Passive Euthanasia

Recently, the country's honourable Supreme Court decided to simplify the process of passive euthanasia.

Guideline by the court:

• A five-judge Constitutional bench, led by Justice KM Joseph, decides to greatly simplify the country's passive euthanasia process.
• The document must now be signed by the "living will" executor in the presence of two attesting witnesses, preferably unrelated, and attested before a notary or Gazetted Officer, following new regulations.
• The Supreme Court previously held that a terminally ill patient or a person in a persistent vegetative state may execute an advance medical directive or a "living will" to refuse medical treatment. The SC also held that the right to live with dignity included the ability to "smoothen" the dying process.
• With the modification of its earlier order and the removal of the requirement that a magistrate's approval be obtained before withdrawing or withholding life support from a terminally ill person, the Supreme Court has streamlined this process for passive euthanasia.
• The ruling by the Supreme Court was based on a PIL that NGO Common Cause had filed to have terminally ill patients' requests for passive euthanasia recognised as "living wills."
• The SC has further stated that the instructions and guidelines will be in effect till Parliament introduces relevant legislation.

What is Assisted Suicide?

• Both assisted suicide and euthanasia are methods of ending a person's life voluntarily with the help of others.

• In certain circumstances, assisted suicide and euthanasia are permitted in a number of European countries, some Australian jurisdictions, and Colombia in South America.

Types of Euthanasia:

Active:

• Only a few nations permit active euthanasia, which involves using drugs to end the patient's life.

Passive:

• This simply entails the patient's agreement, or that of a family member or close friend acting on the patient's behalf, to stop life-saving treatment or medical intervention.
• The act of withholding or withdrawing medical care, such as withholding or removing life support, with the aim of letting a person die, is known as passive euthanasia.
• Active euthanasia, in contrast, entails an active intervention to end a person's life with drugs or an outside force, like giving a deadly injection.

Euthanasia in India:

• The Supreme Court of India legalised passive euthanasia in 2018 in a landmark decision, using the concept of a "living will."
• In accordance with the ruling, an adult who is of sound mind is allowed, under certain circumstances, to voluntarily opt against receiving medical care in order to embrace death in a natural way.
• It also established rules for "living wills" signed by terminally ill individuals who are aware of the likelihood that they will enter a permanent vegetative state.
• The court cited Article 21 of the Constitution, which states that "Dignity in the process of dying is as much an element of the right to life. An individual's sense of purpose in life is taken away when their dignity is violated near the end of their life.

The distinction between physician-assisted suicide and euthanasia.

• Euthanasia and physician-assisted suicide are frequently confused. The lethal medicine is administered differently depending on who does it.
• A doctor or other third party delivers euthanasia.
• Although on the doctor advise, the patient really carries out physician-assisted suicide.
• The term "assisted death" is sometimes used to refer to both assisted suicide and euthanasia.

Classification:

• Voluntary Euthanasia (with Patients' Consent): Patients' consent is obtained before euthanasia is carried out. Some nations, like as Belgium, the Netherlands, etc., have legalised it.
• Non-voluntary Euthanasia: When a patient is unable to provide their consent (for instance, if they are seriously brain-damaged or in a state of coma), another person must make the decision on their behalf. This is frequently the case since the patient had previously stated a desire to end their life in these situations.
• Involuntary Euthanasia: (conducted without the patient's consent or against their will): Euthanasia carried out against the patient's will is referred to as involuntary euthanasia. It's also considered to be murder.

Euthanasia's supporters: have put forth four basic justifications, according to Ezekiel Emanuel, an opponent of the practice:

• That people should be given the freedom to determine their own fate since they have the right to do so.
• Allowing a subject to pass away is preferable to letting them suffer any longer.
• The difference between passive euthanasia, which is routinely permitted, and active euthanasia is not substantive (the fundamental principle, the doctrine of twofold effect, is irrational), thus allowing euthanasia won't inevitably have unfavourable effects.
• In order to prove that legalising euthanasia is generally trouble-free, pro-euthanasia campaigners frequently cite examples of other nations where it has been legalised, such as the Netherlands, Belgium, Luxembourg, etc.

Doctrine of twofold effect:

• The doctrine of double effect says that if doing something morally good has a morally bad side-effect, then it is ethically acceptable to do it provided the bad side-effect wasn’t intended. This is true even if you foresee that the bad effect would probably happen.
• The above principle is used to justify the case where a doctor gives drugs to a patient to lessen distressing symptoms in spite of knowing that doing so may shorten the patient’s life.
• This is because the doctor is not targeting directly to kill the patient, and the bad result of the patient’s death is a side-effect of the good result of reducing the patient’s pain.

Rights-based arguments:

• People have a clear right to die.
• Death is a personal matter, and the government and others have no authority to interfere if no harm is done to others (libertarian case)
• Allowing patients to pass away could free up limited medical resources (this is a possible argument, but so far no authority has seriously proposed it)

Arguments Against Euthanasia

Ethical defences

• The sanctity of life may be less respected in society as a result of euthanasia.
• Euthanasia advocates would be saying that some lives—those of the sick or disabled—are less valuable than others.
• Arguments from religion – Religions are against euthanasia for a variety of reasons.

Euthanasia contravenes God's will. (God prohibits it)

• Many religions consider euthanasia to be a morally repugnant form of murder. Some religions also consider suicide to be "illegal". There is a moral argument that euthanasia will erode society's adherence to the value of human life.

Patient Competence:

• Euthanasia can only be performed voluntarily if the patient is mentally sound, has a clear comprehension of the alternatives and potential outcomes, and is able to communicate both their understanding and their desire to end their own life. Competence is difficult to determine or define.

Guilt:

• Patients could feel like a drain on resources and that giving consent is being psychologically forced upon them. They can believe that their family is under too much of a financial, emotional, and mental strain.

India's History of Euthanasia:

• In the Gyan Kaur case, the Supreme Court ruled that assisted suicide and euthanasia are illegal in India. The Court's misleading statement was:

• According to Article 21 of the Constitution, the right to death is not a part of the right to life. The court concluded that Article 21 cannot reasonably be interpreted to ensure the extinction of life because it is a provision guaranteeing the preservation of life and personal liberty.
• It is also possible to die with dignity if you have the right to live in dignity.
• However, the court was unable to produce any useful guidelines and gave politicians the task of enacting legislation governing euthanasia.
• The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill 2006 was published by the Law Commission of India in its 196th report in 2006. Euthanasia, however, is not covered by any laws.
• In the case of Aruna Shanbaug v. Union of India, the supreme court established procedures for handling requests for passive euthanasia in 2011. It stated that the procedures outlined under the guidelines should be followed up until Parliament has drafted legislation. Additionally, it explained the distinctions between aggressive and passive euthanasia.
• A proposed law known as the Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill was prepared in 2012 as part of The Law Commission's 241st report, which once more recommended passing laws on passive euthanasia.
• The Supreme Court of India's three-judge bench referred the debate over euthanasia to its five-judge Constitution bench in 2014 after finding the ruling in the Aruna Shanbaug case to be "inconsistent in itself."
• The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill is a proposed law that the Health Ministry uploaded in 2016 for public comment. The ministry wants people to share their opinions so that it can decide whether or not to enact a law on passive euthanasia.