ABSTRACT
In an era where the notion of life and its end continues to evolve, the right to die has emerged as a divisive but profoundly personal issue. This paper delves into the ethical and legal landscape of euthanasia, examining the complexities of end-of-life decisions and the desire for a dignified death. Drawing on intellectual and legal analyses, it investigates the tensions between the sanctity of life and individual autonomy, shedding light on the ethical concerns and societal implications of euthanasia. This paper seeks to stir up thought and encourage dialogue on a topic that raises fundamental questions about human existence and dignity by critically examining case studies and legal frameworks.
Keywords: euthanasia, right to die, ethics, autonomy, dignity, will.
INTRODUCTION
How do we define life? It is a question frequently thought upon by philosophers, thinkers, writers, poets, and many others who give it their meaning. Human life is to be cared for. Our basic instincts include survival and reproduction, which is undoubtedly the general rule on this planet, but doesn’t this sentence seem contradictory to the concept of “Right to Die”? We all agree that the “Right to Life” guaranteed to us under Article 21 of our Indian Constitution is the most revered, essential and fundamental right given to us. To date, no substitution for the same has been found. It may seem not easy to justify why and under what circumstances someone would desire to waive this right. However, this perception is not the same for everyone at every stage of life. Epicurus, a Greek philosopher, once wrote:
“Why should I fear death?
If I am, then death is not.
If Death is, then I am not.
Why should I fear that which can only exist when I do not?”
Here, disagreement arises. Sometimes, the mere existence of our body is not enough. It does not equate to “living” or “life”. At times, when the understanding of one’s own identity fades, the essence and value of life diminish, leaving a sense of fragility in a state that feels only partially real; this erosion denies the authenticity of existence. It begs the question: should an individual be allowed to linger in this state of passive decline, enduring pain and anguish under the guise of medical ethics? Is suffering merely a subjective perception, or is it an intrinsic reality?
In this complex terrain, legal considerations emerge: should individuals be subjected to treatments that prolong their existence but potentially disconnect them from the world around them? Or should their dignity be preserved through compassionate end-of-life care that respects their journey towards death?
To understand this, we would talk about what Euthanasia is, which falls under the ambit of “Right to Die”. There have been numerous circumstances in which a patient has an untreatable illness or unbearable pain that has rendered his life worse than death and in which there is no longer any hope for survival. In such cases, the patient frequently decides that it would be better to pass away than to endure the awful situation they are in. However, he is prohibited from doing so because suicide is considered a criminal offence punishable by law. Furthermore, because “abetment to suicide” is a crime and a punishable offence, even medical professionals are powerless in these situations. This is where Euthanasia intervenes. Derived from Greek, ‘Eu’ means goodly and ‘Thanatos’ means death. Euthanasia refers to a situation where a doctor induces the death of a patient with the aid of a Lethal injection, which is given to the patient suffering from unrelievable pain. Euthanasia(passive) “mercy killing”, or “physician-assisted suicide”, was not recognised in India till before March 2018. So, presently, it is required to scrutinise not only the facts in case euthanasia is legalised but also its effects, which would affect the norms and values of society.
RESEARCH METHODOLOGY
This paper takes a multidisciplinary approach, and the research methodology mainly includes a variety of secondary research methods, such as literature reviews, case studies, legal analysis, and online articles. The findings have been combined to provide a nuanced understanding of the issue’s ethical, legal, and social dimensions, allowing for more informed debate and policy development.
REVIEW OF LITERATURE
Knowledge, Attitude and Practices (KAP) of Medical Professionals on Euthanasia: A Study from a Tertiary Care Centre in India by Alexander Muacevic and John R Adler- This paper sought to evaluate medical professionals’ knowledge, attitudes, and practices in a tertiary care hospital.
Euthanasia in India: A Review on Its Constitutional Validity by Jayanta Boruah
North-Eastern Hill University (NEHU)- This article aims to investigate the concept of euthanasia and its various legal parameters in various countries around the world, as well as to understand the Indian legal standpoint.
The complexity of nurses’ attitudes toward euthanasia: a review of the literature by M Berghs, B Dierckx de Casterlé and C Gastmans.– The complexities of nursing attitudes towards euthanasia are demonstrated in this paper. The vast amount of data found in empirical literature is mostly framed within a polarised debate and inconclusive about the complex reality that underpins attitudes towards euthanasia.
METHOD
This paper takes an integrative approach to investigating the ethical, legal, and social implications of euthanasia. The research methodology relies heavily on secondary research methods to ensure a thorough analysis.
First, literature reviews are conducted to collect extensive information on euthanasia from existing scholarly articles, books, and other academic resources. These reviews, which draw on diverse perspectives and expertise, provide a foundational understanding of euthanasia’s ethical implications, legal status, and societal impacts.
Second, case studies are used to investigate landmark legal cases and real-life examples of euthanasia. By delving into these cases, the paper hopes to demonstrate the practical applications and challenges of euthanasia laws. This method aids in understanding how theoretical concepts are applied in real-world scenarios and the consequences of judicial decisions.
Third, the paper provides an in-depth legal analysis of the frameworks, judicial decisions, and statutory provisions governing euthanasia in various jurisdictions, with a particular emphasis on Indian law. This analysis highlights the legal complexities and evolution of euthanasia laws, shedding light on the balance between individual rights and societal values.
Finally, online articles are reviewed to reflect current discussions and debates about euthanasia. Reputable online sources, such as news articles, opinion pieces, and expert commentaries, are examined to capture current perspectives and public sentiment on the subject.
The findings from these various research methods are combined to provide a more nuanced understanding of euthanasia. This approach promotes a more informed debate and the development of policies that carefully balance ethical concerns with legal and societal needs.
CONCEPT OF ‘RIGHT TO DIE’: EUTHANASIA
Euthanasia is defined as an act of death which would provide relief from distressing or intolerable conditions of life, according to the ‘Encyclopedia on ‘Crime & Justice’’. As Roedy Green briefly explains the meaning of euthanasia primarily in four parts viz. good and Peaceful death; Mercy Killing; Physician Assisted Suicide (PAS) called phaspacts; and killing of a Terminally ill patient upon his request. We understand it refers to a painless death or a good death.
KINDS OF EUTHANASIA:
Based on procedure:
- Active Euthanasia: It is a positive contribution to accelerate death. It means killing a patient by active ways, let’s say, by injecting a patient with a lethal dose of some drug, which will cause instant death. It is also known as “aggressive” euthanasia.
- Passive Euthanasia: It refers to the omission of steps that have the potential to sustain life. Treatment provided to the patient, mainly life-prolonging in nature, is withdrawn. For example, turning off the life-support system. In this scenario, the patient eventually dies a natural death.
Based on consent:
- Voluntary Euthanasia: The patient or the legal representatives of the patient explicitly consent or request for it.
- Non-voluntary Euthanasia: The consent of the patient is absent in this case.
- Involuntary Euthanasia: The patient explicitly refuses to give consent but is still euthanised. It is also known as “Medical Zed Killing” or simply murder.
POSITION IN INDIA
The Indian Constitution is the superior law of the land and serves as the foundation of Indian democracy. The law is obliged to preserve the human dignity of an individual. Fundamental rights guaranteed under our Constitution are the most basic rights required to uphold human dignity. The debates and discussions on the topic of Euthanasia are prima facie and mostly based on and emphasise about Human Dignity, which in turn emphasises the Right to Die a proper and dignified death.
Article 21 of the Constitution states, “No person should be deprived of his life or personal liberty...”
The right to life given under Article 21 includes physical existence and quality of life. It denotes the right to the necessities of life, including a roof over one’s head or a proper house, sufficient nutrition, and clothing.
The concept of the right to life inherently encompasses the right to die with dignity. Debates surrounding topics like “Euthanasia” and the “right to die a dignified death” gain significance when viewed within the specific social context in which they occur. In the Indian setting, it’s crucial to consider the often-overlooked viewpoint of the approximately two hundred million impoverished individuals, whose fundamental needs for sustenance, shelter, healthcare, education, etc., remain inadequately addressed.
When discussing the “Right to Die,” it’s imperative to acknowledge the perspective of those who are still grappling with securing even the most fundamental and basic right to life, for whom existence is synonymous with mere physical survival. It’s paradoxical that while there exists a place or Society advocating for the “Right to Die with Dignity” in India, there isn’t a comparable entity championing the “Right to Live with Dignity.”
From a legal standpoint, this right was first mentioned in the Bombay High Court case of Maruti Sripati Dubal (1987). In this case, the Bombay High Court ruled that Section 309 of the IPC (Indian Penal Code), which is used to punish suicide attempts, was unconstitutional. The high court also ruled that under Article 21 of the Indian Constitution, the “right to die” is a component of the “right to life”. The Apex Court made a similar decision in P Rathinam v. Union of India (1994).
In Gian Kaur’s 1996 case, a 5-judge Constitutional Bench determined that the ‘Right to Life’, as stated in Article 21 of the Indian Constitution, does not include in itself the ‘Right to Die’. It can only be allowed through express legislation. The Supreme Court emphasised that the ‘Right to Life’ includes the ‘Right to a Dignified Life’ until death. This must be consistent with a dignified and natural death procedure. The Court meant that the ‘Right to die’ with dignity at the end of someone’s life should not be confused with the ‘Right to die’ in an unnatural manner.
Similarly, the Hon’ble Supreme Court of India ruled in the case of Aruna Ramchandra Shanbaug v. Union of India that passive euthanasia is only permitted for terminally ill patients who cannot recover under any facts or circumstances and for whom all reasonable precautions have been taken to protect them.
In Common Cause v Union of India (2018), a five-judge bench ruled that the right to die with dignity is indeed a fundamental right. Individuals with terminal illnesses have the right to refuse any kind of life-sustaining medical interventions in favour of natural death, a practice known as Passive Euthanasia. They have the right to create an “Advance Directive” or “Living Will” that instructs hospital staff on how to euthanise them.
A living will is also known as an advance directive, is a legal document that expresses a person’s desire for medical care when they are unable to communicate. In this context, it expresses the patient’s wish to discontinue medical treatment in the event of an incurable illness. Furthermore, the court emphasised that the ability to create advance medical directives validates and ensures an individual’s autonomy over their own life, body and decisions.
MERCY KILLING VS SUICIDE
We extensively talked about what mercy killing is above, but we need to understand a closely related topic, i.e. suicide. Suicide comes from Latin “sui”, meaning “of oneself”, and “caedere”, meaning “killing”. To kill oneself is the deadliest thing a person can do. The number of suicide cases is rising every year.
The claim is that since we have complete control over our lives, we ought to have the option to end them. If we have total freedom to practise everything necessary for our quality of life, we should also have complete freedom to pause our lives when things aren’t going well. The phrase “right to die” has two meanings: a positive sense and a negative sense.
Of course, now, we have the right to die with dignity, but this shouldn’t be confused with or interpreted as the right to die. A person may prefer to end a life that is painful and filled with suffering, but doing so on one’s own or with the assistance of another person is wrong and is also punishable by law. The Indian Penal Code’s section 309 governs situations like these. However, let’s consider a situation where a patient has a severe illness and is utterly immobile in bed. He has no chance of recovery in the future, and his ongoing illness is currently causing him a lot of suffering. The option of euthanising that individual can be considered here.
The question of whether suicide or self-killing should also be accepted is a topic of growing discussion because mercy killing is permitted, according to some Supreme Court decisions. While some contend that a person has the freedom and right to choose to live or die, others argue that a person should use every natural and artificial means at their disposal to prolong their lives. Given that mercy killing is acceptable, it is critical to define a distinct line between mercy killing and suicide in this situation so that people are aware of the differences.
In Naresh Maratra Sakhee v. Union of India, Justice Lodha distinguished between mercy killing and suicide. Although mercy killing is a form of homicide, it cannot be a crime unless it is explicitly acknowledged. On the other hand, suicide is a self-destructive act performed without the assistance of any other human agency. Therefore, it can be concluded that suicide is not a part of the “right to die”.
However, what people frequently overlook is that suicide is a complex issue, and as a result, deterrents to it must also be dynamic in both nature and approach. To accomplish this, significant expertise and dedication are required to develop a national strategy pertinent to the community’s social and psychological needs. In India, preventing suicide is not only a social and public health goal but also a long-standing practice in the field of mental health. Therefore, the time is right for mental health professionals to take a proactive approach to preventing suicide. The government should also start a national conversation about suicide prevention.
But the most priceless gift of nature is human life, which is valuable in and of itself. As a result, it shouldn’t be taken away by means that aren’t natural, like suicide. However, the judiciary cannot resolve this complex social issue with just one or two rulings. To solve this issue entirely, consistent and focused effort will be required. Each of the three branches of government—the judiciary, legislature, and executive—as well as the populace, must work together to address the growing suicide problem. Suicide as a problem can only be reduced after that.
CRITICAL ANALYSIS
We understand that euthanasia is a complex issue with moral, ethical, religious, philosophical, social, economic, penal, and constitutional implications. Some ethicists argue that it is important to determine whether a suffering, terminally ill patient died as a result of receiving medicines or painkillers on purpose or was simply anticipating death. If the death was foreseeable and expected, it may be morally acceptable, even if it was not all planned. The moral principle which is known as the principle of double effect is used to support the above mentioned claim. According to the principle of double effect, it is sometimes permissible to cause harm as an unknowing and merely foreseen side effect of achieving a good result, even if such harm is not permissible as a means to the same but good end.
People supporting Active euthanasia typically argue that killing patients is no worse than allowing them to die. Proponents of voluntarily ending patients’ lives argue that they should be able to live their lives as they see fit. Mercy-killing advocates argue that allowing patients in vegetative states with no chance of recovery prevents additional unnecessary and pointless medical interventions. Killing them would put an end to any further suffering they were already experiencing.
Proponents of physician-assisted suicide contend that a doctor is merely helping a suffering or terminally ill patient fulfill their wish to die with dignity. In contrast, opponents of euthanasia often argue that taking a life is inherently wrong, that nonvoluntary or involuntary euthanasia infringes on patient rights, or that physician-assisted suicide breaches the duty to do no harm.
A philosophical discussion of the value of life and the irreverence of a life devoid of meaning and dignity begins Chief Justice Dipak Misra’s and Justice Khanwilkar’s opinion in the most recent case legalising euthanasia, Common Cause vs UOI. He has cited several authors, philosophers, and thinkers who have advanced the idea that death is not an enemy and that a dignified death is a cause to celebrate.
The importance of carefully drafting legislation regarding advanced medical directives is underscored by the fact that he has taken into account the socioeconomic issues surrounding this issue, such as the stigma that may be associated with medical professionals who withdraw life support and the potential for abuse of such legislation by dishonest family members.
Euthanasia can also be discussed in light of the connections between knowledge of science, medical knowledge, morality, and the fundamental principles of individual autonomy and dignity enshrined in the Indian Constitution. We must emphasise the significance of looking at this right in the long term from institutional, political, and social perspectives as well as an individual perspective. Furthermore, we can draw inspiration from the Puttaswamy. The decision was made in which the Court outlined the connection between the notions of dignity, privacy, and personal liberty to provide the groundwork for this right.
We can examine the House of Lords ruling in the Airedale case. For a broader perspective, we are comparing libertarian and utilitarian viewpoints to determine whether passive euthanasia for those with a persistent vegetative state should be permitted.
Despite permitting passive euthanasia, the judiciary decided against passing legislation on the topic and instead provided the Legislature with the opportunity to debate it. The judiciary had also relied on earlier decisions involving assisted suicide, such as R v Director of Public Prosecutions (1995), which highlighted practical thinking and the importance of individual autonomy.
According to the guidelines established by the judiciary for authorising an attorney and issuing advance medical directives, only an individual over the age of 18 years, of sound mind, capable of communicating, reacting, and comprehending the consequences of signing the document, and with complete information and understanding, may freely sign it. The Supreme Court has recently made filing for an Advance Medical Directive easier.
As a result, the Court has established valid comprehensive rules until Parliament enacts pertinent legislation. Given the precedents set in countries like the Netherlands, where the use of advance directives has been permitted for a very long time, ensuring there are no gaps in applying these regulations is imperative.
SUGGESTIONS
In my opinion, the Court should have required the formation of a separate panel of legal and medical experts to monitor the implementation of these regulations in all situations. Given India’s limited resources and poor healthcare, there is a risk that these directives and authorizations will be misused.
Furthermore, there is no indication in the instructions as to whether a person’s “permission” was given freely, under duress, or without coercion. Before someone used their ability to carry out advanced medical directives, the Honourable Court should have required a psychological evaluation and consultation with medical professionals. Furthermore, they do not specify a procedure for rescinding such directives, which could lead to a disagreement over whether the patient did so. The best course of action would have been to establish a similar procedure for cancelling such orders.
CONCLUSION
The “Right to Life” remains an unfulfilled right in India, and a movement for the “Right to Die,” which is diametrically opposed to the former right, has emerged as a result of Western fads. As a result, there is an urgent need for appropriate and practical legislation on this critical issue of the Right to Die. This conclusion was reached after a lengthy legal battle that included numerous cases but was ultimately successful due to the decision in Aruna’s case. To reach a meaningful conclusion, one must examine the entire situation. Furthermore, if a patient begs a doctor to kill them and the doctor agrees, the doctor will face murder charges under Section 302 of the Indian Penal Code. If the patient discontinues life-saving techniques, their actions violate Indian Penal Code Section 309 and constitute an outright attempt at suicide.
To summarise, research into the right to die must begin with a discussion of the concept of life and its various aspects, such as its value, quality, and so on. To summarise, the study of the right to die must begin with a discussion of the concept of life and its various aspects, such as its significance, quality, sanctity, and protection. It has been observed that both the value and the quality of life are extremely important. To address the intrinsic value of life in the process of legalising euthanasia, quality of life has been assessed from both a clinical and legal standpoint. Moral philosophers have emphasised the importance of life protection, which is widely accepted in a civil society. They believe that life has intrinsic value and should be protected, regardless of quality. Article 21 of the Indian Constitution guarantees the right to life, liberty, and privacy. The Indian judiciary has brilliantly expanded the scope of Article 21 by giving it the broadest interpretation possible, encompassing all aspects of life under this provision.
Lavanya Awasthi
Dr Ram Manohar Lohia National Law University, Lucknow