hence, in a welfare state there should not be any role of euthanasia
in any form.
Symptoms of mental illness:Attempts to suicide or complited suicide are commonly seen in patients suffering
from depression, schizophrenia and substance users. It is also documented in
patients suffering from obsessive compulsive disorder. Hence, it is essential to
access the mental status of the individual seeking for euthanasia. In classical
teaching, attempt to suicide is a psychiatry. Hence, attempted suicide is
considered as a sign of mental illness. Malafied intention: In the era of
declining morality and justice, there is a possibility of misusing euthanasia by
family members or relatives for inheriting the property of the patient.
Supreme Court has also raised this issue in the recent judgement. 'Mercy
Killing' in the hands of the noble medical professionals. Hence, to keep control
over the medical professionals, the Indian Medical Council (Professional
Conduct, Etiquette and Ethics) Regulations, 2002 discusses briefly in chapter 6,
Section 6.7 and it is in accordance with the provisions of the Transplantation
of Human Organ Act, 1994. There is an urgent need to protect patients from
unnecessary lawsuit. Law commission had submitted a report (no-196) to the
government on this issue.
Emphasis on care:Earlier majority of them died before they reached the hospital but now it is
converse. Now sciences had advanced to the extent, life of bringing back the
dead one. This phenomenon has raised a complex situation. Earlier diseases such
as cancer, Aids, diabetes, hypertension and mental illness are debated in terms
best 'CARE', since cure is distant. The principle is to add life to years rather
than years to life with a good quality palliative care.
The intention is to
provide care when cure is not possible by low cost methods. The expectation of
society is, 'cure' from the health professionals, but the role of medical
professionals become frustrated and the fellow citizen take extreme measures
such as suicide, euthanasia or substance use. In such situations, palliative and
rehabilitative care comes to the rescue of the patient and the family.
doctors do suggest to the family members to have the patient discharged from the
hospital wait for death to come, if the family or patient so desires. Various
reasons are quoted for such decisions, such as poverty, non-availability of bed,
futile intervention, resources can be utilised for other patients where cure is
possible and unfortunately majority of our patient's family do accordingly. Many
of the terminally ill patients prefer to die at home, with or without any proper
terminal health care.
The societal perception needs to be altered and also the
medical professionals need to focus on care rather in addition to just cure. The
motive for many euthanasia requests is unawareness of alternatives. Patients
hear that a lot can be done through palliative care, that the symptoms can be
controlled, now and in future, many do not want euthanasia anymore.
Commercialisation of health care:Passive euthanasia occurs in a majority of the hospitals across the county,
where poor patients and their family members refuse or withdraw treatment
because of commercial health sector will serve death sentence to many disabled
and elderly citizens of India for meagreamount of money. This has been
highlighted in the Supreme Court Judgement. Research has revealed that many
terminally ill patients requesting euthanasia, have major depression, and that
the desire for death was reported by 3 of the 191 advanced cancer patients, and
these had severe depression.
They need palliative and rehabilitative care. They
want to be looked after by enthusiastic, compassionate and humanistic team of
health professionals and the complete expenses need to be borne by the State so
that Right to life becomes a reality and succeeds before 'Right to death with
dignity'. Palliative care actually provides death with dignity and a death
considered good by the patient and the care givers.
Right to die:Many patients in a persistent vegetative state or else in chronic illness, do
not want to be a burden on their family members. Euthanasia can be considered as
a way to upheld the 'Right to life' by honouring 'Right to die' with dignity.
Encouraging the organ transplantation: Euthanasia in terminally ill patients
provides an opportunity to advocate for organ donation. This in turn will help
many patients with organ failure waiting for transplantation.
euthanasia gives Right to die for the terminally ill, but also 'Right to life'
by providing 'food, safe drinking water and health care'. On the contrary, the
state does not own the responsibility of promoting, protecting and fulfilling
the socio-economic rights such as right to food, right to water, right to
education and right to health care, which are basic essential ingredients of
right to life.
Till date, most of the States has not done anything to support
the terminally ill people by providing for hospice care. If the state takes the
responsibility of providing reasonable degree of health care, then majority of
the euthanasia supports will definitely reconsider their argument. We do endorse
the Supreme Court judgement that our contemporary society and public health
system is not matured enough to handle this sensitive issue, hence it needs to
However, this issue needs to be re-examined again after few years
depending upon the evolution of the society with regard to providing health care
to be disabled and public health sector with regard to providing health care to
poor people. The Supreme Court judgement to withhold decision on this sensitive
issue is a first step towards a new era of health care in terminally ill
patients. The Judgement laid down is to preserve harmony within a society, when
faced with a complex medical, social and legal dilemma.
There is a need to enact a legislation to protect terminally ill patients and
also medical practitioners caring for them as per the recommendation of Law
Commission Report-196 there is also an urgent need to invest in our health care
system, so that poor people suffering from ill health can access free health
care. Investment in health care is not a charity; 'Right to Health' is bestowed
under 'Right to Life' of our constitution.
In a concluding note, I would like to say that the right to have one's life
terminated at will is subject to social, ethical, and legal strictures. The
question that should euthanasia be legalized is not an objective question. It is
a subjective one which depends more upon the cases and circumstances.
If the process of natural death has started, you can only help in that process
on natural death. The person should be in a Permanent Vegetative State, or in
coma, or living with a dead brain. The consent to discontinue life support of
the patient should be must. If the patient is not in a state to give his
consent, then in that case a decision has t be taken either by the parents or
spouse or other close relatives or in the absence of any of them, such a
decision can be taken even by a person who is his next friend.
It can also be taken by the doctors attending the patient. However, the decision
has to be taken bona fide in the best interest of the patient. If a person who
has neither any relative nor any close friend and he is not in a state to give
his consent, then in that case the court would direct the expert doctors to
submit a medical deport of that person and court would look over it.
- Khanna Hans Raj, Making of India 's Constitution (Eastern Book Co. 1981)
- Ratan Lal and Dheeraj Lal, The Indian Penal Code as a Amended by
criminal law (amendment) Act, 2013 (Lexis Nexis, 34th edition, 2013)
- Dr. J.N Pandey, The Indian Constitution (Central Law Agency, 51st
- Basu, Durga das (1984), Introduction to the constitution of India (10th
ed. South Asia Books. ISBN 0-8364-1097-1).
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