Open Access Research Article
Right to Die: Ethical and Legal Paranoma
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RIGHT TO DIE: ETHICAL AND LEGAL PANORAMA
AUTHORED BY - SANJANA MOSES
Abstract
“Life sans dignity is an unacceptable defeat, and life that
meets death with dignity is a value to be aspired for and a moment for
celebration.”
; Dipak Mishra, C.J.I. (former)
The word Euthanasia literally
means good death, also called mercy killing. It is an act whereby a person’s
life is intentionally ended, and the person can die before their natural death
primarily to end their suffering and agony. Active euthanasia involves deliberate
administration of lethal substances to end a patient’s life while passive euthanasia
entails withholding life sustaining treatment to allow natural death. The paper
examines the ethical legal and theological consideration surrounding active and
passive euthanasia in India. Passive voluntary euthanasia
was legalized in India in the year 2011 with the historical judgment of Aruna
Shanbaug v. Union of India and Ors. But Active Euthanasia is still not
permitted: to fully realize the Right to a dignified life, as provided in Article
21[1], it's
important to include the Right to die within its ambit. Right to die with dignity is an inalienable part of
the Right to life as provided under article 21 of the constitution of India. Drawing
on existing literature and legal precedents, this paper aims to explore the
ethics of the right to die. and the contrasting arguments against each type of euthanasia.
It discusses cultural, religious, and ethical considerations. By explaining the
complexities and nuances of active and passive euthanasia within the Indian
framework the work aims to contribute to the ongoing discourse on euthanasia ethics
for a infirmed future decision making,
Key words: Euthanasia, Active Euthanasia, Passive
Euthanasia, Ethics of right to die, Right to Die, theological perspective, India.
According to the Oxford
English Dictionary, Euthanasia means 'the painless killing of a patient
suffering from an incurable and painful disease or in an irreversible coma.' It is the process wherein the life
of one human being is ended by another to revive the former from the
distressing effect of an illness. Since the probability of its misuse is
extremely high becomes vital that a legal framework is provided so that through
it, only the terminally ill needy people are benefited[2].The
debate regarding the legalization of euthanasia has been going on across the
globe since time immemorial. The opponents of this practice hold the view that
life is sacred, and no one has got the right to end it, whereas on the contrary
to this is the supporters of euthanasia who believe that life belongs to the
individual only and so each person has got the right to choose whether to live this
life or not. To summarize, the debate is regarding the Sanctity of life versus
individual autonomy. Different countries have different views on this and
accordingly have formulated their legal framework. In this article some basic
points regarding euthanasia are deliberated, and certain suggestions are given.
Euthanasia can be classified into -
Voluntary, Nonvoluntary, and Involuntary euthanasia. Voluntary Euthanasia: It encompasses instances when a person
requests to help him end his life. The request could be made orally or in a
written form through a document. It usually covers cases where a terminally ill
person is given the right to choose whether to live his life or end it.
Voluntary euthanasia can be further classified into- Passive Voluntary
euthanasia and Active Voluntary euthanasia.
Passive
euthanasia refers to cases where life-sustaining measures are withdrawn or
withheld and measures that could preserve or prolong life are not adopted, thereby
allowing the patient to die. It does not involve actively killing a person but
rather allowing his disease or condition to run its course. For example, not
replacing the oxygen tank when it runs out. Whereas Active Euthanasia covers
those cases in which some active steps are taken to end the patient's life, for
example, directly giving a lethal dose of a drug or poison to a person.
Passive euthanasia is often
considered more ethically correct since it accepts the natural course of
disease and only involves refraining from interventions that would prolong
life. [3]But
in result Passive and Active euthanasia do not differ since both have the same
outcome- the death of the patient on humanitarian grounds. Both raise complex
moral and ethical questions. The primary distinction lies in action. Non-Voluntary
Euthanasia covers those cases where a person is not able to express his wish to
end his life. For instance, he is unconscious in comatose. The patient is
unable to make others know about his willingness to die, unlike involuntary
euthanasia where the patient has been given a prior occasion to make his desire
known. In most cases, it's the family members who take such a decision, but
there are some countries, for example, the Netherlands, where the medical
practitioner takes the final call, keeping in mind certain guidelines provided
to him by the competent authorities. In-Voluntary Euthanasia:
In-Voluntary Euthanasia covers those cases wherein a competent Patient's life
is ended against the wishes of that patient. He is in no circumstance wants to
end his life. No matter how noble the intention of the perpetrator is, this
would be covered under cases of murder and is illegal.
The Genesis of Euthanasia can be traced back to
approximately 5th century B.C, in Greece and Rome, where it was
administered through abortions and at times even mercy killing with the help of
medical practitioners who would give poison to their patient who asked for it.
Moving forward in the 17th and 18th centuries, even
though euthanasia was a topic of discussion amongst people, it was majorly
condemned by them. It was not until 1828 that the first legal provision banning
euthanasia and assisted suicide came in the United States of America. During
the 1930s, euthanasia gradually gained support in developed nations like
America and England. However, this global trend of favoring the practice met
with a setback with the onset of World War 2. Hitler and the Nazis killed many
people through euthanasia by gassing, drugs, and starving the people. In the
late 20thand early 21st century,
euthanasia again came into the picture with different countries and societies
with different approaches towards it. In India, only passive euthanasia is
currently legalized under a decision rendered by the apex court on 7th
March 2011.[4]
Legality of Euthanasia and Right to Die:
Across the globe, the debate
regarding the legality of euthanasia has been going on for a long duration. In
India, this debate was revived when the apex court of the country gave a
verdict in the famous Aruna Shanbaug case in which the court permitted
the patient's plea for euthanasia for had been living in a vegetative condition
for the past 37 years. A division bench comprising of Justice Markandey Katju
and Justice Gyan Sudha Mishra in this case permitted to discontinue Shanbaug's
life support to end her suffering and let her die peacefully. In this case, the
court balanced various aspects ranging from the Patient's suffering, the
constitutionality of the right to life, and that of medical ethics. In the
landmark case, active
euthanasia was declared illegal while permitted passive euthanasia contingent
upon certain circumstances. Hence as of now, In India, Active euthanasia is not permitted and is
illegal -only Passive Euthanasia was
legalized by the apex court on 7th March
2011.
Under the Indian
Penal code, 1860 since in cases of Euthanasia, there is the intention on
the part of the medical practitioners to end the life of the person according
to the general rule is section 300 clause one would attract, but by exception
5 of section 300,[5] the medical practitioner
would be punishable under section 304- for culpable homicide and not section
302 for murder. The benefit of the exception would only be given in cases of
Voluntary euthanasia where consent is an important ingredient. In other cases
of non-voluntary or involuntary euthanasia, the benefit of the exception would
not be provided.
If we look at the
constitutional perspective, Article 21 of
our constitution provided "no person shall be deprived of his life or
personal liberty except according to the procedure established by law. The
question of whether Article 21 includes the right to die or not first came into
consideration in the case State of Maharashtra v. Maruti Shripathi Dubal[6]
in which it was laid down by the Bombay High Court that "Right to life
also includes right to die" and consequently Section 309 of the Indian
Penal code that criminalizes attempt to suicide by a person was abrogated on
the rationale that right to die is even though uncommon and abnormal but is not
unnatural. The court supported this reasoning by giving various situations in
which a person may no longer have the will to live. This was upheld by the
Supreme Court in the case P. Rathinam v. Union of
India[7]. However, in the case Gian Kaur v. the
State of Punjab[8]
it was held "right to life as provided by Article 21 of the Constitution
does not include the right to die"; therefore, the constitution by article
21 only guarantees right to life, and personal liberty and in no circumstance
can right to die be covered within its ambit. Further, the court added that the
right to life means to live a dignified life as well as to die in a dignified
manner, which only means a natural death. Our constitution nowhere provides
that a dignified death means to die unnaturally because such a death is a
violation of the sanctity of life. The gift of life is given to a person by
God, and it his God only who can take this gift away. But on the other hand, in
the Aruna Shanbaug[9]case
Supreme Court in its path-breaking judgment, allowed" Passive
Euthanasia" by rejecting the petition on the ground it was one for active
euthanasia. Further, the court also gave certain guidelines by saying that
until the Parliament of the country does not enact any law on the subject, the
concerned High Court is empowered to give a decision on the merits of the
respective case.
ETHICS OF RIGHT TO DIE: EUTHANASIA.
The advocates for euthanasia base their rationale that an
individual shall be in control of ones' life as much as possible.[10]
There should be Freedom to choose between quality and sanctity of life. Every
individual should be given a choice to choose between having a certain quality
of life or the sanctity of life. When a person is suffering in pain or is
unable to do even the basic day to day work like eating his food or going to
relieve himself in the bathroom, causes a feeling of dejection and in such
cases, people who value the quality of life at a higher pedestal than the
sanctity of life should be able to do so. Hence an option to end intolerable
suffering should be given to terminally ill patients or who are incapacitated.
Some diseases cause such suffering that a person becomes a living corpse. It
takes away the mental peace of a person. On the other hand, it drains the
family or the care tackers of the patient as well because it is extremely
difficult to see one is loved one in so much pain and suffering; in such cases,
death is the only option.
On the other hand, Opponents of the
legalization of euthanasia treat it as a synonym for murder and feel that
euthanasia is not the right to die but the right to kill. Further it is
inconsistent with medical ethics. medical practitioners and healthcare workers
are under a professional duty that does not permit them to take any life. It is
a noble profession whose only aim is to improve and save lives. Euthanasia is
inconsistent with the roles and duties of people in this profession.[11]
Moreso There is rapid progress in the field of medical science, which will only
grow in the coming times. A disease that is terminal and incurable today may
not be so in the coming years to come. Hence no one has the right to deny any
person the chance of future recovery and a promising life ahead. There is a
chance of misuse of the provisions of euthanasia by close relatives and family
members who may put undue pressure on the patient for monetary gains,
particularly old and frail patients. Life is a sacred gift bestowed to us by
the almighty. Therefore, the sanctity of life must be preserved over individual
freedom The gift of life is given by God, and it is only he who can take it
away.
THE MORAL ARGUMENT: ACTIVE EUTHANASIA V PASSIVE EUTHANASIA.
The
question whether one is “better” than the other is highly subjective and
depends on various factors like individual’s ethical framework, cultural norms,
and morals. The advocates for active euthanasia
believe that it provides a more immediate relief tot eh suffering of the
patient compared to passive euthanasia, which is a prolonged process. Further
Active Euthanasia gives the patient greater sense of control and agency over
his own death by allowing the patient to make an active choice to end his
suffering. Thereby making it a clear and accurate process where all the
stakeholders- the patient, family members and the health care workers are all aware
if the decision and its consequences, leading to a more dignified death. From a
practical standpoint, it minimizes the burden on the family members by saving
them from prolonged emotional distress and the uncertainty associated with
waiting for the patient to die by passive euthanasia.
In
stark contrast the advocates for passive euthanasia feel that passive
euthanasia preserves the sanctity of life by allowing death to occur in its
natural course and not interfering with Go/d plan. By no direct intervention of
healthcare workers, it saves them from ethical dilemma of actively causing
death to a person. It is thus more consistent
with medical ethics based on the principle of non-maleficence which emphasizes
the obligation to refrain from causing harm.
The chances of abuse if passive euthanasia is also less as compared to
active euthanasia because the latter involves deliberate administration of a
legal substance. The passive approach ensures that the deal of patient occurs naturally
and gives better protection for vulnerable individuals. Passive euthanasia also promotes comprehensive
palliative care by prioritizing comfort and dignity in the dying process rather
than hastening it.[12]
THEOLOGICAL
PERSPECTIVE
The Hindu religion is based on the notion of
life after death. [13]The soul's next life is decided by the karma(net
consequence deeds) in his previous birth, and the ultimate goal of this cycle
is moksha(freedom from the cycle of death and rebirth), which cannot be
achieved without good deeds. There are two Hindu views
on euthanasia: according to the first view, By aiding a person suffering to end
his suffering and thereby life, a person is performing good karma, which will
help him attain his ultimate aim of Moksha. Hence promoting some form od
Paassive Euthanasia. The other view is a stark contrast with the former view,
according to which a person is interfering with the natural cycle of birth and
death if he helps end a life, irrespective of how much pain and suffering was
there in the life. Those involved in such bad deeds will assume it oneself the
residual karma of the patient.
On the same lines regarding the use of life support to keep alive,
it would not be appreciated because it is again interfering with the natural
cycle of birth and death. But if the user is not permanent and only for a
certain duration for recuperation, then it is permitted.
Prayopavesa, or fasting to death, is permitted under Hinduism with
certain conditions like to be done under community regulation, etc.
Regarding euthanasia, Pope John Paul II has spoken
out against what he calls a 'culture of death' in today's modern society and
said that "human beings should always prefer the way of life to the way of
death."
[14]Human
beings are valuable because they are created in God's image; they possess an intrinsic
dignity within themselves from the day they come into existence. To put forward euthanasia for a human being is equivalent to saying
that his current life is not worthwhile, which contradicts the very notion of a
worthy human being.
The church opposes the notion of the
right to die, even though a human being is free individuals, but this freedom
doesn't extend to taking their own lives "human being who insists that
they have the right to die is denying the truth of their fundamental relationship
with God.[15] But others including some
protestants and liberal schools of Christianity may accept some forms of
passive euthanasia since it is morally permitted to refuse extraordinary and
aggressive medical ways to save a life. It is not equivalent to killing
oneself, but instead, it is an acceptance of the very truth of death[16]
Since Islam and Christianity have a common base, even in Islam like
Christianity attempting to kill ourselves is not permitted on the ground that
we have not created us. Only Allah has created us, and it is his right alone to
destroy us.
[17]The Qur'an says: "Do not kill (or destroy) yourselves, for
verily Allah has been to you most Merciful.' (Quran 4:29)...The concept of a
life not worthy of living does not exist in Islam."
The ethics taught under Sikhism is
primarily derived from the teachings of their scripture, Guru Granth
Sahib, the Rehat Maryada(code of conduct), along with teachings of
all the gurus. [18]Sikhs
view life as a gift of God and hence have extremely high respect for it and
hence do not support the idea of euthanasia. Since it is a gift of God, the
timing when it should be taken away must be left to God to decide. According to
Sikhism, euthanasia interference in God's plan- pain and offering is part of
life, and human beings should accept it gracefully and make the best out of it.
Teaching so Sikhism is revolved around caring for others who are less
privileged, and, on this understanding, Sikhs believe "to provide such
good care that euthanasia became an unattractive option."[19]
CONCLUSION
Human life's sanctity does not mean
that a person is forced to continue to live a life full of pain and suffering.
Even if we look at it from a constitutional perspective, Article 21 of the
Indian Constitution says every person has a right to life; such life does not
mean mere animal existence but dignified life. Hence when a person is supposed
to live a dignified life and the state has a corresponding duty to provide such
a life, he cannot be forced to live to his disadvantage. Law must be stable,
but it should not stand still.The debate of which one is better – active or
passive euthanasia is multifaceted and deeply nuanced– reflecting a vast and
diverse perspective of ethical legal and cultural perspectives. While the
former provides immediate relief from suffering it does raise serious ethical dilemmas
and the potential risk of abuse. passive euthanasia on the other hand aligns
with the principle of non-maleficence by respecting the natural course of death
but it does prolong the suffering not only f the patient but of the family members
as well. A possible solution to the problem can be the apex court may consider
reading freedom to die as part of the right to privacy, autonomy, and self-determination.
The gift of life is precious and needs to be given the respect it deserves, but
at the same time, it has to be one with dignity. Living in a vegetative state
does not qualify to be a dignified life where one has to depend on everything
on others. If the living standard of a person falls below dignity and his life
is like a punishment for him, he should be permitted to have a choice whether
to continue living in this suffering to end his life. It is morally incorrect
and even cruel to force a person to live such a life.Right to life
means to live a peaceful life as a human being, if a patient is unable to take
normal care of his own self or has lost all senses or has lost the zeal to
continue to live, forcing him to continue with a life full of pain and
suffering is mental torture for an individual. It causes deep agony not only to
the patient but also to his near and dear ones who are tortured to see their
loved ones in such a position feeling helpless to relieve them from the suffering.
To check the misuse of the provisions, a holistic approach needs to be adopted.
A body should be constituted consisting of medical practitioners, social
workers, psychologists, and other experts whose decision must be based on the
person’s point of view and his caretakers. In navigating these complexities, the policy
makers of the country should take a case-to-case basis approach by taking into
consideration the interest of the patient, the caretakers and the social
implications of legalization of euthanasia. Hence a thoughtful and compassionate
deliberation is needed that the ethics of right to die are not compromised and
every individual is entitled to a right to dignified death.
[3] Subhash Chandra Singh, ‘Euthanasia and assisted suicide: revisiting the
sanctity of life principle’ (2012) 54 Journal of the Indian Law Institute 196.
[4] N.D.A Kemp, Merciful
Release: The History of the British Euthanasia Movement, (Manchester University Press
2002.)
[5] Culpable homicide is not murder when the person whose death
is caused, being above the age of eighteen years, suffers death or takes the
risk of death with his own consent.
[8]Gian Kaur v. the State of Punjab,
(1996) AIR 1996 SC 946.
[10]BR Sharma, ‘Euthanasia: An overview of the Journey
from inception to implementation’ (2005) 5J Punjab Acad Forensic Med
Toxicol 33
[12] Anita Manchanda, ‘Euthanasia:
A Social Science Perspective’ (2015) 51 journal
of Indian law institute 26
[13]Available
at https://www.bbc.co.uk/religion/religions/hinduism/hinduethics/euthanasia.shtml
(last visited 02.02.23)
[14]Available at http://www.bbc.co.uk/religion/religions/christianity/christianethics/euthanasia_1.shtml(last
visited 01.02.23)
[17]Mohammad
Ali Showali, ‘Islamic bioethics-a general scheme’ (2008) 2 Journal of Medical
Ethics and History of Medicine.
Article Information
Right to Die: Ethical and Legal Paranoma
Authors: Sanjana Moses
- Journal IJLRA
- ISSN 2582-6433
- Published 2024/06/17
About Journal
International Journal for Legal Research and Analysis
- Abbreviation IJLRA
- ISSN 2582-6433
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