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Legal Recognition of Passive Euthanasia
Context:
The Delhi High Court and the Supreme Court recently rejected a plea by the parents of 30-year-old Harish Rana, seeking the constitution of a medical board to assess whether his case qualifies for passive euthanasia.
Introduction to Euthanasia:
- Euthanasia originates from the Greek words ‘eu’ (good) and ‘thanatos’ (death), meaning a ‘good’ or ‘easy’ death.
- The act of euthanasia involves administering a lethal substance to relieve intolerable and incurable pain and suffering.
- Euthanasia can be classified into active and passive forms:
- Active Euthanasia: Directly causing a patient’s death (Illegal in India).
- Passive Euthanasia: Withholding or withdrawing life-prolonging treatments, allowing the patient to die naturally.
- Physician-Assisted Suicide (PAS): Involves a doctor assisting a patient in ending their life, typically due to terminal illness or prolonged suffering.
- Voluntary vs. Non-Voluntary: Voluntary euthanasia involves a patient’s consent, while non-voluntary occurs when a family member decides on behalf of the patient.
Historical Context:
- Gian Kaur vs State of Punjab (1996): The Supreme Court rejected the argument that the “right to life” under Article 21 includes the “right to die.”
- Aruna Shanbaug Case (2011): Aruna Shanbaug, a nurse left in a vegetative state after a 1973 assault, had a petition for life-support withdrawal filed by journalist Pinki Virani.
- The Supreme Court recognised passive euthanasia’s legality but denied it in her case, requiring High Court approval for similar requests.
- Expanded Legal Framework (2018): The Supreme Court expanded passive euthanasia’s legality by recognising the “right to die with dignity” under Article 21 of the Constitution, establishing guidelines for advance directives and approvals by medical boards and Judicial Magistrates.
- In 2023, the Court revised these guidelines to introduce decision-making timelines and reduce Judicial Magistrate involvement.
- Recent Case: Harish Rana (2023): Harish Rana, in a vegetative state since 2013, had his plea for passive euthanasia denied by the Supreme Court.
- The Court ruled that the use of a Ryles tube for feeding does not qualify as life support.
- This case highlighted the ethical dilemma between prolonging life and allowing a dignified death.
Ethical Considerations:
The debate surrounding euthanasia involves the four pillars of medical ethics:
- Beneficence: Acting in the patient’s best interest.
- Non-maleficence: Avoiding harm to patients.
- Justice: Fair distribution of healthcare resources.
- Autonomy: Respecting patients’ rights to make informed decisions.
Cultural and Legal Challenges:
- Cultural Attitudes Toward Death: Cultural and religious beliefs stigmatise discussions about death, complicating passive euthanasia decisions.
- Additionally, feeding is viewed as an act of care, creating emotional conflicts around treatment withdrawal.
- Aruna Shanbaug’s Legacy: The Shanbaug case established the legal acceptance of passive euthanasia in India and sparked discussions on palliative care and the state’s responsibility toward victims of medical neglect.
Future Considerations:
- The legal framework surrounding euthanasia needs refinement to differentiate between euthanasia and the withdrawal of futile life-sustaining measures.
- Involving medical and ethical experts in decision-making is essential to avoid legal confusion.
Global Perspectives on Passive Euthanasia
- Netherlands: Euthanasia is legal under strict conditions since 2002.
- Australia: Passive euthanasia has seen varying legal statuses across states.
- Belgium and Luxembourg: Euthanasia legalised in Belgium in 2002 and Luxembourg in 2009.
- Spain: Legalised passive euthanasia in 2021.
- Canada: Medical assistance in dying legalised in Quebec in 2014.
- Italy: Adults can refuse treatment, permitting passive euthanasia.
- Germany: Assisting in suicide is illegal, but passive euthanasia is allowed.
- United States: Active euthanasia is illegal; however, passive euthanasia is generally accepted.
Legalisation of Passive Euthanasia in India:
- The Supreme Court’s ruling in the Common Cause v. Union of India case in 2018 legalised passive euthanasia, recognising the right to die with dignity.
- Guidelines emphasise that living wills must be respected and outline procedures for withdrawing life support.
Key Takeaways from the Ruling:
- Legal recognition of passive euthanasia allows both competent and incapacitated patients to be eligible.
- Advance directives must be voluntary and in writing, witnessed and countersigned by a Judicial Magistrate.
- Close relatives or physicians can make decisions to discontinue life support, subject to high court approval.
Acceptance of Passive Euthanasia in India: Challenges Ahead
- Despite legal recognition, societal and religious opposition persists.
- Religious communities argue that the sanctity of life should take precedence, complicating the acceptance of euthanasia.
- While passive euthanasia practices are reportedly common, disparities exist based on socio-economic status, impacting access to quality end-of-life care.