Prelude- The essay contemplates various aspects of Right to Dignified Death , Euthanasia and Suicide .
Life Exists, therefore it has a right to exist ; Death exist, therefore it has a right to exist too
Right to dignified death has been a one of the most debated issues across the world after abortion.Rightly so , it has been able to bring a philosopher out of a policy maker and few judges probably became poets after the deliberation on Life and Death. It is as much a matter of importance for religion as it is for any philosopher or for a man of science.
All our science stops at the doorstep of death. Philosophy and religion has taken a discourse life after death, but to test them is to die first , and death is where our communication stops with the living world.While life after death may remain a mystery for centuries to come , death strikes every now and then, the question remains how to get there peacefully, without suffering , without misery . From the discourse of peaceful exit and exit from suffering , born the philosophy of right to dignified death.
Save the religious and philosophical tenets of the matter at hand , it is essential to understand the different manifestation of right to dignified death such as – Euthanasia and Suicide.
Euthanasia – Objective Analysis of a subjective matter :-
The word ‘Euthanasia’ is a derivative from the Greek word ‘eu’ and ‘thanotos’ which literally mean “good death”.It is otherwise described as mercy killing.The death of a terminally ill patient is accelerated through active or passive means in order to relieve such patient of pain or suffering.
Medical Ethics defines Euthanasia as – a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering.However same medical ethics also states that -medicalised killing of a person without the person’s consent, whether non -voluntary (where the person in unable to consent) or involuntary (against the person’s will) is not euthanasia: it is a murder. Hence, euthanasia can be voluntary only.
There has been considerable debate over two different forms of Euthanasia – Active and Passive.
Active and Passive Euthanasia :-
Aruna Ramachandra Shanbaug vs. Union of India :-
Aruna Ramchandra Shanbaug (1 June 1948 – 18 May 2015), alternatively spelled Shanbhag, was an Indian nurse who was at the centre of attention in a court case on euthanasia after spending 42 years in a vegetative state as a result of sexual assault.
In 1973, while working as a junior nurse at King Edward Memorial Hospital, Parel, Mumbai, Shanbaug was sexually assaulted by a ward boy, Sohanlal Bhartha Walmiki, and remained in a vegetative state following the assault. On 24 January 2011, after she had been in this state for 37 years, the Supreme Court of India responded to the plea for euthanasia filed by Aruna’s friend, journalist Pinki Virani, by setting up a medical panel to examine her. The court rejected the petition on 7 March 2011. However, in its landmark opinion, it allowed passive euthanasia in India.Shanbaug died from pneumonia on 18 May 2015 after being in a persistent vegetative state for nearly 42 years.
In this landmark judgement SC has differentiated the Active and Passive Euthanasia . Aruna is no more with us, but she has left us with the question of this century – Is Right to dignified death is justified ? Can it be permissible in contemporary jurisprudence ? Answer to these question emerge from the SC judgement.
Active euthanasia involves taking specific steps such as injecting the patient with a lethal substance e.g. Sodium Pentothal which causes the person to go in deep sleep in a few seconds and the person dies painlessly in sleep, thus it amounts to killing a person by a positive act in order to end suffering of a person in a state of terminal illness. It is considered to be a crime all over the world(irrespective of the will of the patient) except where permitted by legislation,as observed earlier by Supreme Court.
In India too,active euthanasia is illegal and a crime under Section 302 or 304 of the IPC.Physician assisted suicide is a crime under Section 306 IPC (abetment to suicide)
Passive euthanasia, otherwise known as ‘negative euthanasia’, however, stands on a different footing. It involves withholding of medical treatment or withholding life support system for continuance of life e.g.,withholding of antibiotic where without doing it, the patient is likely to die or removing the heart–lung machine from a patient in coma
Passive euthanasia is legal even without legislation provided certain conditions and safeguards are maintained (SC Judgement in Aruna’s case)
Distinction between Active and Passive Euthanasia :-
The core point of distinction between active and passive euthanasia as noted by Supreme Court is that in active euthanasia,something is done to end the patient’s life
while in passive euthanasia, something is not done that would have preserved the patient’s life.
In passive euthanasia,“the doctors are not actively killing anyone; they are simply not saving him”, “while we usually applaud someone who saves another person’s life, we do not normally condemn someone for failing to do so”.
The Supreme Court pointed out that according to the proponents of Euthanasia ,while we can debate whether active euthanasia should be legal,there cannot be
any doubt about passive euthanasia as “you cannot prosecute someone for failing to save a life”.
Passive euthanasia is further classified as voluntary and non-voluntary.Voluntary euthanasia is where the consent is taken from the patient. In non-voluntary euthanasia, the consent is unavailable on account of the condition of the patient for example,when he is in coma.In this regard the SC observed that –
while there is no legal difficulty in the case of the former, the latter poses several problems, which we shall address”. The Supreme Court was concerned with a case of non-voluntary passive euthanasia because the patient was in coma.
A hundred years ago, when medicine and medical technology had not invented the artificial methods of keeping a terminally ill patient alive by medical treatment, including by means of ventilators and artificial feeding,such patients were meeting their death on account of natural causes.Today, it is accepted, a terminally i
ll person has a common law right to refuse modern medical procedures and allow nature to take its own course, as was done in good old times. It is well -settled law in all countries that a terminally ill patient who is conscious and is competent, can take an ‘informed decision’ to die a natural death and direct that he or she be not given medical treatment which may merely prolong life.There are currently a large number of such patients who have reached a stage in their illness when according to well -informed body of medical opinion, there are no chances of recovery. But modern medicine and technology may yet enable such patients to prolong life to no purpose and during such prolongation, patients could go through extreme pain and suffering. Several such patients prefer palliative care for reducing pain and suffering and do not want medical treatment which will merely prolong life or postpone death.
From the above discourse it is clear that refusing treatment is one’s right so is welcoming natural death is one’s right , but as far the argument stands , till now it holds active euthanasia or positive intervention of death as illegal and Passive euthanasia or negative intervention is allowed.
The Larger debate of Active Euthanasia and Suicide :-
It is well understood by the now the stand of jurisprudence on Passive Euthanasia, However the debate is far from conclusion unless the active euthanasia is taken in to legal discourse for debate, deliberation and discussion .Without it the right to dignified death is incomplete.
In so far, the Honorable SC , and multiple commissions has contemplated the passive euthanasia and shied away from the larger question on active euthanasia. In Aruna’s case it was a selective judgement in the sense that , though the SC held active euthanasia as illegal , yet it had not delved in to the larger question of right to dignified death or right to death as a fundamental right.
The general fear that entails over active euthanasia is that – if it is made illegal , it will be used as an weapon. And given our socio-political milieu , it would be much difficult a task to manage and carry out it judiciously.When the society is wrecked in corruption, it does make everyone anxious of a law that allows ‘assisted suicide’. Especially when the large body of medical practitioners as acting as mere commercial agents, it would take no time for them to make active euthanasia a viable business proposition and the danger of it in Indian society looms large.
Another fear hovers on the active euthanasia is of the medical ethics, Doctors are taken pledge to save lives, hence it directly contradicts with the medical ethics to let one die.However , if we use the same analogy , a state’s duty is also to protect its citizens, but it does executes one of its own when there is a need be in accordance with the legal procedures.
So it makes clear that Indian society is not ready as yet to legalize active euthanasia. More so, India is a deeply religious society, thus to take any adventurous run in this path for any politician or policy maker is dangerous and thus their rather unusual shyness on this matter is understandable.They are supposed to make the society ready for change, but as long as this issues is concerned , everyone is just so silence, even the judiciary as pointed out above.
Keeping the fears , views of policy makers, politicians, Judiciary , religious and philosophical questions aside, If one encounters the suffering and pain endured by terminally ill patients , one would be humbled . With the person, suffers his whole family , the misery associated with it leads many to take psychological care and breaks the family economically.The terminally ill person just awaits for death , but death is not to avail.It is not the death that he fears, it is the journey that he is incapable of enduring.With his illness , he brings many under stress, pain and misery.Therefore , he appeals, appeals for a dignified death, wants his family to remember by the good he has done, not by the the suffering that he has brought them .In this context , right to dignified death or so to say active euthanasia holds true.It’s the pain of the non-recoverable terminal ill , who awaits get in to the deep sleep and make preparation for it so as not to just, exit this world but exit it with dignity.
Suicide : – When the assisted suicide is not allowed for terminally ill, it makes no sense to argue in favor of general suicide. However the oddity of our law is that , we have provisions where if someone jumps off a cliff and unfortunately survives , he/she gets imprisonment . It makes no sense to imprison a person who just tried death .Hence better course of action in this regard would be to decriminalize the suicide clause from IPC and create trauma care infrastructure and counseling centers to assist the needy and a fund to help them start or carry on with their lives.
The dilemma of right to dignified death looms large on anybody who has seen people suffering and has seen the commercialization of medical industry.To conclude , it would be non judicious to legalize active euthanasia . However , Supreme Court , can come up with solutions such as a special bench on Euthanasia , where they can very well judge the case on its merit and give the directions accordingly.But this has to be done on a case by case basis and justice must be given as fast as possible , becuase the time is the only luxury the terminally ill can’t afford.Moreover, The SC can frame guidelines to consider the cases and it would be a better discourse than just outrightly denying the right to dignified death by a mere generalization not on a case by case basis.