The ‘Right to life’ under Article 21 of the Indian Constitution has been treated as the most fundamental right conferred to the citizens of India since independence. It has historically received the widest possible interpretation, not only by the courts but also by the multiple governments that have made amendments to the rights and responsibilities under the constitution. The courts in India have long debated over what is the limit of Article 21 of the Indian Constitution, more particularly, if the ‘Right to die with dignity’ was a right that could be conferred under the provisions of this article of the Indian Constitution. The right to die with dignity is often considered the logical conclusion of the right to life as defined under Article 21 of the constitution of India as it is reasonable to accord someone with the power to choose their time and means of death. The right to die, however, has been resisted for quite some time in India and it is only recently that the Supreme court ruled in favor of passive euthanasia.
While the right to die may be the antithesis of the right to life, it must be considered within the wide and historically liberal definitions of Article 21 of the Indian Constitution
Understanding the Right to Die with Dignity
The right to die with dignity is merely a representation of the allowance of some form of voluntary death. It is usually seen in aged or vegetative patients on life support in hospitals or in homes where they are unable to resume living without the assistance of a machine and they can choose to, through the removal of a machine or physician-assisted means, voluntarily terminate their own lives. The right to die with dignity came from the understanding of the right to life as a right to live dignified lives rather than a simple animalistic life.
The apex court in K.S. Puttaswamy and Another v. Union of India and Others reaffirmed this assessment and held that causing a person to live an undignified life or one similar to an animal existence is in itself, a violation of Article 21 of the Indian Constitution. In light of this, it becomes reasonable to allow people suffering from terminal illnesses, vegetative conditions or other problems which cause them to be unable to live a meaningful life or become a burden to others the right to die with dignity as well.
Euthanasia is derived from the Greek words ‘Eu’ and ‘Thanos’ which translate roughly to ‘Good Death’. It is a form of assisted death where the physician attending to the patient either removes the life support device or administers medication to painlessly end the life of the suffering patient. There are 3 primary types of euthanasia –
- Voluntary Euthanasia; in this form, the ailing patient requests the physician through a will, clear communication, or through a family member of their intention to end their life and require assistance in doing so.
- Non-Voluntary Euthanasia; is when the patient is unable to communicate their intention to end their life and it is done at the behest of a family member or on recommendation by the physician.
- Involuntary Euthanasia; is when the patient has communicated their intention against the act of euthanasia and is still under physician assistance or the removal of life support that the patient is dependent on.
Of the above, practitioners of medicine are conflicted about the legality of non-voluntary and involuntary euthanasia where the patient is unable to or has opposed to the act of euthanasia, voluntary euthanasia has been allowed in India and abroad as voluntary death. Voluntary euthanasia can be further divided into two more types of euthanasia;
- Passive Euthanasia; is where the physician attending to the patient does not actively euthanize the patient but merely disconnects/removes treatment that was essential to keeping the patient alive. For example, the removal of a ventilator when a patient is dependent on it.
- Active Euthanasia; is where the physician is actively involved, through the administration of drugs or any other painless means in the euthanizing of the patient.
In India, only passive, voluntary euthanasia through a ‘living will’ has been permitted under the provisions of a judgment passed in Common Cause (A Registered Society) vs. Union of India & Ors. Despite the restrictions placed on euthanasia in India, people both welcomed and detested this judgment as it allowed those coherent and of sound mind to literally ‘warrant their own deaths’.
Euthanasia and Suicide at a Juxtaposition
Yes, Euthanasia and Suicide are entirely different concepts and should not be confused with one another. While they both share characteristics in that they are both the voluntary cessation of life by a person, the difference lies in the execution of that cessation of life. In Suicide, the person suffering is responsible for taking their own life and can only be aided or abetted by a third person. In Euthanasia, the physician is required for the procedure and is the only person legally allowed to perform the procedure. Any form of Euthanasia without the prior consent/approval of the attending physician is no euthanasia but murder and the person carrying out the action is liable to be tried under Sections 300 and 302 of the Indian Penal Code.
Further, attempted suicide is punishable under provisions of Section 309 of the Indian Penal Code with a term of imprisonment for up to 1 year, however, the Mental Healthcare Act, 2017, which went into effect in July 2018, has limited the scope for the use of Section 309 of the IPC and made suicide attempts punishable as an exception. Suicide has always been controversial and the Indian government with the help of courts has been trying to create structure and organize the law around suicide and self-harm. Euthanasia, on the other hand, is outright barred in most countries due to the nature of the act, the involvement of the physician, and the overall lapses in current laws to help deal with cases of euthanasia.
The current procedure for euthanasia in India is cumbersome and time-consuming. It involves the person applying for euthanasia making a living will before two witnesses in the presence of a Judicial Magistrate before end-of-life care (yes, you have to plan for euthanasia) which is a process that may take months if not years to complete due to a lack of non-standard practices at both the central and state levels. This is an issue because people that recognise the need for euthanasia are usually those undergoing treatment for some form of worsening disease or are already close to entering a phase of treatment that will render them unable to make further appearances before the court.
While the Supreme Court drafted guidelines to make the process watertight, the additional complications of court appearances and the three-tiered process of approval of a living will make it unsustainable and unviable for most. In addition, voluntary passive euthanasia is the only form of euthanasia allowed in India which leaves patients that are not vegetative but cannot live meaningful lives entirely devoid of options. On the other hand, some argue that the three-tiered process of approval from the judicial magistrate is not enough and the high court must be involved in all cases invoking a right to die.
Arguments in favor of the Right to Die with Dignity
There have been many arguments in favor of euthanasia. These arguments range from a Hohfeldian analysis of the right to life to the utilitarian and stoic approaches to death. All these arguments often point towards the legalization of euthanasia as a choice offered to alining and dying patients. While all of these arguments are valid, the supreme court considered the following in their judgment;
- The future of the patient is kept on life support or any other form of constant treatment for extended periods,
- The position of Article 21 of the Indian Constitution in these contexts and how they would be a violation of a person’s right to live a meaningful and pain-free life,
- The conflicting provisions of Section 306 and 309 of the Indian Penal Code,
- The technicality of considering euthanasia as a necessary means to ease the suffering of the patient.
On a thorough examination of the above, the court found it sufficient to grant people the right to passive euthanasia, through the execution of a living will which was drafted when the person was of the sound mind of their own accord and signed by a judicial magistrate in the presence of 2 witnesses. This was considered a landmark as multiple people suffering from or bound to suffer from serious and paralyzing ailments could now opt for passive euthanasia in case their medical condition deteriorated and they were no longer able to live without the support of a machine or lead a meaningful life.
Arguments against the Right to Die with Dignity
While some in their advanced ages and others that have witnessed their relatives undergo suffering and pain while being dependent on a machine in their immediate proximity celebrate the right to passive euthanasia, there are other factions of society that do not share the same sentiment as those in favor of euthanasia. For one, medical practitioners consider it to be a grave and erroneous violation of medical ethics, one which cannot be condoned and must be discouraged at all costs. Apart from this, popular arguments include;
- The religious condemnation of taking your own life through euthanasia,
- The possible commercialization of euthanasia for personal gain,
- Those in abject resorting to this instead of opting for medical treatment,
- Old and frail dependents can be unburdened through this means,
- The general devaluation of human life and dignity.
These arguments in addition to medical ethics violations, physician misuse, and euthanasia based on misdiagnosis were all presented before the apex court for consideration before the landmark judgment was passed, however, apart from medical ethics violations and physician misuse, the other arguments do not fairly represent the seriousness of a meaningless life confined to a hospital bed.
The Global Take
Many countries that have been known for their progressive laws and outlooks have already made euthanasia legal in many forms and have implemented safeguards against the arguments made against euthanasia above. Those countries reason that a person should not be made to suffer unnecessarily when they do not wish to due to a constitutional provision. Many of these countries allow all forms of voluntary euthanasia while restricting physician-assisted suicide or other forms of euthanasia. Countries such as the UK and Australia have passed legislation to this effect although thanks to their advanced and affordable healthcare, patients seldom opt for euthanasia.
Concluding the Discussion
Euthanasia, through its various forms, is the same, it is the action of taking one’s own life with the help of a physician. The only difference between the various types of euthanasia is the involvement of the physician or the consent given/not given. It is considered rightly as an end resort when there are no other avenues left to live a meaningful life.
Despite society’s reservations about euthanasia, it is a choice that is deeply personal and should not be made under duress or any other form of coercion. It must be taken by the person after carefully considering and assessing the situation they may find themselves in and must be done in a manner prescribed by the law in India. The choice of euthanasia should be offered to those who may find themselves in critical conditions and dependent entirely on the care of a machine. It is in the best interests of India to legalise active and passive euthanasia in all forms and streamline the process to make it more accessible to those who require this particular choice. It should also be extended to their immediate family members after an analysis of their behaviour with the patient to properly execute the true purpose of euthanasia, to end the suffering of the ailing patient.