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

Introduction :-

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.
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.

Conclusion :-

  • 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.

 

 
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    Norman Borlaug and MS Swaminathan in a wheat field in north India in March 1964

    Political independence does not have much meaning without economic independence.

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    The overall food grain scenario in India has undergone a drastic transformation in the last 75 years.

    India was a food-deficit country on the eve of Independence. It had to import foodgrains to feed its people.

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    As a result, high-yield varieties (HYV) were developed. The combination of seeds, water and fertiliser gave a boost to food grain production in the country which is generally referred to as the Green Revolution.

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    Most of the remaining areas were deficit in food grain production.

    Therefore the Union government had to procure food grain from surplus states to distribute it among deficit ones.

    At the time, farmers in the surplus states viewed procurement as a tax as they were prevented from selling their surplus foodgrains at high prices in the deficit states.

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    The distribution of food grains was left to the concerned state governments.

    Kerala, for instance, was totally a deficit state and had to adopt a distribution policy which was almost universal in nature.

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    The state government had to purchase another million tonne of rice from rice millers in the state at a negotiated price, which was higher than the procurement price offered by the Centre, but lower than the open market price.

    A large number of studies have revealed that many poor households have been excluded from the PDS network, while many undeserving households have managed to get benefits from it.

    Various policy measures have been implemented to streamline PDS. A revamped PDS was introduced in 1992 to make food grain easily accessible to people in tribal and hilly areas, by providing relatively higher subsidies.

    Targeted PDS was launched in 1997 to focus on households below the poverty line (BPL).

    Antyodaya Anna Yojana (AAY) was introduced to cover the poorest of the poor.

    Annapoorna Scheme was introduced in 2001 to distribute 10 kg of food grains free of cost to destitutes above the age of 65 years.

    In 2013, the National Food Security Act (NFSA) was passed by Parliament to expand and legalise the entitlement.

    Conventionally, a card holder has to go to a particular fair price shop (FPS) and that particular shop has to be open when s/he visits it. Stock must be available in the shop. The card holder should also have sufficient time to stand in the queue to purchase his quota. The card holder has to put with rough treatment at the hands of a FPS dealer.

    These problems do not exist once ration cards become smart cards. A card holder can go to any shop which is open and has available stocks. In short, the scheme has become card holder-friendly and curbed the monopoly power of the FPS dealer. Some states other than Chhattisgarh are also trying to introduce such a scheme on an experimental basis.

    More recently, the Government of India has introduced a scheme called ‘One Nation One Ration Card’ which enables migrant labourers to purchase  rations from the place where they reside. In August 2021, it was operational in 34 states and Union territories.

    The intentions of the scheme are good but there are some hurdles in its implementation which need to be addressed. These problems arise on account of variation in:

    • Items provided through FPS
    • The scale of rations
    • The price of items distributed through FPS across states. 

    It is not clear whether a migrant labourer gets items provided in his/her native state or those in the state s/he has migrated to and what prices will s/he be able to purchase them.

    The Centre must learn lessons from the experiences of different countries in order to make PDS sustainable in the long-run.

    For instance, Sri Lanka recently shifted to organic manure from chemical fertiliser without required planning. Consequently, it had to face an acute food shortage due to a shortage of organic manure.

    Some analysts have cautioned against excessive dependence on chemical fertiliser.

    Phosphorus is an important input in the production of chemical fertiliser and about 70-80 per cent of known resources of phosphorus are available only in Morocco.

    There is possibility that Morocco may manipulate the price of phosphorus.

    Providing excessive subsidies and unemployment relief may make people dependent, as in the case of Venezuela and Zimbabwe.

    It is better to teach a person how to catch a fish rather than give free fish to him / her.

    Hence, the government should give the right amount of subsidy to deserving people.

    The government has to increase livestock as in the case of Uruguay to make the food basket broad-based and nutritious. It has to see to it that the organic content in the soil is adequate, in order to make cultivation environmentally-friendly and sustainable in the long-run.

    In short, India has transformed from a food-deficit state to a food-surplus one 75 years after independence. However, the government must adopt environmental-friendly measures to sustain this achievement.

     

    Agroforestry is an intentional integration of trees on farmland.

    Globally, it is practised by 1.2 billion people on 10 per cent area of total agricultural lands (over 1 billion hectares).

    It is widely popular as ‘a low hanging fruit’ due to its multifarious tangible and intangible benefits. 

    The net carbon sequestered in agroforestry is 11.35 tonnes of carbon per ha

    A panacea for global issues such as climate change, land degradation, pollution and food security, agroforestry is highlighted as a key strategy to fulfil several targets:

        1. Kyoto Protocol of 2001
        2. Reducing Emissions from Deforestation and Forest Degradation (REDD) as well as REDD+ mechanisms proposed by the United Nations Framework Convention on Climate Change
        3. United Nations-mandated Sustainable Developmental Goals (SDG)
        4. Paris Agreement 
        5. Carbon Neutrality

     

    In 2017, a New York Times bestseller Project Drawdown published by 200 scientists around the world with a goal of reversing climate change, came up with the most plausible 100 solutions to slash–down greenhouse gas (GHG) emissions. 

    Out of these 100 solutions, 11 strategies were highlighted under the umbrella of agroforestry such as:-

    1. multistrata agroforestry,
    2. afforestation,
    3. tree intercropping,
    4. biomass production,
    5. regenerative agriculture,
    6. conservation agriculture,
    7. farmland restoration,
    8. silvopasture,
    9. tropical-staple tree,
    10. intercropping,
    11. bamboo and indigenous tree–based land management.

     

    Nowadays, tree-based farming in India is considered a silver bullet to cure all issues.

    It was promoted under the Green India mission of 2001, six out of eight missions under the National Action Plan on Climate Change (NAPCC) and National Agroforestry and Bamboo Mission (NABM), 2017 to bring a third of the geographical area under tree cover and offsetting GHG emissions. 

    These long-term attempts by the Government of India have helped enhance the agroforestry area to 13.75 million hectares. 

    The net carbon sequestered in agroforestry is 11.35 tonnes of carbon per ha and carbon sequestration potential is 0.35 tonnes of carbon per ha per year at the country level, according to the Central Agroforestry Research Institute, Jhansi.

    India will reduce an additional 2.5-3 billion tonnes of CO2 by increasing tree cover. This extra tree cover could be achieved through agroforestry systems because of their ability to withstand minimum inputs under extreme situations. 

    Here are some examples which portray the role of agroforestry in achieving at least nine out of the 17 SDGs through sustainable food production, ecosystem services and economic benefits: 

    SDG 1 — No Poverty: Almost 736 million people still live in extreme poverty. Diversification through integrating trees in agriculture unlocks the treasure to provide multifunctional benefits.

    Studies carried out in 2003 in the arid regions of India reported a 10-15 per cent increase in crop yield with Prosopis cineraria (khejari). Adoption of agroforestry increases income & production by reducing the cost of input & production.  

     

    SDG 2 — Zero hunger: Tree-based systems provide food and monetary returns. Traditional agroforestry systems like Prosopis cineraria and Madhuca longifolia (Mahua) provide edible returns during drought years known as “lifeline to the poor people”. 

    Studies showed that 26-50 per cent of households involved in tree products collection and selling act as a coping strategy to deal with hunger.

    SDG 3 — Good health and well-being: Human wellbeing and health are depicted through the extent of healthy ecosystems and services they provide.

    Agroforestry contributes increased access to diverse nutritious food, supply of medicine, clean air and reduces heat stress.

    Vegetative buffers can filter airstreams of particulates by removing dust, gas, microbial constituents and heavy metals. 

    SDG 5 — Gender equality: Throughout the world around 3 billion people depend on firewood for cooking.

    In this, women are the main collectors and it brings drudgery and health issues.

    A study from India stated that almost 374 hours per year are spent by women for collection of firewood. Growing trees nearby provides easy access to firewood and diverts time to productive purposes. 

    SDG 6 — Clean Water and Sanitation: Water is probably the most vital resource for our survival. The inherent capacity of trees offers hydrological regulation as evapotranspiration recharges atmospheric moisture for rainfall; enhanced soil infiltration recharges groundwater; obstructs sediment flow; rainwater filtration by accumulation of heavy metals.

    An extensive study in 35 nations published in 2017 concluded that 30 per cent of tree cover in watersheds resulted in improved sanitisation and reduced diarrheal disease.  

    SDG 7 — Affordable & Clean Energy: Wood fuels are the only source of energy to billions of poverty-stricken people.

    Though trees are substitutes of natural forests, modern technologies in the form of biofuels, ethanol, electricity generation and dendro-biomass sources are truly affordable and clean.

    Ideal agroforestry models possess fast-growing, high coppicing, higher calorific value and short rotation (2-3 years) characteristics and provide biomass of 200-400 tonnes per ha.

    SDG 12 — Responsible consumption and production: The production of agricultural and wood-based commodities on a sustainable basis without depleting natural resources and as low as external inputs (chemical fertilisers and pesticides) to reduce the ecological footprints.

    SDG 13 — Climate action: Globally, agricultural production accounts for up to 24 per cent of GHG emissions from around 22.2 million square km of agricultural area, according to the Food and Agriculture Organization. 

    A 2016 study depicted that conversion of agricultural land to agroforestry sequesters about 27.2± 13.5 tonnes CO2 equivalent per ha per year after establishment of systems. 

    Trees on farmland mitigate 109.34 million tonnes CO2 equivalent annually from 15.31 million ha, according to a 2017 report. This may offset a third of the total GHG emissions from the agriculture sector of India.

    SDG 15 — Life on Land: Agroforestry ‘mimics the forest ecosystem’ to contribute conservation of flora and faunas, creating corridors, buffers to existing reserves and multi-functional landscapes.

    Delivery of ecosystem services of trees regulates life on land. A one-hectare area of homegardens in Kerala was found to have 992 trees from 66 species belonging to 31 families, a recent study showed. 

    The report of the World Agroforestry Centre highlighted those 22 countries that have registered agroforestry as a key strategy in achieving their unconditional national contributions.

    Recently, the  Government of India has allocated significant financial support for promotion of agroforestry at grassroot level to make the Indian economy as carbon neutral. This makes agroforestry a low-hanging fruit to achieve the global goals.