Euthanasia comes from the Greek words, EU
.1 Bringing these together, Euthanasia means 'the good death'.
Euthanasia also called mercy killing, act or practice of painlessly putting to
death persons suffering from painful and incurable ailments or physical disorder
allowing them to die by withholding treatment or by withdrawing artificial life-
Euthanasia was first used in a medical context by Francis Bacon in
the 17th century, to refer to an easy, painless, happy death, during which it
A physician's responsibility to alleviate the 'physical sufferings' of the
Religious views on Euthanasia:
Islamic religious views are against Euthanasia. They believe that all human life
is Sacred because it is given by Allah, and that Allah chooses how long each
person will live. However, IMANA (Islamic medical association of America) says
that turning off life support for deemed to be in a persistent vegetative state
is permissible. This is because they consider all mechanical life support
procedures as temporary measures.
They are mostly against it. The arguments are usually based on beliefs that life
is given by God, and that human beings are made in God's image. Some churches
also emphasize the importance of not interfering with the natural process of
death. Life is a gift of God Christianity requires us to respect every human
In ancient India, under Hindu religion there are illustrations where to renounce
the body (kaya) for eternal gains and benefits in the search of God is supported
by monks. The making demand for death is advocated in such a situation where a
sick person is facing intolerable pain. Right to make a claim for death emanates
from the right to choose one's own way. Everyone is enriched with the right to
self-determination and is free to choose his way of living. Similarly, it is
advocated that everyone should have the right to end one's life when life would
become so panicked then it is easier to die in comparison to live alive. As such
death will give him relief from incurable disease and painful life. Euthanasia
was practiced since ages. With official permission, residents of Athens could
obtain a dose of poison which would allow them to choose death over suffering.
The controversy over Euthanasia differs from country to country and culture to
Most Hindus would say that a doctor should not accept a patient's request for
Euthanasia since this will cause the soul and body to be separated at an
unnatural time. The result will damage the karma of both doctor and patient.
Other Hindus believe that Euthanasia cannot be allowed because it breaches the
teaching of ahimsa (doing no harm).
Karma: Hindus believe in the reincarnation of the soul (or atman) through many
lives - not necessarily all human. The ultimate aim of life is to achieve moksha,
liberation from the cycle of death and rebirth. A soul's next life is decided by
karma, as the consequence of its own good or bad actions in previous lives. You
could regard a soul's karma as somehow representing the net worth of its good
and bad actions. A soul cannot achieve moksha without good karma.
The doctrine of karma means that a Hindu tries to get their life in a good state
before they die, making sure that there is no unfinished business, or
unhappiness's. They try to enter the state of a sannyasin - one who has
renounced the world.
The ideal death is a conscious death, and this means that palliative treatments
will be a problem if they reduce mental alertness. The state of mind that leads
a person to choose Euthanasia may affect the process of reincarnation, since
one's final thoughts are relevant to the process.
Hindus live their lives according to their dharma - their moral duties
and responsibilities. The dharma requires a Hindu to take care of the older
members of their community.
Types of EuthanasiaThere are four main types of Euthanasia:
- Active Euthanasia
Active Euthanasia is also known as mercy killing. It involves the
intentionally ending the life of the person either with the consent of the
patient or without the consent of the patient during incurable circumstances
where the possibility of taking consent of the patient is nil or almost nil.
Active Euthanasia is given to the patients who are incurable, and in severe
painful conditions at their deathbed. The aim of active Euthanasia is to
eliminate the agony and pain through means of death with the help of some
It is a crime under Section -302 or 304 of IPC in India.
- Passive Euthanasia
Passive Euthanasia is the intentional killing of the patient who is in
incurable condition as well as in severe pain by withdrawing or withholding
life-supporting means. Here ordinary and extraordinary means of life comes
into picture. Ordinary means of life means food, nutrition, hydration to a
person which are one's basic rights on the contrary extraordinary means are
the additional life support provided to the patient to keep them alive such
as medicines, drugs, and ventilatory support.
- Voluntary Euthanasia
Voluntary Euthanasia is the mercy killing of
the patient who is in in incurable condition and in severe pain by willingness
or autonomous cooperation of the patient. Voluntary Euthanasia is the mercy
killing of a patient in a terminally ill and incurable condition expresses a
serious request to be killed while still conscious.
- Non-Voluntary Euthanasia and Involuntary Euthanasia
When a person is unable to understand the decision between life and death,
then Euthanasia would not be voluntary, since
it has no ability to grasp the decision. The concerned person takes the decision
of mercy killing of the patients who re in severe pain and incurable terminally
ill on behalf of the patient. Whereas Involuntary Euthanasia occurs when a
person is able to give consent to their death but doesn't do so because either
they are not asked but still want to live.
Concept of living will
The concept of living will is associated with passive Euthanasia. A Living Will
is a legal document which allows an individual to express their wishes to
doctors in Case they become incapacitated. In this, one can outline whether or
not they want their life to be artificially prolonged in the event of
devastating illness or injury. However, Govt. didn't support it and said that
living wills could be misused and might be a threat to public health policy. J. Dipak Mishra said that a living will relieve the relatives of taking the painful
decision of advising doctors to withdraw life support from the patient.
The Medical Treatment of Terminally ill Patients (Protection of Patients and
Medical Practitioners) Bill, 2006 recognized the concept of living will but
doesn't make it binding on medical practitioners and says that it can't be
executed by any patients since it would be considered void.
In Maruti Shripti Dubal v. State of Maharashtra,
1987 (1) BomCR 499, the Bombay
High Court ruled that section 309 is unconstitutional as it violates Article 21.
The court observed that when the freedom to remain silent exists concurrently
with the freedom of speech and expression, there also exist a right to die
concurrently with the right to life; the desire to die is not unnatural and so
there exists a right to die.
In 1987, the decision of Andhra Pradesh High Court in Chenna Jagadeeswar v.
State of Andhra Pradesh
, AIR 1988 Cr.L.J. 549 contradicted the aforesaid
decision. The constitutional validity of Section 309 was challenged on the
ground of violating Articles 14 and 21. It was held that the said section was
not unconstitutional as it did not violate any of these articles.
Abrogating this decision, the division bench of the Supreme Court while
disposing of P Rathnam v. Union of India
, 1994 AIR 1844 held Section-309 as
unconstitutional and void for it violates Article-21. The court also observed
that the provision is cruel and inhuman as it once again punishes a person who
had already suffered agony and as a result of which that person attempted
This proposition was overruled in Smt.Gian Kaur v. State of Punjab
, 1996 AIR
946. The Supreme Court held that right to life is a natural right while suicide
is an unnatural extinction of life and therefore the latter is inconsistent with
the former. Aspects which are in accord with and will add on to life with
dignity can be read into Article-21 and not those which extinguishes it. The
court thus upheld the constitutional validity of Section 309.
However, as an
exception to this, the Apex Court in Aruna Ramchandra Shanbaug v. Union of India
, (2011) 4 SCC 454, upheld the validity of Passive Euthanasia,
assisted suicide, whereby the life support of a terminally ill patient is
removed or halted. So, as far as India is considered, right to life does not
include the right to die but provides for Right to Die with Dignity
which is facilitated
by Passive Euthanasia only in certain circumstances permitted with the leave of
the Supreme Court.
Legal Perspective In India
Aruna Shanbaug's Case, 2011The Incident in 1973
Aruna was a staff Nurse working in King Edward Memorial Hospital (KEM), Parel,
Mumbai. On the night of 27th November 1973, she was assaulted by a sweeper in
the doctor's facility who wrapped a canine chain around her neck and yanked her
back with it. He attempted to assault her however finding that she was
discharged, he sodomized her.
To immobilize her amid this demonstration he curved the chain around her neck.
The following day on 28th November 1973 at 7.45 AM, a cleaner discovered her
lying on the floor with blood all over in an oblivious condition. It is asserted
that because of strangulation by the pooch chain the supply of oxygen to the
cerebrum halted and the mind got harmed. This brought on unsalvageable harm to
her mind and pushed her into a Permanent Vegetative State.
Her nearby relatives
and her life partner relinquished her following a couple of years. From that
point forward, it is the staff of the KEM healing facility that has been taking
excellent consideration of their associate. They have been family to her
throughout the previous 40 years and treat her as one among them. The way that
she didn't build up a solitary bed-sore however she is on the bed for quite a
while is a declaration to their administration.
In 2009, one Ms. Pinki Virani of Mumbai documented a writ request in the Supreme
Court asserting to be Aruna's next companion. (In the lawful speech, a next
companion is a man who speaks to someone else who is under inability and not
able to choose for himself/herself and who has no legitimate gatekeeper).
In her request, she said that Aruna can't be said to be a living individual and
it is just by virtue of pounded sustenance which is put into her mouth that
there is a veneer of life that is absolute without any human component. She
additionally said that there is no probability of any change in her condition
and her body lies on the bed in the KEM Hospital like a dead creature, and this
has been the position throughout the previous 36 years. She implored that the
KEM healing facility powers be coordinated to quit bolstering Aruna and let her
pass on gently.
It is additionally to be noticed that the court acknowledged this request under
Article 32 of the Indian Constitution.
Supreme court decision
The Hon'ble Division Bench of the Supreme Court of India, consisting of Justice
Markandey Katju and Justice Gyan Sudha Mishra, delivered this historic judgment
on 7 March 2011. The Court argued that Aruna was not brain dead on the basis of
the doctor's report and the concept of brain death under the Transplantation of
Human Organs Act, 1994.
On 9th March, SC ruled that individuals had the right to
die in dignity, enabling Euthanasia with guidance. The need to amend the laws
on Euthanasia was prompted by famous Case of aruna shanbaug. In 2011, court
recognized that passive Euthanasia which enabled the removal of life-sustaining
care from patients who were not in a position to do so.
Common cause v. Union of India, 2018
(Right to die with dignity as a part of his/her Right to life and personal
liberty under Article -21)
A Constitution Bench decided that the right to life with dignity under Article
21 includes a right to die with dignity.
On 8th March, 2018 the Supreme Court delivered two concurring opinions:
Majority opinion authored by CJI Dipak Mishra on behalf of himself and Justice
AM Khanwilkar, Concurring opinion authored by Justice DY Chandrachud.
In 2002, Common Cause, a registered society had written to the Ministries of Law
& Justice, Health & Family Welfare, and Company Affairs, also addressing the
State Governments, on the issue of the right to die with dignity.
In 2005, Common Cause approached the Supreme Court under Article 32, praying for
the declaration that the right to die with dignity is a fundamental right under
Article 21. It also prayed the Court to issue directions to the Union Government
to allow terminally ill patients to execute 'living wills' for appropriate
action in the event that they are admitted to hospitals. As an alternative,
Common Cause sought guidelines from the Court on this issue, and the appointment
of an expert committee comprising lawyers, doctors, and social scientists to
determine the aspect of executing living wills.
Common Cause argued that terminally ill persons or those suffering from chronic
diseases must not be subjected to cruel treatments. Denying them the right to
die in a dignified manner extends their suffering. It prayed the Court to secure
the right to die with dignity by allowing such persons to make an informed
choice through a living will.
On 25th February 2014, a three Judge Bench of the Supreme Court comprising the
then Chief Justice P. Sathasiavn, Justice Ranjan Gogoi and Justice Shiva Kirti
Singh had referred the matter to a larger bench, to settle the issue in light of
inconsistent opinions in:
- Aruna Ramchandra Shanbaug vs Union of India & Ors.
- Gian Kaur vs State of Punjab (1996).
On 9th March 2018, a 5 judge bench comprising Chief Justice Dipak Mishra and
Justices A K Sikri, A M Khanvilkar, D Y Chandrachud and Ashok Bhushan held that
the right to die with dignity is a fundamental right. An individual's right to
execute advance medical directives is an assertion of the right to bodily
integrity and self determination and doesn't depend on any recognition or
legislation by a state.
- Eliminating the invalid:
Euthanasia opposers argue that if we embrace 'the
right to death with dignity', people with incurable and debilitating illnesses
will be disposed from our civilised society.
The practice of palliative care counters this view, as palliative care would
provide relief from distressing symptoms and pain, 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 the State to protect life and the physician's duty to provide
care and not to harm patients.
If Euthanasia is legalized, then there is a grave apprehension that the State
may refuse to invest in health (working towards Right to life).
Legalized Euthanasia has led to a severe decline in the quality of care for
terminally-ill patients in Holland. Hence, in a welfare state there should not
be any role of Euthanasia in any form.
- Symptom of mental illness:
Attempts to suicide or completed 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 assess the mental status of the individual
seeking for Euthanasia. In classical teaching, attempt to suicide is a
psychiatric emergency and it is considered as a desperate call for help or
assistance. Several guidelines have been formulated for management of suicidal
patients in psychiatry. Hence, attempted suicide is considered as a sign of
- Malafide 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. The Supreme Court has also raised this issue in the
recent judgement.. 'Mercy killing' should not lead to 'killing mercy' 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 Euthanasia 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 and also medical practitioners caring the terminally ill 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
can be prolonged but not to that extent of bringing back the dead one. This
phenomenon has raised a complex situation. Earlier diseases outcome was
discussed in terms of 'CURE' but in the contemporary world of 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 is to provide 'care'. Hence, Euthanasia for no cure illness does
not have a logical argument. Whenever, there is no cure, the society and 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. At times,
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 utilized 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
appropriate 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 from their doctors that 'nothing can be done
anymore'. However, when patients hear that a lot can be done through palliative
care, that the symptoms can be controlled, now and in the future, many do not
want Euthanasia anymore.
- Commercialization of health care:
Passive Euthanasia occurs in majority of
the hospitals across the country, where poor patients and their family members
refuse or withdraw treatment because of the huge cost involved in keeping them
alive. If Euthanasia is legalized, then commercial health sector will serve
death sentence to many disabled and elderly citizens of India for meagre amount
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 in terminal patients is
correlated with the depression.
- Caregiver's burden:
Right-to-die supporters argue that people who have an incurable,
degenerative, disabling or debilitating condition should be allowed to die
in dignity. This argument is further defended for those, who have chronic
debilitating illness even though it is not terminal such as severe mental
illness. Majority of such petitions are filed by the sufferers or family
members or their caretakers. The caregiver's burden is huge and cuts across
various domains such as financial, emotional, time, physical, mental and
social. Hence, it is uncommon to hear requests from the family members of
the person with psychiatric illness to give some poison either to patient or
else to them. Coupled with the States inefficiency, apathy and no investment
on health is mockery of the Right to life.
- Refusing care:
Right to refuse medical treatment is well recognized in law,
including medical treatment that sustains or prolongs life. For example, a
patient suffering from blood cancer can refuse treatment or deny feeds through nasogastric tube. Recognition of right to refuse treatment gives a way for
passive Euthanasia. Many do argue that allowing medical termination of pregnancy
before 16 weeks is also a form of active involuntary Euthanasia. This issue of
mercy killing of deformed babies has already been in discussion in Holland.
- 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 honoring '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. Not only
Euthanasia gives 'Right to die' for the terminally ill, but also 'Right to life'
for the organ needy patients.
Constitution of India reads under Article-21 Right to life
is in positive
direction of protecting life. Hence, there is an urgent need to fulfil this
obligation of Right to life
by providing food, safe drinking water and health
The courts in India, have taken a long time, from the Cases of Gian Kaur, Aruna
Shanbaug, to the Case of Common cause (a regd. Society), in recognizing and
legalizing the Euthanasia, and have legalized passive Euthanasia. It is the duty
of the family to see the social and psychological condition of the frustrated
person. Our state India being a social welfare state is interested with the duty
to take suitable steps.
The real alternative to Euthanasia is to provide loving, competent care for the
dying. A new concept for the dying arose in England, where institutions called
Hospices specialize in compassionate, skilled care of the dying. This concept
has spread throughout the Western world. Once a patient feels welcome and not a
burden to others, once his pain is controlled and other symptoms have been at
least reduced to manageable proportions, then the cry for Euthanasia disappears.
Proper care is the alternative to it as soon as there is adequate instruction of
medical students in a teaching hospital.
- Right To Death
Euthanasia in India
In-Depth Analysis Of Euthanasia
Right To Die - To Be Or Not To Be
Euthanasia: A Human Rights Perspective
Euthanasia and Human Rights - Euthanasia illegal in India
Constitutionality Of The Right To Die - A Brief Analysis
A Critical Analysis Of Mercy Killing: A Good Or Harm To Humanity