AIR 2018 SUPREME COURT 1665
FACTS-
One of the sacrosanct pillars of any legal system is the concept of fundamental rights. Out of these rights, the right to life and personal liberty emerges as extremely important as it also facilitates the exercise of other rights. The right to life and liberty essentially ensures an individual’s right to not be killed by another. However, if flipped on its head, can the right to life also include the right to be devoid of life? In other words, can this right give an individual the autonomy to end their own life if they consent to the same. This question was answered in the case of Common Cause v Union of India. Common Cause, a registered society, filed a petition that demanded the inclusion of the right to die with dignity as a component of the right to live with dignity, which is governed by Article 21 of the Indian Constitution. Moreover, it requested the setting up of policies as well as facilities and centres
that would facilitate people with terminal illnesses or steadily declining health conditions to forgo their life and execute living wills.
ISSUES RAISED-
- Can the Right to Life under Article 21 of the Constitution of India include the right to die with dignity?
- Can passive euthanasia be allowed in the living will of Indian patients?
CONTENTIONS-
The petitioners argued that person can exercise their right to self-determination and autonomy when it comes to making decisions about their health and medical care by deciding whether and to what extent they are willing to submit to medical procedures and treatments, by selecting an alternative treatment from the list of options, or by choosing not to receive any treatment at all if it is not in line with their personal goals and values.
Additionally, if there is good reason to believe that the individual in question has received the information, considered their alternatives, and decided that refusing or withdrawing medical care is the appropriate course of action, they must be permitted to do so. Moreover, from a philosophical and humane perspective, it is a much kinder and softer death that is experienced when one chooses that course as opposed to a death that greets a sick individual after dragging out his life for a gruelling period. Allowing an individual to choose death when it has been confirmed that their chances of getting better are next to none is the kinder and more merciful approach.
The petitioners also argued that dragging on a person’s life artificially with a goal to extend it is immoral as the patient, in most cases, is unconscious and cannot consent to the same. Choosing to prolong the life of an unconscious person is often the decision of doctors and family members and rarely takes into account the pain and trouble that the patient themselves is going through.
It is expressly mentioned that the petitioners wish for the patients to have the option to choose passive euthanasia, while active euthanasia is also discouraged by the same. They suggest creating guidelines for living wills, which patients can sign to indicate what medical procedures they can and cannot have done on them should the time come when they are unable to communicate their desires.
The petitioners argued on the grounds of the patient’s right to privacy under Article 12 and relied upon the Supreme Court’s judgement in the case of K. S. Puttaswamy v. Union of India case in 2017. They contended that the right to privacy included the freedom and the autonomy to make
decisions in regards to sensitive and private matters such as the medical procedures which the individual would undergo. It also included, by extension, the agency to decide whether they wished to continue their medicated life or end their suffering,
They also argued that under Article 21, the right to live with dignity included the right to die with dignity and thus, a life which is dependent wholly on an artificial machine is a life which does not allow for a natural and dignified death. Stretching a life unnecessarily merely because the loss of the individual would cause pain to the family members involved is cruel and undignified. However, considering the precedents of the Apex Court, the right to life has been stated to not include the right to death, the petitioners still maintained that although the right to death is not a part of the right to life, it must be a part of the right to a life with dignity. Arguments for the right to liberty, agency and autonomy were also included under Article 21 where the petitioners believed that individuals should have the option of ending a life of pain and suffering in a dignified manner. It was stated that if a person merely remained physically alive but was mentally or emotionally incapacitated, they should have the autonomy to refuse life-extending medical procedures.
The respondent, i.e, the Ministry of Health and Family Affairs countered these arguments by stating that the regulation of something as sensitive as euthanasia was highly distasteful and that every individual must be examined on a case-to-case basis. Creating rules and regulations to bring about uniformity in a space where uniformity is the last thing that should be considered was said to be unfavourable for the Ministry. The Ministry further stated that the right to life under Article 21, included the right to live with dignity, but only to the extent of food, clothing, shelter and medicine. They aligned themselves with the earlier views of the Court and said that the right to die with dignity could not become a part of the right to live with dignity and legalising any form of euthanasia would create chaos and confusion socially, psychologically and medically.
RATIONALE-
The then Chief Justice of India, Dipak Misra, authored the majority opinion and his main focus was on whether there existed a right that permitted an individual to stop receiving medical treatment or for the removal of life-supporting medical equipment so as to induce death.
In the case of P. Rathinam v. Union of India it was stated in the heavily criticised judgement that the right to life did indeed include the right to die, just as the right to express one’s opinion included the right to remain silent. It was deeply condemned in the case of Gian Kaur v. State of Punjab where a distinction between the right to die, which is unnatural, and the right to die with dignity, which is natural was drawn. It was decided that the court, when acting as the Parens Patriae (parent of the nation), makes the final decision with regard to what is considered to be the best for the patient and thus can intervene and act as a guardian. The court further stated in Gian Kaur v. State of Punjab that euthanasia could be made legitimate and legal only by the introduction and assent of the concerned legislation.
The Court, in this case, came to the conclusion that Gian Kaur approved of the early death of an individual who had a terminal illness or was in a vegetative state for the rest of their life. The Court referred to the act of withholding treatments in order to hasten the patient’s death as “passive euthanasia.” It was determined that doctors could remove a patient’s life support as long as they followed educated medical advice and that passive euthanasia was permitted.
Justice Misra also said that individuals above the age of 18 must have the agency to make their own choice, which includes the agency to accept or refuse medical treatment. He further stated that self-determination and autonomy are two of the fundamental pillars of a meaningful and
dignified life. Thus, if an individual was above 18 and of sound mind, he should be given the chance to forgo medical attention, however, this decision would be void if the individual was a minor, the decision was made under undue influence, if the terms were confusing or unclear or if it was based on falsified information.
The Court held that the right to privacy included the decisions made by an individual in very personal matters such as choices relating to death. Protecting this as a fundamental right was an extension of the right to privacy and thus also affected the right to life and personal liberty under Article 21. Thus, in 2018, the Supreme Court recognised the right to die with dignity as a fundamental right and laid down certain directives for terminally ill patients which would allow them to enforce this right. Further, in recent developments, the Supreme Court made minor modifications to these guidelines in 2023 which made them even more accessible to the general public.
DEFECTS OF LAW-
Justice Dhananjay Yeshwant Chandrachud held the dissenting opinion and stated that-
“The right to privacy is an element of human dignity. The sanctity of privacy lies in its functional relationship with dignity. Privacy ensures that a human being can lead a life of dignity by securing the inner recesses of the human personality from unwanted intrusion. Privacy recognises the autonomy of the individual and the right of every person to make essential choices which affect the course of life. In doing so, privacy recognizes that living a life of dignity is essential for a human being to fulfil the liberties and freedoms which are the cornerstone of the Constitution.”1
1 SUPREME COURT OBSERVER – A LIVING ARCHIVE OF THE SUPREME COURT OF INDIA.,
https://www.scobserver.in/wp-content/uploads/2021/09/25360_2019_3_504_41295_Order_24-Jan-2023.pdf(last visited Mar. 21, 2024).
Justice Chandrachud further stated that the court should not limit itself by considering euthanasia on merely individual levels but must also consider socio-cultural, administrative and institutional aspects. He also expanded upon the ways in which law and bioethics interact and explained that passive euthanasia would be immoral and problematic if the withdrawal or refusal of the medical treatment would put the patient in a state of chronic pain and suffering and thus lead to a tortured and painful death. Thus, the very aim of euthanasia which was to ensure a painless death would be defeated.
In this judgement of the court, there have been no guidelines laid down as to when a person’s permission would be regarded as being given without informed choice or undue influence. Moreover, no mechanism has been laid down for a person to revoke the decision that consents to the stoppage of the very support that is providing them with life, which is a very dangerous situation. This can create confusion and uncertainty in an area where every decision has to be calculated and measured.
CONCLUSION-
This decision of the Supreme Court in the case of Common Cause v Union of India demonstrated how the Court must often be tasked with balancing two opposite aspects of the same right. In this case, with the liberty to make decisions regarding one’s own health, the law has inadvertently also given the individual the liberty to refuse treatment. The Court made careful considerations regarding the social, intellectual, moral, economic and psychological aspects of euthanasia and diverted from the principle of sanctity of life by stating that certain circumstances can permit the snuffing out of the miracle of life when the person’s existence has lost all meaningful
significance and prolonging his life and ultimately drawing out his suffering is immoral and cruel.
Tejaswi Lal
Symbiosis Law School, Nagpur.