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In-Depth Analysis Of Euthanasia

Article 21 assures every person the right to life and personal liberty. Over the years it has come to light that the concept of Right to Life under Article 21 does not merely imply a physical right to live but it includes the ambit of the Right to Live with dignity. In addition to that, there have been distinctive observations by various Courts to imply that the right to life also implies that an individual has the right to die with dignity. On that note, the word Euthanasia has always been at the center of the debate of the right to live with dignity and the right to die with dignity.

With this article, I am trying to conduct an intense, holistic study on the subject of Euthanasia and, its legal aspects Moreover, I will not be limiting the study into the said arena of issues but there will be a certain amount of comprehension on the authority over which Euthanasia is depended upon, the intriguing dilemma in dealing with the provisions and implementation of Euthanasia as a medical practice, legal right, also, on a far-fetching note as a human right Keywords: Euthanasia, Right to life, Right to die, the dignity of life, Terminally ill, etc.

Introduction
Article 21[1] assures every person the right to life and personal liberty. Besides, the expression 'life' under Article 21 has been interpreted by the Supreme Court of India both liberally and broadly. In Kharak Singh V. The State Of U.P & Others,[2] Supreme Court stated that the word Right to Life under Article 21 does not merely imply a physical right to live but includes the ambit of the Right to Live with dignity.[3]

But at present, there is no precise definition for human dignity in the Constitution. However, the term dignity protects the civil, political, religious, and social rights of individuals. Human dignity means a state worthy of honor respect, equal status, and its inherent connection - mentally with human life, irrespective of caste, creed, sex, color and the status of the person.[4] But one of the important questions that arise in Common Cause vs. Union of India on 9 March 2018 was:
if a person has a right to life with dignity, he or she has a right to die with dignity?.

According to the landmark judgment of the Supreme Court in Common Cause vs. Union of India on 9 March 2018 was that the right to die with dignity is an intrinsic facet of the right to life under Article 21 of the Constitution of India. Also, in the Aruna Ramachandra Shanbaug V. Union of India and others (March 7, 2011)[5] case, Justice Mishra stated that everyone has a right to life, but at the same time, he or she has a right to die with dignity.

If he or she is unable to live with dignity because of prolonged illness from which he or she will not overcome. Then in such case, he or she has the right to die with dignity. It is at this moment the word "euthanasia" becomes significant because it grants dignified death to a person who is unable to live with dignity for they have prolonged illness from which, he or she will not overcome. But the relevant issue in the context of Article 21 is that right to live with dignity and the right t to die with dignity cannot coexist because granting the right to die means the ending of the life of a person.

Our Constitution did not give any definition or method to measure the dignity of life and its extent that mentioned under Article 21. It has also not explained who has the authority to decide, the dignity of a person's life. Moreover, euthanasia has always been a choice between the right to life and the right to die. So this research is dealing with the legal aspects of euthanasia in determining the dignity of a person's life, analyzing situations in which court can grant euthanasia and not grant euthanasia, euthanasia in case of patients who can't communicate, etc..

Research Methodology
For the making of In this paper, the researcher opted for the traditional Doctrinal research method for the completion of the paper. The author solely depended upon secondary data for collecting information on this topic. Some of the secondary sources referred to are books, articles, journals, websites, and so on.

Object of the Study
  1. To have a detailed analysis of the legal aspect of Euthanasia
  2. The main object of this project is to analyze the Concept of Euthanasia in the light of the right to live with dignity and the right to die with dignity under Article 21.
  3. To identify the measures and procedures was taken by the court to differentiate between the situations in which euthanasia can be allowed and euthanasia can't be allowed.
  4. To analyze the Guideline proposed by the court to prevent the misuse of Euthanasia.
  5. To evaluate and understand the Importance of dignity of life that guaranteed under Article 21 in terms of Euthanasia.

Research Questions/Hypothesis
  1. If Euthanasia is allowed only in a situation in which a person is unable to live a dignified life, which method is used to measure the dignity of a life?. Who has the right to decide the extent to which s person is unable to get back a dignified life?.
  2. What happens in a situation in which a person is unable to communicate? What is the importance of a living will in euthanasia?
  3. Whether euthanasia grants a dignified death to the patient and is euthanasia a solution for the absence of a dignified life?
  4. Why Only Passive Euthanasia is legal in India?. Active euthanasia or passive euthanasia is better for the patient?
  5. What are the measures taken to prevent misuse?
Limitation of the Research
  1. The complication in finding the primary source of data
  2. Absents of credible data related to the treatment of People in a vegetative state

Life Expectancy In Permanent Vegetative State
According to a special article that explaining the medical aspect of the persistent vegetative state published by the New England journal of medicine, probability of recovery of consciousness in a patient 12 month after a traumatic injury is exceedingly rare and always almost involve a severe disability.

Available data indicates that the mortality rate for adults in a persistent vegetative state after an active brain injury is 82% at three years and 95% in 5 years. Even though, few patients in a persistent vegetative state have undergone a verified recovery of consciousness, more than 12 months after a traumatic injury or more than 3 months after a non-traumatic injury.

Treatment
Therapy aimed at reversing the persistent vegetative state has not been successful. There has been an occasional report of a benefit from dopamine against or dextroamphetamine, but the benefit has been modest at best and there have been no blindfold studies. Direct electrical stimulation of the mesencephalic reticular formation, non-specific thalamic nuclei, or dorsal column has been attempted experimentally in patients in a vegetative state with claims of recovered consciousness in a few instances.

The quality of the recovered state was not described in detail however and these approaches remain experimental. Reports of improvement with comma situation programmer have been published, but there are no verified controlled studies reports in pre-reviewed journals. Overall, there is no published evidence that coma sensory stimulation improves the clinical outcome in patients in a persistent vegetative state.[6]

Even though there is less chance for the recovery of a patient 12 months after a traumatic injury, many people have shown the potential for recovery after many years. But one of the major issues faced in India is the limited development of medical science to find a solution for this other than euthanasia.

Euthanasia and Right to Die With Dignity
In the Common Cause vs. Union of India 9 march 2018 Case, Supreme Court states that the right to die with dignity is an intrinsic facet of the right under Article 21 of the Constitution. But the real question that arises here is that whether euthanasia helps in guaranteeing a dignified death or not and whether Euthanasia is a solution ?

If dignified death means a painless ending of the life of a person, euthanasia is not helping in guaranteeing a dignified life, because allowing a person to die by removing his or her life support or taking of their life by lethal injection is painful. If dignified death means, ending the suffering of a person who is unable to live a dignified life, euthanasia helps that person to die with dignity. But the real solution for lack of a dignified life is not the taking of life, but to take the necessary measures to bring back that dignity of life and euthanasia is just a last resort in a situation in which all other possibilities fail (proper treatment and palliative care).

Dignity of Life and Euthanasia
Article 21 assures every person the right to life and personal liberty. And in Kharak Sing V. State of U.P[7] Case, Supreme Court states that the expression right to life under Article 21 means not merely a physical right but includes the ambit of the right to live with dignity.

But in the Common Cause vs. Union of India case, the Court stated that the right to die with dignity is also an intrinsic facet of the right under Article 21 of the Constitution. So if a person is unable to live a dignified life because of prolonged illness from which they might not overcome, then they have the right to die with dignity. That means we can euthanize a person who is in a situation in which, he is unable to live a dignified life. But the problem is that there is no exact definition or method to measure the dignity of life.

The dignity of life varies according to the physical and mental health of the patient, his or her religious belief, viewpoint and so on. Some actions, a person believe to be dignified, may none dignify to another person. For example, there is a large population consider importuning as none dignified. But there are a lot of people they are begging their entire life to keep their family alive. So the concept of the dignity of life of a person is subjective and varies from person to person.

So the first person who has the right to decide the dignity of his or her life is the person itself, and no one should take away that life without his permission. But what happens in a situation in which a patient claimed that he is unable to live a dignified life and wants to die, but a medical practitioner certifies that there is still a chance for recovery. Euthanasia will not be allowed in that situation because euthanasia only allows in a situation in which a person lacks dignified life. So in the case of euthanasia, the person who should decide the extent to which a person is unable to get back a dignified life is the medical practitioner who treats him.

So if a patient gives consent for euthanasia and the doctor certifies that there is no chance of recovery, voluntary euthanasia can be allowed. But the Court should make sure that the consent made by the patient is free and, the judgment made by the medical practitioner is not under any influence.

Euthanasia and Patients Unable to Communicate
A patient has the right to choose between his life and death in a situation in which, that person is unable to live a dignified life. But what happens in a situation in which a patient who suffers from an incurable disease is unable to communicate his will?

Before answering this question, just imagine a situation that, a person who is in a persistent vegetative state wish to live but is unable to communicate his will is decided to be euthanized by his or her relatives. In this situation, those relatives are violating his right to life even though they are not aware of it. After that just imagine that another person who is in a persistent vegetative state wish to die but is unable to communicate, and his or her relatives decided not to euthanize him or her. In this situation, those relatives are clearly violating his or their right to die even though they are not aware of it.

So if a person made a choice for another person in a situation in which that person is unable to communicate, there is always a chance for violating either right to die or the right to live. So if a person needs to choose for another person, that should always be right to life because the right to life is a basic and important right for all human beings and the right to die is a less prescribed one that only allows in a special circumstance in India. Even though if there is a person who is entrusted by the patient(Friend or relatives), he can choose for the patient because he knows the patient's wish and viewpoints very much.

So if a person is in a persistent vegetative state and is unable to communicate, Non-voluntary euthanasia cannot be allowed unless there is a living will (euthanasia without the consent of the patient in a situation in which the patient is unable to communicate) or a person entrusted by the patient(only close relative or friend ) choose for Euthanasia.[8]

Euthanasia and Living Will
A living will also be known as a directive to physician or advance directives, is a document that allows people to state their wishes for end of life, medical care in case they become unable to communicate their decisions. It has no power after death.[9]

A living will outline your health care choices with many different medical scenarios.

The decision you need to make may include:
  1. Whether or not you want life-sustaining procedure withheld or withdrawn, if you are in a persistent vegetative state.
  2. Whether or not you want certain conditions to be met before life-prolonging care is withheld or withdrawn.
  3. Whether or not your consent to medical research or the donation of your organs. You may also include any unique or special request.[10]

Here, the patient gives consent before he becomes ill, even after understand that, his choice may change in a situation in which he becomes terminally ill. He or she can also suggest the conditions and situations. So we can allow passive euthanasia in case there is a living will.[11]

Active and Passive Euthanasia
Active euthanasia occurs when the patient dies because the medical professionals or another person deliberately do something that causes the patient to die and passive euthanasia occurs when the patient dies because medical professionals either don't do something necessary to keep the patient alive or when they stop doing something that is keeping the patient alive.[12]

But in India, passive euthanasia is legal and active euthanasia is illegal. The major reason or moral behind it is the difference between killing and letting die. But another side of the subject, we need to think that, when passive euthanasia exercise, it may become a lengthiest process and may cause discomfort and disturbance to the patient. But instead of passive euthanasia, active euthanasia grants quicker and cleaner death.

Euthanasia and It's Misuse
The legalization of Euthanasia may cause a higher chance of its abuse. So in the Common Cause V. Union of India[13] case, the Court set up some guidelines for exercising passive euthanasia and according to this guideline, passive euthanasia is only allowed in a situation in which there is free consent or living will be written by the patient.

If there is consent or living will, the treating physician of a terminally ill or patient undergoing prolonged medical treatment shall refer the matter to a medical board consisting of the head of the treating department and at least 3 experts from the fields of general medicine, cardiology, neurology, psychiatry, or oncology with experience in critical care with overall standing in the medical profession. The decision of the medical board shall be communicated to the jurisdictional collector who shall then constitute a medical board comprising the chief district medical officer of the concerned district as chairman and three expert doctors in the same field mentioned above.

The chairman of the medical board shall after taking consent of the executor of the advance directive or the guardian named therein shall communicate his decision to the jurisdictional judicial magistrate first class who shall then authorize the implementation of the decision of the medical board. The Court has also laid down the procedure for altering the advance directive and for cases where there is no advance directive. So as of now, it is very difficult to misuse the right to be euthanized because of its detailed and strict procedure to follow.

Conclusion
Article 21 of our Indian Constitution guarantees the right to life with dignity and the right to die with dignity to every citizen of India. But the right to die with dignity under Article 21 of the Constitution is not an absolute right and so it's only guaranteed in the special circumstances in which a patient is unable to lead a dignified life. So if a person who is suffering from a terminal illness or the person entrusted by him and also the doctor of a patient who treated him for a long time felt that, the patient is unable to continue a dignified life due to his terminal illness, he can be grant Euthanasia after following guidelines established in Common Cause V. Union Of India[14].

But even though, only passive form of Euthanasia is legalized in India due to the higher chances of its misuse. So allowing passive Euthanasia in special circumstances, only with the consent of the patient or the person entrusted by him and the doctor who treated him after following the complete guideline. It helps to grant a peace full and dignified death to a person who needs it and it also helps in preventing its misuse.

Suggestions
  1. If Court decided to guarantee Euthanasia to a patient after finding out that he/she is unable to live a dignified life, it is better to go for Active Euthanasia. Because, when passive euthanasia exercise, it may become the lengthiest process and may cause discomfort and disturbance to the patient. But instead of passive euthanasia, active euthanasia grants quicker and cleaner death.
  2. Euthanasia is not a solution for a lack of dignified life. The real solution for the lack of identified life is to bring back a dignified life and the only way to do that is to provide proper medical care. So India has to Concentrate on Research on patients who are in a vegetative state and they should try to find a Cure
  3. Court acquainted some guidelines to prevent the misuse. But Government should make sure that the guidelines and rules are followed.
End-Notes:
  1. Art.21 , The Constitution of India , 1950
  2. Kharak Singh V. The State Of U.P &Ors , 1963 AIR 1295,
  3. Right to life and personal liberty explained , Aparna Ramamoorthi , Visited On 9:30 am , Jun 7, 2020, https://www.legalbites.in/right-to-life-personal-liberty-article-21/
  4. Right to Life with Dignity , Salij Saroj, Visited on 10.00 am , Aug. 22, 2020, https://www.thehillstimes.in/featured/right-to-life-with-dignity/
  5. Aruna Ramachandra Shanbaug vs. Union of India & Ors , On 7 March, 2011.
    Passive Euthanasia now legal -Landmark Judgement by Supreme Court, Lalit Mohan Sharma, Visited on 10.15 am , Mar. 24, 2018 , https://www.news18.com/news/india/as-sc-recognizes-right-to-die-heres-a-look-at-living-will-and-right-to-die-1683977.html
  6. NEJM, Medical Aspect of the Persistent Vegetative State, Nejm , visited on 11.30 , June.2, 1994https://www.nejm.org/doi/full/10.1056/nejm199405263302107
  7. Kharak Singh V. The State Of U.P &Ors , 1963 AIR 1295, 1964 SCR(1) 332
  8. Common Cause V. Union Of India On 9 March , 2018
  9. How to make a Living will, Romain Coleman , visited on 2.30, Jull. 24, 2019https://www.romaincoleman.co.uk/wills-probate/how-to-make-a-will/
  10. Ibid
  11. Passive Euthanasia: What is Living Will and right to die? Here is a Look, Debayan Roy, Visited on 2.50, 18 Mar. 09, 2018https://www.news18.com/amp/news/india/as-sc-recognizes-right-to-die-heres-a-look-at-living-will-and-right-to-die-1683977.html
  12. What is Passive Euthanasia, Pro Corn Org, visited on 3.30, Dec.4, 2018https://euthanasia.procon.org/questions/what-is-passive-euthanasia/
  13. Common Cause V. Union Of India on 9 March, 2018
  14. ibid


    Award Winning Article Is Written By:
    1. Mr.Thomas Sebastian &
    2. Mr.Thomas P B
    Awarded certificate of Excellence
    Authentication No: SP123895944349-16-0921

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