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CRITICAL ANALYSIS OF EUTHANASIA AND ITS RELEVANCE IN TODAY’S INDIA
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CRITICAL
ANALYSIS OF EUTHANASIA AND ITS RELEVANCE IN TODAY’S INDIA
AUTHORED BY - JOSYN BIJOY
Introduction
The issue of euthanasia or mercy
killing of terminally ill patients have been rising in the recent time.[1]
There has been advocates for the both for and against the legalisation and
implementation to euthanasia. Much of the contention surrounding the factor
that whether the patient has self-autonomy over his/her life or shall such an
interest over one’s life be superseded by social, moral, ethical and legal
constructs.
India has dealt with the matter of
euthanasia primarily through the landmark judicial judgements in Aruna Ramachandra Shanbaug v.
Union of India[2]
and Common Cause v. Union of India[3]
which have distinguished active and passive euthanasia, where the former was
prohibited while the latter could be administered by following the guidelines
put forward by the court. These instructions and procedures put forward by the
court were contented to be cumbersome and subsequently were modified in 2023 by
a 5-judge bench which essentially simplified the procedure in withholding the
life support of a terminally ill patient.[4]
However the question still remains prevalent on whether the such modifications
were necessary and if positive then are they sufficient to address the matter
in the most efficient way.
Study on the same holds relevance
given the current evolving status of law regarding euthanasia. Euthanasia
revolves around the complex ethical, moral, social and medical considerations
and the rights of the patient.[5] As
identified, one of the primary obstacles in liberalising such a practice would
be the vulnerability of the patients and the minority community to abuse and
coercion regarding such matters. Hence legal safeguarding is essential and its
efficiency can be rightly met if only proper research on the same is conducted.
In light of the aforementioned, the research scholar believes that research is
necessary regarding the matter. The paper shall primarily focus on determining
the practice of euthanasia and justification for its current limitation
considering the rights of the patient and is there a need for liberating the
still complex procedures regarding the matter.
BODY
The intervention of the judiciary
into the subject matter of euthanasia and the right to a dignified death of the
terminally suffering patient has been crucial, especially with the limited
involment of the legislature even after multiple landmark holdings by the
Supreme Court on the matter. The judiciary was able to bring the much-required
legal clarity upon the subject, with the landmark case of Aruna Shanbaug laying
down the guidelines for passive euthanasia.
In India the legal landscape
concerning euthanasia can be seen in the evolvement and transformation of the
reasoning and understanding of the Supreme Court pertaining to the matter. It
is broadly categorised into passive and active euthanasia with the former being
still illegal to be practiced in the country. However the same has been
criticised for the lack of clarity and consistency in its interpretation in
end-of-life decision due to the absence of comprehensive legislation.[6]
The three judgment of the Gian Kaur
case where it observed the right to die in dignity to be within the definition
of right to life with dignity is what that brought the reasoning for legalising
passive euthanasia in the landmark judgment delivered by a divisional bench of
the court in Aruna Shanbaug. However the concept of a living will was only
recognised latter in the 2018 judgment of Common Cause v. Union of India by a
constitutional bench where the court answered the question of whether an
individual can execute his or her right to die with dignity through a validly
executed and legally enforceable document, which is the living will.[7]
However, though being studied and
discussed numerously, the contend of euthanasia is still considered to be an
understanding foreign to the citizens with major contentions concerning
sociocultural and ethical issues.
Socio-cultural concerning the implementation of euthanasia
The
societal landscape in India heavily influences perspectives on euthanasia.
Religious diversity plays a crucial role, with different faiths having varying
views on the sanctity of life and the moral implications of ending it
intentionally. Hinduism, the predominant religion in India, may have diverse
interpretations of death as a natural process, while some interpretations of
Islam and Christianity may vehemently oppose euthanasia due to beliefs about
the sacredness of life. While such a view can be said as the most saturated of
all and there being a huge population standing against the “unnatural
curtailing of human life” through euthanasia, studies have shown that practices
similar to euthanasia which are essentially end of life practices have been
prevalent in rural regions of India. Practices such as “Thalaikoothal” where the terminally ill person is given an oil bath
using gingelly oil and cold water several time a week or feeding the bedridden
with holy water or mil with the intention to end the suffering or the ritual of
feeding the ill with water mixed with mud until death occurs can be seen as
customary practices which are believed to ensure the peaceful death of the
bedridden, have been stated as customary practices.[8]
This essentially shows that people do believe in the right to have a dignified
and peaceful death. However the study showed that reasons for such practices
were not just spiritual, customary and moral obligations but also
socio-economic factors.[9]
This calls for a need for a more civilised and legaly structured framework in
favour of euthanasia that ensures the peaceful and dignified death of the
bedridden but at the same time helps in resolving the issue of elderly abuse.
Moreover
the vulnerability of being abused cannot be the reason for rejecting the
concept of euthanasia. The 196th report of the Law Commission suggested not
acknowledging living wills or advance directives in Indian law due to concerns
regarding potential misuse, specifically highlighting the risk associated with
oral advance directives given the literacy and education levels in India.[10]
This recommendation was reiterated in the 241st report of the Law Commission,
where a proposed draft bill allowed doctors to disregard living wills or advance
directives.[11]
Such a approach can be considered equal to stating that women should not go
outside in the street since they are more vulnerable to get abused, rather than
tackling the cause of abusing and ensuring a safe environment to women.
Ethical issues concerning
the implementation of euthanasia
Ethical
discussions surrounding euthanasia in India encompass multiple frameworks,
notably patient autonomy, beneficence, non-maleficence, and justice. A major
opposition against legalisation of euthanasia is with regards to its
contradiction with the principles of medical ethics. The medical profession is
guided by a desire to cure and prolong life.[12]
The Hippocratic Oath exquisitely exemplifies this concept, which states “I
will prescribe regimen for the good of my patients according to my ability and
my judgment and never do harm to anyone. To please no one will I prescribe a
deadly drug, nor give advice that may cause his death.”[13]
Hence, the prospect that a doctor might expedite a patient's death directly,
especially after having presumably provided treatment to prolong and enhance
the patient's life, goes against the fundamental principle of the medical
profession.[14]
The principle of autonomy asserts an
individual's right to make decisions regarding their own life, including the
choice of a dignified death. However, this clashes with the sanctity of life, a
value deeply rooted in Indian society, influenced by cultural, religious, and
familial beliefs. The clash of ethical principles, cultural values, and religious
beliefs creates divergent viewpoints on euthanasia. Indian society
traditionally values the preservation of life, yet the ethical dilemma emerges
from the desire to alleviate intolerable suffering. These conflicting values
shape the discourse on euthanasia and complicate the establishment of a clear
ethical path.
In
the Common Cause judgment the court has dived into the ethical, theological,
philosophical and constitutional concpets.[15]
The principle of Snactity of Life was also addressed with observation from
several well known minds such as the opinion put forward John Stuart Mill where
he describes an individual as the soverign body over himself, his body and his
mind.[16]
Prof. Upendra Baxi defines digninty as the respect for an individual person based
on his freedom and decision making capacity and a good/just society shall be
the one that respects dignity.[17]
Furthermore,
in the KS Puttaswamy judgment[18],
a nine-judge Constitutional Bench recognized privacy as a fundamental component
of the right to life outlined in Article 21. This acknowledgment also
encompasses an individual's right to refuse medical care that prolongs life.
Justice Chelameshwar commented that the state's forced feeding of certain
individuals raises privacy concerns. He also noted that an individual's freedom
to decline life-extending medical treatment or to end their life falls within
the realm of privacy.[19]
Comments
The
case of Rodriguez v. British Columbia
(Attorney General)[20],
heard before the Supreme Court of Canada, the argument was made that
restricting euthanasia impinged on the individual's right to life as guaranteed
by section 7 of the Canadian Charter of Rights and Freedoms. The contention was
that such limitations hindered the individual's ability to end their life when
they were unable to do so independently. The court determined that while the
law appeared to encroach upon the rights protected by section 7 of the charter,
it served the state's aims of preserving life and safeguarding the vulnerable.
This legislation mirrored the state's policy of valuing human life and
preventing the devaluation of life by permitting its termination.[21]
Furthermore, the observation that no one has the right to curtail the natural
life span of a human being as submitted in the Gian Kaur case is a defining
factor that has influenced all subsequent judgments. However with the right to
a dignified death being observed by the court in these cases, it is
unreasonable to object the implementation euthanasia as an essential in today’s
India.
We
can see that the ethical issues pertaining to the same that such an approach is
against medical guidelines as professed by the medical practitioners and the
morality believed, practiced and professed in the country, should not mean that
the individual autonomy and an individuals say on ones life and his privacy can
be overlooked. Furthermore, the contention that easy access to euthanasia can
make people, especially the marginalised, vulnerable is not to be considered as
an justifiable defence as previously observed.
Moreover,
it is nothing new when said that India lacks medical infrastructure and enough
availability or access to palliative care. Studies show that more that 60% of
the deaths require palliative care. At such a situation with lack to proper
health and care the state must realise that it is not up to them to burden the
individual with sufferings and they are inherent of their right to die a
dignified death. The same shall be said to be more reasonable when the
definition of life is understood not just by its physical aspects but by its
intellectual, emotional, psychological and spiritual make-up of a person.[22]
A statement, articulated by two medical experts from India, suggests that life
transcends mere existence, emphasizing the importance of living in a state of
well-being.[23]
They highlight that health encompasses more than the mere lack of illness,
emphasizing a vibrant vitality that embodies a sense of completeness and the
potential for ongoing intellectual and spiritual development.[24]
The experts underscore the interconnected nature of physical, social,
spiritual, and psychological well-being, emphasizing their intrinsic
integration within the framework of life.[25]
Challenges and Future Implications
Even
with the supreme court trying to de-complicate the whole process regarding
euthanasia with the 2023 judgment revaluating Common cause guidelines, it is
still is far from avoiding the cumbersome tag that the whole process comes
with. With the legislature still seemingly staying silent on the matter leads to
multifaceted challenges. The lack of legal clarity results in varying
interpretations and ethical dilemmas for healthcare professionals, ultimately
impacting the patient's right to choose a dignified death. Moreover,
disparities in access to quality healthcare intensify ethical concerns about
unequal opportunities for a compassionate end of life.
Addressing
these challenges and shaping the future implications of euthanasia in India
necessitates a comprehensive approach. Crafting inclusive legislation that
considers the nuances of cultural and ethical diversity, while addressing
disparities in healthcare access, is critical. Promoting extensive public
discourse and education on end-of-life decisions will be fundamental in
establishing a balanced and inclusive approach to the right to die.
Furthermore,
the whole contention for easier access to euthanasia is on the absence of
proper quality healthcare to all and thereby being the ones to suffer. The
paper does not study on a day when technology is accessible to all and allows
the recovery of all diseases and health conditions. Also, the concept of
cryonics, which currently is regarded as a pseudoscience, a theory of freezing
oneself in the hope of healing them in the future when technology and medicine
is adequately developed, is something that is studied upon if practiced. Shall
the concept of euthanasia still prevail or will the life be frozen and
preserved till the technology allows the cure for the same. Only that can
eventually conclude on whether there is essentially a right to die peacefully.
Conclusion
Euthanasia
in India is a multifaceted issue influenced by legal, ethical, and
sociocultural factors. The absence of comprehensive legislation has led to a
complex landscape where varied interpretations and ethical dilemmas persist. A
need for a holistic approach, balancing individual autonomy, ethical
principles, and cultural values, is imperative in navigating this sensitive
territory. India’s path forward involves drafting inclusive legislation that respects
diverse perspectives, ethical considerations, and societal values, aiming for a
compassionate and comprehensive understanding of the right to die. The paper
recognises the need for the same but finds a dilemma on figuring whether it is
a right of the individual or a compensation at the absence of access to proper
healthcare and cure .
This
expanded version provides a deeper exploration of the legal, ethical, and
sociocultural facets of euthanasia in India, acknowledging the complexities and
challenges inherent in this deeply debated issue.
[1] Sinha, V.K., S. Basu, and S.
Sarkhel. "Euthanasia: An Indian Perspective." 54(2) Indian Journal of
Psychiatry 177, 177 (2012)
[2] (2011) 4 SCC 454
[3] Common Cause (A Regd. Society) v.
Union of India 2018 SCC OnLine SC 208.
[4] Common Cause (A Regd. Society) v. Union of India, 2023 SCC
OnLine SC 99
[5] Aditi S Milap, “Euthanasia: Right
to die with dignity”, 10(1) International Journal of Science and Research
Archive, 398, 398-403 (2023).
[6] Sinha, V.K., S. Basu, and S.
Sarkhel. "Euthanasia: An Indian Perspective." 54(2) Indian Journal of
Psychiatry 177, 177 (2012)
[7] KUMAR, ALOK PRASANNA. “Tilting at the Windmills (Again): Should the
Supreme Court Legalise ‘Living Wills’?” Economic and Political Weekly,
vol. 49, no. 34, 2014, pp. 10–12. JSTOR, http://www.jstor.org/stable/24480904.
Accessed 3 Nov. 2023.
[8] Ramalingam S, Ganesan S. End-of-Life Practices in Rural South
India: SocioCultural Determinants. Indian J Palliat Care.
2019;25(2):224-227. doi:10.4103/IJPC.IJPC_173_18
[9] Id.
[10] Law Commission of India, Medical
Treatment to Terminally 111 Patients (Protection of Patients and Medical
Practitioners), Report No 196, pages 328-29
[11] Law Commission of India, Passive
Euthanasia – A Relook, Report No. 241, page 43.
[12] Sinha, Vinod K et al. “Euthanasia: An Indian
perspective.” Indian journal of psychiatry vol. 54,2 (2012):
177-83. doi:10.4103/0019-5545.99537
[13] Miles, Steven H. The Hippocratic Oath and the Ethics of
Medicine. Oxford ; New York :Oxford University Press, 2004.
[14] Sinha, Vinod K et al. “Euthanasia: An Indian
perspective.” Indian journal of psychiatry vol. 54,2 (2012):
177-83. doi:10.4103/0019-5545.99537
[15] Bharathi Challa, “Constitutional
Bench Explainer Series: Common Cause v. Union of India”, Law and other things,
(Nov. 04, 2023, 11:27 PM) https://lawandotherthings.com/
[16] John Stuart Mill, On Liberty, 1859
(Batoche Books Limited, Ontario, 2001)
[17] T.N. Madan, “Living and Dying” in
Non-Renunciation: Themes and Interpretations of the Hindu Culture (Oxford
University Press, New Delhi, 1987).
[18] K.S.
Puttaswamy & Anr. vs. Union of India & Ors. (2017) 10 SCC 1
[19] Id.
[20] (1993) 107 DLR 4th 342.
[21] Fontalis,
Andreas et al. “Euthanasia and assisted dying: what is the current position and
what are the key arguments informing the debate?.” 111 Journal of the Royal
Society of Medicine 407-413
(2018).
[22] Stanley Yeo, Dying With Dignity: Case for Legalising Physician-assisted suicide,
JOURNAL OF THE INDIAN LAW INSTITUE, Vol 50, No.3, 321-338 (2008)
[23] 3. M. Indira and A. Dhal,
"Meaning of life, suffering and death", paper presented at the
International Conference on "Health Policy, Ethics and Human Value"
held in New Delhi in 1986 and cited by the Supreme Court of India in Rathinam ,
supra note 17 at 29
[24] Id.
[25] Id.
Article Information
CRITICAL ANALYSIS OF EUTHANASIA AND ITS RELEVANCE IN TODAY’S INDIA
Authors: JOSYN BIJOY
- Journal IJLRA
- ISSN 2582-6433
- Published 2024/04/19
- Issue 7
About Journal
International Journal for Legal Research and Analysis
- Abbreviation IJLRA
- ISSN 2582-6433
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