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A Look Into Euthanasia

"Please Die!" But do you have the right?

The right to die is a concept that closely contradicts the concept of the Right to life under article 21 of the Indian Constitution based on the opinion that human beings are entitled to end their life or undergo euthanasia voluntarily the same way as they have the right to life.

In common parlance, this right is often understood that a person with a terminal illness, or without the will to continue living, should have the option to end their own life, use assisted suicide, or to decline life-prolonging treatments such as ventilators and the sort.

In this article, we will move away from this perspective and will only think of arguments that exclude people with a terminal illness or that are in a vegetative state.

Just so that you know, the current position in India is that a person who is terminally ill or is in a vegetative state can approach the court and seek permission to end his life.

The Supreme court also enables a person of sound mind and health to make a 'living will' specifying that in the event of him/her slipping into a terminal medical condition in the future, his/her life should not be prolonged through the life support system. The person concerned can also authorize, through the will, any relative or friend to decide in consultation with medical experts when to pull the plug.

Section 309 of the Indian Penal Code: Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year 1[or with fine, or with both].

Therefore, If you try to kill yourself unnaturally, you are liable to be prosecuted under the Indian Penal Code. This brings us closer to a question: Do we not have the right to die?

Have you ever thought of death? I know you have, death is a part of life which everyone knows will come to them sooner or later. But everyone doesn't talk about it much, But put this thing in our head your not an immortal and it will sooner or later caught hold of you. Have you ever heard of murder, where a person kills the other and then is punished by the juducual system, if i tell you there's a case where a person asks the other person to kill him and gives his consent to him to do the same, will that amount to murder? Will that person who was asked to kill be behind the bars?.

A great poet quotes, "I'm not afraid of being dead. I'm just afraid of what you might have to go through to get there."

What is Euthanasia?
Euthanasia is the practice of ending a person's life in order to free the person from incurable pain of disease or terminal illness. The word Euthanasia derives from the Greek for good death and originally referred to intentional mercy killing. In modern times Euthanasia is limited to killing of patients at the request of the patients by the doctors to free the patient from terminal illness.

It can also be treated as a mercy killing, where if a person is under pain or is suffering from incurable disease where we know that the person will die sooner, and to get rid of his pain and to show mercy we can take the help of euthanasia. The practice of euthanasia was firstly started in 1958 in New Zealand were people who were under serious pain and were suffering from incurable disease can be euthanasia.

The case which I mentioned earlier, Nothing here would be termed to be as murder and the person who did practise euthanasia on him will not be punished, unless it was done without Informing the person was not under serious pain or was suffered with some disease which was curable.

Does morality come into play in the form of bioethics as a main cause for not legalizing right to die?

Thomas Mann had in 1924 said; a mans dying is more the survivor affair than his own. Today his words are considered to be true as there is a wide range of debate on legalizing euthanasia. Euthanasia has been accepted in some form or the other by certain societies in history. In ancient Rome and Greece helping to die or putting them to death was considered permissible in some situations. For instance, in the Greek city of Sparta newborns with severe birth defects were put to death. Voluntary euthanasia for the elderly was an approved custom in several ancient societies.

Talking about morality and ethics, the fact that sometimes people with terminal illness would rather like to embrace death 'peacefully' than clinging on to life filled with intractable pain and suffering. Death is something which ones think that he may receive in a peaceful way, telling of morals and ethics, seeing someone suffering and knowing that he might never leave the bed or never recover is a sign of not to judge this aspect with morals. What will you do seeing a person in pain? You would help him and try to reduce his/her pain, so that he might be relied.

These what ethics and morals talks about, some people would critise that we cannot kill someone using are morals. Yes, you're right but to some extent, but tell me when someone's pet gets infected and he cannot recover from that infection what the pet owners do? they show their morals and help their pet not to suffer more pain, same goes with human, you know that he wont recover or he is in insufferable pain or a person is in coma for many years there's no chance that he'll get up from that, you have to set aside your morals for time being and help the suffering one, and if you would listen to your so called morals you'll do the same. And you need to note that you cannot compare morals and KARMA at the same time, both are different aspects in your life.

In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or "mercy killing" of terminally ill patients. Proponents of physician-assisted suicide feel that an individual's right to autonomy automatically entitles him to choose a painless death.

According to The Medical Treatment of Terminally ill patients (Protection of Patients and Medical Practitioners) Bill 2006, 'terminal illness' means:
  1. Such illness, injury or degeneration of physical or mental condition which is causing extreme pain and suffering to the patients and which, according to reasonable medical opinion, will inevitably cause the untimely death of the patient concerned, or
  2. Which has caused a 'persistent and irreversible vegetative' condition under which no meaningful existence of life is possible for the patient.
Thus according to it, the patient must be suffering some ailment causing extreme pain and suffering, which according to equitable and unbiased medical opinion, will lead to his death sooner or later. Second scenario is when the patient has slipped into Irreversible Permanent Vegetative State. These patients without active lifesaving mechanisms or life prolonging procedures will die a natural death. Thus one would like to ask would it be reasonable to simply keep the patient alive if he is suffering from intractable pain, psychological and emotional distress just for the sake of keeping him alive.

Euthanasia can be categorized into two types: active and passive:
  1. Active Euthanasia:
    When a person directly and deliberately does something which results in the death of patient. Here specific steps/procedures are undertaken (by the third party) like the administration of a lethal drug. This is a crime in India (and in most parts of the world) under the Indian Penal Code Section 302 or 304. There are countries which have passed legislation permitting assisted suicide and active euthanasia. The differences between them are in the former, patient himself administers lethal medications and in the later doctor or some other person does it.

    In Netherlands, euthanasia is sanctioned by the passage of "Termination of Life on Request and Assisted Suicide (Review Procedures) Act" 2002 providing well defined guidelines for the same. Belgium was the second nation to take a stand in this direction. In Switzerland assisted suicide can be performed by non physicians . Both Active Euthanasia and Assisted Suicide are legal in Luxembourg since 19th February 2008. Apart from these handfuls of nations, none in Europe have legalized Active Euthanasia or Assisted Suicide.

    In USA, active euthanasia is a criminal offence except in the states of Oregon, Washington and Montana where strict guidelines are in place. It is important to mention that the state of Michigan banned euthanasia and assisted suicide after Dr. Kevorkian (infamously known as 'Doctor Death') recklessly encouraged and assisted in suicides.
  2. Passive Euthanasia:
    It involves withholding of medical treatment or withdrawal from life support system for continuance of life (like removing the heart- lung machine from a patient in coma). Hence in passive euthanasia death is brought about by an act of omission. Euthanasia can be further classified as 'voluntary' where euthanasia is carried out at the request of the patient and 'non-voluntary' where the person is unable to ask for euthanasia (perhaps because he is unconscious or otherwise unable to communicate), or to make a meaningful choice between living and dying and a surrogate person takes the decision on his behalf.

    Legally speaking voluntary euthanasia is illegal as it can be interpreted as attempt to commit suicide which is punishable under Indian Penal Code section 309. The same was advocated by the judgment from the Constitution Bench of the Apex Court in the year 1996 in Gian Kaur vs. State of Punjab where it stated that the right to life guaranteed by Article 21 of the Constitution does not include the right to die.

Notwithstanding these legal predicaments, passive euthanasia is not illegal in most parts of the world including India; provided certain standard safeguards are present as demonstrated by Supreme Court in Aruna Shanbaug case, which we will be discussing here. To put things into right perspective let us ask ourselves a simple question, what is the need of Euthanasia?

Before the industrial and scientific revolution, the scientists had not invented the artificial ways of keeping a terminally ill patient alive, like ventilators, heart lung machines, artificial feeding, etc. Such patients would have naturally died during the ordinary course of nature. With the scientific revolution, there was better and in-depth understanding of the human body.

Simultaneously there was advent of new technology and machines, through which it is possible to prolong the life. Even though the patients are kept alive, often they will be in extreme physical pain and suffering (emotional, social and financial). At this stage let's reiterate that these advanced intensive care procedures which we are referring here, will by no means cure/control the disease, but it will only prolong the agony as well as existence of terminally ill patients.

Talking about India, India also legalised the practise of euthanasia in the country, but there's only passive euthanasia legalized and not the active euthanasia. As the active euthanasia can be used in a unlawful manner by the countrymen to kill someone they had arguments or in some property matters. The order of legalizing euthanasia came in the year 2011 by the Supreme Court Of India in Aruna Shonbaug Case, where the facts of the case were;

Aruna Shanbaug was a nurse working at the King Edward Memorial Hospital, Parel, Mumbai. On 27 November 1973 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 her in a vegetative state ever since. She has been treated at KEM since the incident and is kept alive by feeding tube. On behalf 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 broad guidelines legalising 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 a period of 42 years.

On 25 February 2014, while hearing a PIL filed by NGO Common Cause, a three-judge bench of the Supreme Court of India observed that the judgment in Aruna Shanbaug case was based on a wrong interpretation of the constitution bench judgment in Gian Kaur v. State of Punjab. Court observed that the judgment in inconsistent in itself as though it observes that euthanasia can be allowed only by legislature yet it goes on to lay down guidelines on the same. Therefore, court has referred the issue to a constitution bench which shall be heard by a strength of at least five judges. Court observed:

In view of the inconsistent opinions rendered in Aruna Shanbaug and also considering the important question of law involved which needs to be reflected in the light of social, legal, medical and constitutional perspective, it becomes extremely important to have a clear enunciation of law. Thus, in our cogent opinion, the question of law involved requires careful consideration by a Constitution Bench of this Court for the benefit of humanity as a whole. The Five-Judge Bench of the Supreme Court was tasked with deciding whether Article 21 of the Constitution includes in its ambit the right to die with dignity by means of executing a living wills/advance directives.

Legalization of euthanasia simply means granting an individual his natural right to die or terminate his life owing to non-normalcy of life or bad quality of life due to medical reasons. Attempt to suicide under mental coercion is punishable under law, but asking for granting of death due to perpetual suffering of an individual is not punishable. In most of the cases when an individual suffers with Persistent Vegetative State (PVS), the court grants physician assisting suicide with a standing consent from the patient showing his willingness to die and there is no undue influence while deciding so. The willingness should be out of the ground fact that there is no hope in improvement in quality of life in the future.

After reading this article many minds would have the question that why we should legalise euthanasia? Why we need to kill someone if there is no scope of recovery, might a miracle could happen and the person could be back at his feet.

Do you still think miracle happen? apart from movies and television shows? Then why Aruna shonbaug didn't recovered from coma, why she was in coma for 42 years? Why no miracle happened with her, she was in a need to seek it. The only miracle that exists is when you recover from the disease, when you a sign that you're body is healing and is fighting from what you're going through.

The need to legalize euthanasia is for the betterment of the patients and for their families, and the need is now because of the following reasons,

Moral Objectives: It is morally incorrect to keep a person fighting for no cause when all hope is lost. The sufferer and his fraternity go through mental trauma for a long period of time. The society is obligated to acknowledge the rights of patients and to respect the decisions of those who elect euthanasia. Every individuals right to self-determination or his right of privacy needs to be respected. Interference to such rights can be justified if it is to protect values, which is not the case where patients suffering unbearably at the end of their lives request euthanasia leaving them with no alternatives. People can't suffer against their will. It is plain cruelty on them and cessation of their human rights and dignity.

Individual's right to exercise his choice: Firstly deciding if one wants to live or die is a personal decision. Every individual has his/her own rights over their body. When the birth of an individual is not questioned by anyone naturally death as well should not be a speculative debate. A painless death is better than a painful life. The increase in patients of Cancer, AIDS and other dreadful and irreparable diseases has sparked a world-wide need of euthanasia or mercy killing. Especially in the final stages of such diseases which are incurable the want of euthanasia is justified.

Economic Factor: Economic concern in a country like India is of primary importance. The medical charges are unaffordable for the needed medical care; unsure if the patient is going to improve in any possible way or remain as he is. And every irreparable disease attracts a big amount of risk and money which can't be ignored.

Moreover, there is increasing pressure on hospital and medical facilities; it is argued that the same facilities should be used for the benefit of other patients who have a better chance of recovery and to whom these facilities provided by the hospital would be of greater value. Thus, the argument runs, when one has to choose between a patient beyond recovery and one who may be saved, the latter should be preferred as the former will die in any case.

Euthanasia, both in active and passive form, should be allowed in every society. It should be legalized owing to the amount of pain an individual goes through due to the fatal disease or disorder for a long period of time. Having a patient suffer endlessly is not giving him a better quality of life. The kind of quality of life is defined by the patient, not the doctor or government. Consequently, when the patient feels he is not getting the quality of life he wants the doctors can insist upon Physician Assisted Death (PAD). Supporters of active euthanasia contend that since society has acknowledged a patient right to passive euthanasia , active euthanasia should similarly be permitted. Court needs to lay reasonable grounds as to why there is a refusal in the first place to grant euthanasia; be it active or passive.

When arguing on behalf of legalizing active euthanasia, proponents emphasize circumstances in which a condition has become overwhelmingly burdensome for the patient, pain management for the patient is inadequate, and only death seems capable of bringing relief. In a liberal democracy like India where Fundamental Rights are given highest significance over any other substantial law, right to die should be treated at par with the fundamentals of the constitution.

Euthanasia During Coronavirus Scare

There has not been, in living memory, more focus on healthcare, the vital role of doctors, the sacrifices made by nurses, and the wonderful efforts of everyone involved in the sector. Amid the coronavirus crisis, daily heroism, the scale of human loss, and the awful scenes in hospitals underline what is important - and what is not.

It will surprise some that in the Netherlands, the only dedicated clinic providing euthanasia and assisted suicide has closed. Euthanasia Expertise Centre (formerly known as End of Life Clinic) has suspended all euthanasia procedures. The clinic's website says that existing procedures have been put on hold and new patients are no longer admitted.

The centre - which in 2019 alone ended the lives of 898 patients suffering from cancers, psychiatric problems, early on-set dementia, and accumulated age-related complaints - is willing to make an exception only for those expected to die soon and those who may soon lose their capacity for decision-making. Similarly, in Belgium, Jacqueline Herremans, a member of the federal commission reviewing euthanasia, has noted that there are few resources and even fewer doctors available for euthanasia at the moment: 'The most important thing right now is that we fight the coronavirus.'

In Canada, authorities are also shutting down services. For a process that requires two different medical assessments and witnesses, the lives involved are not worth the risk. According to the Globe and Mail, two places in Ontario, where euthanasia and assisted suicide have been legal since 2016, have stopped providing medical assistance in dying (MAID) because of the coronavirus pandemic (one has since resumed for existing patients and those whose deaths are imminent).

The Euthanasia Expertise Centre explains its decision on its website, noting that in 'the interest of public health, our patients, their loved ones and employees of the expertise centre, it is no longer responsible to continue our current care provision'. As it admits, 'euthanasia care cannot be identified as a top priority in healthcare'. In Canada, health authorities said that MAID is being cut back along with other 'elective services'.

This is an extraordinary admission. Those carrying out euthanasia in the Netherlands, where euthanasia and assisted suicide are legal, and those campaigning to change the law in places like the UK, have long insisted that assisted dying is necessary to alleviate 'unbearable suffering'. To shut down euthanasia clinics and services because of the danger of infection from Covid-19 means that those who perform euthanasia no longer believe their services are necessary; otherwise, many of them would brave the risk and dispatch suffering patients.

What the Covid-19 crisis has demonstrated is that the need for euthanasia and assisted suicide is abstract rather than practical. In the Netherlands in the 1980s, assisted dying started out as the ultimate solution to impending horrible deaths. In present times, with a high level of care for the dying available in most countries with good healthcare, assisted dying is not about actual deaths, but about deaths that people fear. The reality is that most people die peaceful deaths. But many fear loss of control and find the prospect of others caring for them terrifying.

Covid-19 brings the reality of death, the necessity of caring for others and being cared for by others, into our living rooms, making the preciousness of all lives and the tragedy of all deaths real. We see the humanity of the elderly and frail; no longer are they burdens to be dispatched from this world, but victims of horrifying disease that all are invested in fighting.

In a few months we may return to normal, in which case euthanasia clinics will return to granting people's wishes to no longer be, to escape this life, or to be in control of their deaths. Perhaps, though, we can remember this time when we made huge sacrifices to preserve every life, no matter how frail and vulnerable. We can remember this time when euthanasia no longer seemed necessary.

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