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Euthanasia

"Dying can be a peaceful event or a great agony when it is inappropriately sustained by life support." - Roger Bone.

Each individual wants to lead his or her life to the fullest degree possible and for a lengthy period of time. However, in certain cases, the relatively similar individual chooses to take his own life. If an individual decides to terminate his or her own life, he or she has two options - suicide or euthanasia. While the first is prohibited in India, the second is a fiercely disputed subject.

Physicians are increasingly concerned about compassionate care and services concerns in patients with incurable illnesses such as advanced cancer or even AIDS. Euthanasia or mercy killing of chronically sick individuals has also emerged as a hot-button subject. Advocates of physician-assisted suicide (PAS) argue in favor of a person's right to die without suffering.

Critics assert that a physician's participation in a patient's death is a violation of the medical profession's basic precept. In addition, the likelihood of undetected depression & societal 'coercion' in those who request euthanasia raises other ethical questions. As a result of these issues, the PAS implementation process now has tight requirements. Psychiatrists play a vital role in assessing the mental health of those who agree to undergo PAS. There are many proponents for the practice of palliative care in our nation, including non-profit groups like the dying with dignity initiative.

When translated, euthanasia implies merciful death, since the Greek words for eu and Thanatos (death) are combined. Lawfully & medically, mercy killing is classified as 'the conduct of aborting or eliminating the person's life whose suffering out of an irreparable condition or circumstance that is exceptionally agonizing. In general language, euthanasia denotes purposeful execution by an action/omission of anyone whose existence is considered is not being honorable.

Merriam-Webster defines it as:
The deed or practice of murdering or allowing to be killed irredeemably unwell or damaged persons for the sake of humanity.

Another term for it is mercy killing. Victims are put to death in accordance with this practice if they or anyone on their account accepts dying for themselves, generally due to their health circumstances. Because of the victim's terminal sickness and unbearable agony and torment, it is performed solely to finally put a conclusion to his or her life.

Types Of Euthanasia:

  • Physician-Assisted Suicide (PAS):
    Assisted suicide occurs if a physician purposefully offers a patient medicinal help in order to end their life because of their extreme pain and grief. Victims' health conditions are thoroughly examined by the physician before he or she decides on an appropriate method of dying
     
  • Voluntary Euthanasia:
    Assisted suicide occurs while an individual (patient) decides to take his or her own life using the help of someone else. The notion and technique implemented must be fully agreed upon, consented to as well as understanding.
     
  • Non-Voluntary Euthanasia:
    An individual's (patient's) lifetime is terminated by somebody else's will, perhaps with a close relative or a spouse.
     
  • Active Euthanasia:
    The physician has the authority to terminate a person's life at any time. The physician may recommend a hassle-free method of terminating a human's life straight to the patient. Death via fatal injection or medication overdose is rapid than consuming a deadly amount of the substance. Approval is by far the main crucial consideration.
     
  • Passive Euthanasia:
    Through restricting or denying vital treatment (such as a ventilator), nourishment or drink, it is characterized as purposefully triggering the killing of a patient. In this case, the patient's mechanical intensive care equipment is also removed as part of the procedure. It's only utilized if the subject has lost all mental and physical faculties. In cases of brain death, passive euthanasia is often the very common form of euthanasia.


There are certain types of euthanasia coined by the Senate Selection of Bills Committee.
The aforementioned are included:

  • Active Voluntary Euthanasia:
    If a patient requests the use of clinical assistance to bring a conclusion to their lifetime.
     
  • Passive Voluntary Euthanasia:
    In the event that a patient's healthcare is discontinued or held at the patient's desire to die.
     
  • Passive in non - voluntary Euthanasia:
    In the means to bring a halt to the patient's suffering, medical treatment and intensive care may be ignored or withdrawn against their permission.
     
  • Active in non - voluntary Euthanasia:
    When one patient's life is ended by therapeutic assistance with no patient's permission.


Suicide v/s Euthanasia:

Suicide & euthanasia are conceptually separate. Whether by injuring, intoxication or just about any method, a guy commits suicide. There is zero question that suicide is a deliberate act on the part of the person who commits it. When someone commits suicide, they usually do this because they are depressed or because they are unhappy with their life for any number of circumstances (as with a bad relationship or a lack of success in life or most of the time financial related issues).

Euthanasia, from the other side, involves another individual taking measures to stop the existence of another individual. A 3rd Party is either directly or indirectly engaged in euthanasia, i.e., he assists or authorizes the death of another individual. Within that perspective, it's also worth noting that assisted suicide & euthanasia are not interchangeable terms. In order to perform assisted suicide, one provides another person the tools to end his or her life.

Doctor Aided Suicide
refers to a therapist's role in assisting a victim's death by prescribing fatal drugs. Such that, in assisted suicide, the victim is the one who actually commits suicide, and so has an entire choice over how and when the process ends. Another individual is just there to assist. Euthanasia, but on the other side, can be passive or active, as in the case of a physician administering a deadly dosage or terminating a person's life-sustaining mechanism.

History Of Euthanasia

When we go back in time, euthanasia had not permeated this many sectors. Suicide & assisted suicide were common practices in ancient Greece and Rome, and there was no cultural stigma associated with them. Until that point in time, the clinical field had not developed to its current level of sophistication and had not been considered a dignified calling.

Furthermore, the current campaigning for this issue is grounded on the historical Grecian as well as Latin scriptures' notions of liberty & personal freedom.

The theological teachings of Christianity & Judaism throughout the Common Period provided the very first major obstacle to euthanasia practice. Christianity believes that human life is a present from the Divine and one should embrace it to the fullest extent possible.

Euthanasia is indeed opposed by Muslims, which believe that lives are holy and only Allah may determine how much a person should live.

Srutis, Smritis, Vedic, Upanishads, Puranas, Bhagavad Gita, Mahabharata, & Ramayana as well as various religious and ethical works of Indians will have to be respected from birth to demise by the masses. The teachings of Hinduism appeared to advocate self-destruction & conscience. Self-liberation may be achieved also in the face of a deadly sickness, according to Manusmriti.

Dharma, Arth, Karma, & Moksha are the four major concepts of Hinduism. It is the 4th and last conviction, Moksha, that brings a conclusion to every misery as well as the loop of demise & resurrection that follows:
first 3 beliefs aid in achieving this desired outcome; and that it's the ultimate faith, Moksha, that brings an ending to the sequence of birth & death that follows (reincarnation).

Reincarnation is highly held in Hinduism and dying is merely seen as the spirit discarding its older self to get a fresh body. As a result, according to Hindu teachings, it is perfectly acceptable to end one's personal life under specific conditions. Surayu River is reputed to have been where Lord Rama & his sibling Lakshmana were said to have taken Jal Samadhi. Moreover, Satguru Sivaya Subramuniyaswami took up the practice of Prayopavesa, or abstinence till death, in Nov of that year (back in 2001).

Enlightenment under Hinduism is permitted, but it must be accomplished at a specific time. If an individual is severely disabled with no hope of a cure, religious books, the Vedas, and so forth indicate that he or she might attain release from the cycle of samsara by pursuing death.

Certain Indian faiths, such as Jainism & Buddhism, also allow various forms of euthanasia. When Jainism arose about the 6th century BC, it included a belief in reincarnation & ultimate freedom as well During the 5th century BC, Buddhism, founded on the principles of Gautama Buddha, taught the doctrine of samsara (the cyclical nature of life & death) and thus the final purpose of life, escape from samsara.

Euthanasia In India

Passive Euthanasia: Legal
Active Euthanasia: Illegal
Physician-Assisted Suicide: Illegal

When it comes to rituals & practices, Indians take them extremely seriously and adhere to them with a strong sense of devotion. There are many faiths in our country, however, euthanasia isn't one of those Therefore, implementing a policy that might offend the sacred sensibilities of the large percentage of these faiths shouldn't be an attractive concept.
Through the Indian portion of civilization that likes hoaxes, legalizing euthanasia might be abused to its full extent.

Taking away medication or life-supporting equipment was made permissible by the Apex Court on March 7, 2011, in the landmark Judgment of Aruna Ramchandra Shaunbag v. Union of India[1]. In the very same judgment, the prohibition of active euthanasia was reassured. As long as Assembly does not establish a bill in this area, the Judge's order is the supreme law.

Aruna Shanbaug, a nurse who had been suffocated and brutally molested in 1973, has been the subject of the Ruling of the supreme court of India. Shanbaug was paralyzed after the incident. "Long term survival of Aruna is in infringement of her freedom to live in dignity", Pinki Virani said in her lawsuit against Shanbaug's life backing, which Shanbaug's colleague lodged. The institution where Shanbaug was being treated had not complied to turn off her medical assistance.

Passive euthanasia was ruled legal by the Supreme Court, which supported health care workers. Even just a parent, a partner, a direct family member, or a best friend (in the absence of family members) might stop a life-sustaining medication, according to the Justice. The medical personnel, not Virani, according to the Law, was the "next acquaintance" in line to take the call. Aruna Shanbaug, who had been in a slumber for 42 yrs., perished to pneumonia on May 18, 2015.

The scenario was different in the past, because even when passive euthanasia was illegal in India. Exception 5 of S.300 of IPC applies to physicians who induce euthanasia because they have the required purpose to induce patient's death affected; in instances of voluntary euthanasia, as there is a reviewed and accepted, the said physician, or other such individual resulting euthanasia, would've been punished for culpable homicide not amounting to murder u/s. 304 of the IPC.

There are certain exceptions, such as in circumstances of assisted dying, in which an 18-year-old victim provides his or her permission to a doctor's decision to end his or her life. Involuntary & involuntary euthanasia isn't included because of the 1st proviso of S.92 of IPC, which prohibits such practices. In India, it is a criminal to actively end someone's life through lethal injection.

Everyone in India is guaranteed this privilege under Art.21 of the provision of the constitution. If the freedom to live also involves the choice to end? the citizens of the nation started to wonder. This sparked a huge discussion on the notion as well as its applicability in India. Human liberties, as well as the constitutionality of specific provisions, were at the center of the 2 situations M.S. Dubal v. the State of Maharashtra (1986)[2] & Chenna Jagadeeswar v. state of Andhra Pradesh (1987)[3]. On the Liberty of Life encompasses the Choice to End issue, the two instances are at odds.

On both the good and bad sides of the liberties offered to the citizens, the disagreement occurred in M.S. Dubal v. State of Maharashtra (1986). At issue was whether or whether a person's liberty to life also includes the freedom to not survive.

"People who commit suicide because of psychological syndromes need psychological therapy, not jail bars wherein the status is sure to deteriorate, resulting to further psychological instability," the judge said. Nursing facilities rather than jails should be used to deter all who try suicide because of severe medical symptoms, terminal illnesses, trauma, or the deteriorated physiological state created by older aging or disability.

The trial statement on the freedom to live in dignity would be as observes:
This phrase life is utilized to refer to anything deeper beyond the sheer presence of animals. The resistance to its loss spreads to every one of life's boundaries & capacities. "By the word privilege, more than just simple independence against physical intervention or jail ties is intended," the law reads. "By the phrase, disability, such as in this clause more than just simple free from physical intervention or jail bonds is implied."

However, in the other instance, the High Court of Andhra Pradesh ruled that Section 309 of the IPC, which criminalizes the conduct of suicide, is legitimate.

Cases like P. Rathinam vs Union of India (1994)[4], which authorized assisted suicide, sparked this argument more. In Gian Kaur v. State of Punjab (1996)[5], it became determined that Article 21 cannot contain the liberty to die or be executed, which was subsequently disputed.

Justice J.S. Verma presided over the 5 - Judge panel that overturned Section 309 of the IPC, 1860 in Gian Kaur v. the State of Punjab. The ruling held that A.21 of the Constitution of India only recognizes a person's right to life and nothing else, including a person's right to die. Due to such a judgment, assisted suicide & passive euthanasia was deemed illegal.

On many forums, people were debating this issue, and soon the Supreme Court with its 5 - Judge bench noted that euthanasia is relevant and that a person's right to life might be defined as their right to a dignified life as well as value. As a result of this long-awaited decision, the discussion for the legalization of passive euthanasia has penetrated our culture, but mostly in cases when the patient is critically unhealthy and medical life treatment has been removed from the victim.

The Law Commission made several suggestions in its findings as a result of historic instances like these.

A famous issue concerning euthanasia, Common Cause v. Union of India (UOI)[6] and Ors., ruled that the freedom to die with dignity is an inalienable human privilege, and the Apex Court agreed. Mentally stable adults could reject or choose not to accept healthcare services if they are mentally sound. It is possible that he will choose to die a slow death rather than seek therapy.

While examining Manu's code and legal commentary, it was noted in the 42nd Report that suicide should be accepted as a legitimate option for those who are sick or otherwise miserable in their lives. According to Vedic writings, those who leave earthly desires and give up their self-centeredness are those who will attain redemption. It was of the opinion that suicide's statutory prohibitions were oppressive and unjustified.

In 1997, its 156th Law Commission's report affirmed the legality of criminalizing suicide and credited medical research and the law for their role in the process. Moreover, it bolstered the claim that widespread social ills including drug smuggling, violence, and many who tried suicide as a result of such occurrences were backed by the verdict in Gian Kaur, as was the legality of that section's Penal Code.

When the Law Commission issued its 210th report in 2008, it suggested that Section 309 of the IPC, which punishes those who self-harm, be repealed. IPC modifications were also presented.

The former statute was repealed and the Attempt to Suicide part was decriminalized under the new Mental Healthcare Act, which was signed into law in 2017. According to Section 115 of the Act. S.309 of the Indian Penal Code does not apply to those who attempt to take their own lives; thus, they will not be prosecuted or penalized within this Law. The state has a responsibility to offer therapy and support to an individual to lessen the likelihood of another suicidality.

As long as the physician doesn't really induce the patient's death, passive euthanasia is legal, as long as the physician doesn't really halt the patient's therapy or disable the patient's life-support apparatus. Indian courts acknowledge active euthanasia in which fatal or overdosed medication is administered to the sufferer and injected into the system, as an acceptable form of euthanasia, at least for the time being.

It is the opinion of the law that a physician could not be penalized for failing to save a patient. When one considers the definition of act, one must remember that an act comprises not just appropriate behaviors by a criminal, but it also any and all exclusions of the statutory responsibility that one must carry out in accordance with the law. If someone fails to carry out a constitutional responsibility that is owed to them by statute, then they must be penalized for it.

Euthanasia In Other Countries

China:

According to the People's Republic of China's Criminal Justice system, euthanasia & physician-assisted suicide are both illegal under A.232 & A.233 of the law:
As per A.232:
That whoever purposefully intended to commit murder will be given the death penalty, life sentences, or rectified confinement about not just under ten yrs. if the situations are comparatively small, he will be sentenced to set detainment of not below 3 years but not that much than ten years.

As per A.233, "Unless the grounds are insignificant, the penalty can be neither over than 3 years set detention, other than what is explicitly established in this Article."
"Although a number of National People's Congress (NPC) lawmakers suggested euthanasia measures in March of 1994, they also weren't enacted. It was in March 2007 when a lady with neuromuscular disorders made her request for euthanasia laws aired live on TV at the time of NPC's annual meeting."

Russia:

This On Health Care of Russian Citizens law, enacted in 1993, explicitly prohibits euthanasia.

Canada:

Assisted suicide & euthanasia are illegal in Canada; however, sufferers could decline life-sustaining care. Canadian Supreme Court in Rodriguez v. Attorney,1994 General of British Columbia stated that the public's interest would triumph above the individual stand in the situation of voluntary euthanasia.

USA:

Passive euthanasia is separate from active euthanasia. Clients may ask that doctors suspend or remove life-sustaining care from them, however, surgeons are still not considered accountable if they're on their own or on behalf of the patient's legal agent. By virtue of the Supreme Court decisions in Vacco v. Quill and Washington v. Glucksberg, it is now unlawful in the USA to end the life of an individual.' 'Oregon, a jurisdiction in the United States, became the first jurisdiction to authorize physician-assisted suicide in 1994 when it passed the Death & Dignity Act. Assisted suicide became allowed in California in April 2005, making it the second jurisdiction to do so.

England:

'Given terms of the autonomous & conscience privileges, Lords, an individual has the power to withhold life-sustaining therapy. Non-voluntary euthanasia for people in a chronic paraplegic condition was also allowed by the British parliament. In addition, a British High Court recently awarded the choice to end by turning off a patient's life-supporting mechanism to a lady who was paralyzed mostly from the neckline down.'[7]

UK:

However, the Royal College of Obstetricians and Gynaecologists in the UK proposed a solution to the Nuffield Council on Bioethics on November 5, 2006, asking for a review of allowing the euthanasia of handicapped newborns.

France:

French Parliament enacted a bill on January 27, 2016, allowing physicians to anesthetize fatally sick people till they die of their sickness or famine. As a resolution, French President Francois Hollande advocated for the creation of the bill.

Germany:

Physician-assisted suicide conducted on a case by case basis from our humanitarian motivations" became allowed in Germany on November 6, 2015. "Suicide business", or commercialized euthanasia, are both prohibited terms. Before the 2015 act, physicians could administer lethal amounts of painkillers to hasten to die. After a Supreme Court ruling on 26.02.2020, sufferers would be able to obtain expert assistance in ending their lives.

Israel:

Physician-assisted suicide & active euthanasia is prohibited under both Israeli as well as Jewish law. Jewish law prohibits "Passive Euthanasia", however, the Tel Aviv District Court on December 9, 2014, ruled in favor of allowing it. Passive euthanasia has been proposed in Senate, but then other "Physician Aided" or "Sabbath clock" legislation has yet to be enacted.

Arguments For Euthanasia
For

  • The term Euthanasia refers to the act of putting an end to the life of someone who is struggling from a fatal condition and whose quality of existence has become so wretched that it is not good enough to justify continuing. However, the issue is how to determine when one's existence is still fit to live or otherwise. As a result, the phrase "Euthanasia" has a great deal of connotation. The question of if euthanasia must be legal has indeed been debated for a great period.

    There is currently more discussion about active euthanasia over passive. Disagreement abounds over the fact that the objectives of social & personal are in direct opposition to one another. Whether any of these options must be prioritized? 'Euthanasia proponents argue that patients' wishes must be respected. Weighing societal ideals against personal interests, however, reveals that the interests of individuals triumph over those of the community.

    Instead of focusing on the interests of persons, civilization is built to ensure that everyone has a respectable & pleasant existence. Obviously, the best interests of the person in excruciating agony can be compromised if he or she is unable to make an informed decision. If such is the scenario, this should constitute a denial of his basic humanity as well as his entitlement to life.
     
  • A person's unbearable torment can be alleviated by euthanasia. It alleviates the suffering of those who are nearing the end of their lives.
     
  • Forcing someone to reside in an inconvenient manner goes over their will and goes even against the core of human life. As a result, it conveys an individual's essential decision.
     
  • It is apparent that A. 21 of the Constitution of India guarantees the right to a dignified existence. Life must be lived that have at most some respect, and those who drop beyond that threshold must be allowed to terminate their lives. The advocates of euthanasia further argue out that since passive euthanasia is already legalized, and thus must active euthanasia. Unless an affected person is in excruciating misery would he decide to terminate his life, since he prefers a peaceful death to a daily existence of torment & misery? In this scenario, allowing the terminally ill patient peacefully is a preferable option out of a moral standpoint as he or she already understands that he or she will end up dying from that untreatable disease.
     
  • Its goal is to help individuals that are struggling from terrible and severe illnesses by placing them out of their misery in a peaceful manner. As a result, the goal here is to provide assistance instead of doing damage.
     
  • For both the sufferer and his or her loved ones, it eases both their physical and emotional anguish.
     
  • It is a common criticism of proponents of euthanasia that severely disabled persons may abuse the choice to end if it is given. Because all privilege has a chance of misuse, the proponents say it's wrong to deny it to those who deserve it. It's better to focus on the positive aspects themselves than the negative ones.


Against

  • In India, trafficking organs is not a new phenomenon. Following non - voluntary euthanasia, physicians may be eagerly expecting the protracted victims to pass, so they get some funds by illegally committing such crimes.
     
  • When a baby is conceived with a specific disability or a blemish, it is common. When a baby's family doesn't want to care for him or her, they might take up the mantle of euthanasia to terminate the helpless child's life, which makes a joke of the compassionate policy that was put in place for that purpose.
     
  • According to persons who are influenced by the erroneous ideas of tantric & mystics, people might use the authorization of terminating the life of a patient despite his agreement, as non-voluntary euthanasia, to devote them as a ritualistic offering.
     
  • The delivery of a woman or girl is still considered undesirable by certain individuals, which belief it to be a strain or indeed a bane. By triggering a big tragedy or catastrophe that might force her to go into a persistent paralytic condition early age or further on, bring her death by non-voluntary euthanasia.
     
  • The abuse of euthanasia might occur as well if the family of the patient commits some harm in addition to securing certain assets as well as a getaway of an ailing relative, thereby avoiding the costs of his maintenance.
     
  • As a society that places great value on its customs & beliefs, Indians adhere to their values, whether they are traditional or spiritual, with great fervor. There are many faiths in our country, and euthanasia isn't one of them. So, implementing a policy that might offend the emotional feelings of the mass of these faiths wouldn't be an amazing option.

Conclusion
Despite the fact that euthanasia is currently allowed in several nations throughout the planet, legalizing it's not really a particularly popular notion. It has taken a while for the Indian courts to recognize & approve euthanasia, starting with the trials of Gian Kaur, Aruna Shanbaug, and Common cause (a registered society).

Every individual must regard & adhere to the rulings made by the Constitutional Court because it is the highest authority of jurisprudence, as well as the panel considering the issues is extremely knowledgeable & smart. There has recently been a lot of discussion about the legality of assisted suicide in several nations and this judgment is welcomed.

For now, the practice of active euthanasia is still not permitted, and perhaps it would not be applied in the long term either. The authorization of euthanasia will do more harm than good to the persons upon whom it's been implemented.

References:

  1. Sinha, V. K., Sarkhel, S., & Basu, S. (2012). Euthanasia: An Indian perspective. Indian Journal of Psychiatry, 54(2), 177. https://doi.org/10.4103/0019-5545.99537
  2. Gupta, A. (2020, November 28). Euthanasia Indian View. SCC Online Blog. Retrieved from https://www.scconline.com/blog/post/2020/11/28/euthanasia-indian-view/.
  3. Pranav, N. (2021, August 2). Euthanasia in India - Legal and Social aspect. Lexlife India. Retrieved from https://lexlife.in/2021/08/02/euthanasia-in-india-legal-and-social-aspect/.
  4. Khan, Z. A. (2020, May 16). Euthanasia in India: Legal aspect. iPleaders. Retrieved from https://blog.ipleaders.in/euthanasia-india-legal-aspect/.
  5. Krishanu. (n.d.). Euthanasia in India. Legal Service India. Retrieved from http://www.legalservicesindia.com/article/787/Euthanasia-in-India.html
  6. Trivedi, U. (2020, July 3). Euthanasia: Should it be legalized in India? Latest Laws.com. Retrieved from https://www.latestlaws.com/articles/euthanasia-should-it-be-legalized-in-india.
  7. Roy, C. (2011, July). Position of Euthanasia in India - An Analytical Study. Research Gate. Retrieved from https://www.researchgate.net/publication/259485727_POSITION_OF_EUTHANASIA_IN_INDIA_-_AN_ANALYTICAL_STUDY.
  8. Inbadas, H. (2018, March 23). 'Passive euthanasia is legal in India: what difference does it make? End of Life Studies. Retrieved from http://endoflifestudies.academicblogs.co.uk/passive-euthanasia-is-legal-in-india-what-difference-does-it-make/.
  9. Euthanasia & Physician-Assisted Suicide (PAS) around the World. Britannica ProCon.org. (2021, November 11). Retrieved from https://euthanasia.procon.org/euthanasia-physician-assisted-suicide-pas-around-the-world/#india.

End-Notes:

  1. 2011 4 SCC 454 S. 140
  2. CrlJ 549 AIR 1987
  3. CrlJ 549 AIR 1988
  4. 3 SCC 394 AIR 1994
  5. 2 SCC 648 AIR 1996
  6. MANU/SC/0232/2018
  7. Dr. S.S Jaswal & S.C Baseen, civil & military law journal, pg. - 90

Written By: B.U. Rajavelan

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