Euthanasia: Definition And History.

1. Understanding "Euthanasia":

   The Death can be defined as the termination of life. Death can be categorized basically into two kinds � (i) natural and (ii) unnatural death. The word "euthanasia" derives from the Greek words "eu" (good) and "thanatos" (death). The idea is that instead of condemning someone to a slow, painful, or undignified death, euthanasia would allow the patient to experience a relatively "good death."[1] It is pertinent to note that, the definition of Euthanasia in legal terms has been changing and is construed differently in different parts of the world. Due to the wide scope and ambit of the way Euthanasia is used on a person, its meaning changes.
   
   The British House of Lords select committee on medical ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering".[2] In the Netherlands and Belgium, euthanasia is understood as "termination of life by a doctor at the request of a patient". The Dutch law, however, does not use the term 'euthanasia' but includes the concept under the broader definition of "assisted suicide and termination of life on request".[3]
    

2. Historical Origin And Evolution Of Euthanasia:

   The term euthanasia, in the earlier sense of supporting someone as they died, was used for the first time by Francis Bacon. In his work, Euthanasia medica, he chose this ancient Greek word and, in doing so, distinguished between euthanasia interior, the preparation of the soul for death, and euthanasia exterior, which was intended to make the end of life easier and painless, in exceptional circumstances by shortening life. That the ancient meaning of an easy death came to the fore again in the early modern period can be seen from its definition in the 18th century Zedlers Universallexikon: Euthanasia: a very gentle and quiet death, which happens without painful convulsions. The word comes from bene which means well and mors which means death.[4]
   
   The concept of euthanasia in the sense of alleviating the process of death goes back to the medical historian Karl Friedrich Heinrich Marx, who drew on Bacon's philosophical ideas. According to Marx, a doctor had a moral duty to ease the suffering of death through encouragement, support and mitigation using medication. Such an "alleviation of death" reflected the contemporary zeitgeist, but was brought into the medical canon of responsibility for the first time by Marx. Marx also stressed the distinction of the theological care of the soul of sick people from the physical care and medical treatment by doctors.[5]
   
   In the mid-1800s, the use of morphine to treat "the pains of death" emerged, with John Warren recommending its use in 1848. A similar use of chloroform was revealed by Joseph Bullar in 1866. However, in neither case was it recommended that the use should be to hasten death. In 1870 Samuel Williams, a schoolteacher, initiated the contemporary euthanasia debate through a speech given at the Birmingham Speculative Club in England, which was subsequently published in a one-off publication entitled Essays of the Birmingham Speculative Club, the collected works of a number of members of an amateur philosophical society.
   
   The first attempt to legalize euthanasia took place in the United States, when Henry Hunt introduced legislation into the General Assembly of Ohio in 1906.[6] Hunt did so at the behest of Anna Sophina Hall, a wealthy heiress who was a major figure in the euthanasia movement during the early 20th century in the United States. Hall had watched her mother die after an extended battle with liver cancer, and had dedicated herself to ensuring that others would not have to endure the same suffering.
   
   Hunt's bill called for the administration of an anesthetic to bring about a patient's death, so long as the person is of lawful age and sound mind, and was suffering from a fatal injury, an irrevocable illness, or great physical pain. It also required that the case be heard by a physician, required informed consent in front of three witnesses, and required the attendance of three physicians who had to agree that the patient's recovery was impossible. A motion to reject the bill outright was voted down, but the bill failed to pass, 79 to 23.
   
   The Voluntary Euthanasia Legalization Society was founded in 1935 by Charles Killick Millard (now called Dignity in Dying). The movement campaigned for the legalisation of euthanasia in Great Britain. In January 1936, King George V was given a fatal dose of morphine and cocaine to hasten his death. At the time he was suffering from cardio-respiratory failure, and the decision to end his life was made by his physician, Lord Dawson.
   
   As of 2023, euthanasia is legal in Belgium, Canada, Colombia, Luxembourg, the Netherlands, NewZealand, Portugal (awaiting regulation), Spain and all six states of Australia.
    

3. Classification Of Euthanasia:

   In the modern era, the understanding of term Euthanasia is with regard to the law and usage of Euthanasia in a particular country/ region. Therefore there is no definite meaning associated to Euthanasia, without understanding its legality.
   
   Following is the recognized classification of Euthanasia in different parts of the world[7][8]:
   
   • Active Euthanasia: Active euthanasia is also called ''aggressive' euthanasia. In this, the patient is put out of his misery by active means. This could include administering a lethal injection of a drug. It is a controversial method and contains many religious, moral, ethical, and compassionate considerations that are hotly debated.
   • Passive Euthanasia: Passive euthanasia is when a patient's life is ended indirectly by cutting off the life-sustaining treatments. It involves intentionally withholding the life support systems like the ventilator or the feeding tube.
   • Voluntary Euthanasia: Voluntary euthanasia takes place with the consent of the patient. This includes situations such as:
     • Requesting aid is dying;
     • Refusing intensive medical care;
     • Request that medical treatment is halted or life support equipment be turned off;
     • Refusing to eat or drink or fasting on purpose.
   • Involuntary Euthanasia: Involuntary euthanasia is administered without the patient's consent. It occurs when the person killed is capable of consenting to his or her own death, but does not do so, either because they are not asked, or because that person is asked and yet decides to go on living. This is blatantly done without consent of the patient.
   • Non-voluntary Euthanasia: Non-voluntary euthanasia occurs when the person is not in a position to make a meaningful choice between living and dying and an appropriate person takes the decision on their behalf. This is done without the consent of the patient, but his wishes to die are known. This covers situations in which:
     • the person is in a coma;
     • the person is too young (e.g. a newborn infant);
     • the person is forgetful;
     • the person is intellectually challenged - the person has severe brain damage.
   • Self-administered Euthanasia: Self-administered euthanasia is when the patient himself/herself administers the means of death.
   • Other-administered Euthanasia: Other-administered euthanasia is when a person other than the patient, like the doctor or a close family member administers the means of death.
   • Assisted Euthanasia: It is called assisted euthanasia when the patient himself/herself administers the means of death, but with the assistance of another person like the doctor.
   • Mercy Killing: Mercy killing is an umbrella term that includes active, involuntary, and other-administered euthanasia thus, it implies killing a patient without his/her explicit consent to end the pain and suffering, i.e. out of mercy.
   • Physician-assisted Euthanasia: Physician-assisted euthanasia is active, voluntary, and assisted euthanasia where a physician ends a patient's life with his/her consent by actively providing a means of death.

Debate On Right To Life And Right To Die In India- Legal Position.

1. Law On Euthanasia:

   The law in India is clear on the aspect of assisted suicide. Abetment of suicide is an offence expressly punishable under Sections 305[9] and 306[10] of the IPC. Moreover, attempt to suicide is also punishable offence under section 309[11] of IPC. In cases of euthanasia or mercy killing there is an intention on the part of the doctor to kill the patient, such cases would clearly fall under clause first of Section 300[12] of the Penal Code, 1860. However, as in such cases there is the valid consent of the deceased, Exception 5 to the said Section would be attracted and the doctor or mercy killer would be punishable under Section 304[13] for culpable homicide not amounting to murder. But it is only the cases of voluntary euthanasia (where the patient consents to death) that would attract Exception 5 to Section 300. Cases of non-voluntary and involuntary euthanasia would be struck by proviso one to Section 92[14] of the IPC and thus be rendered illegal.
   
   
   The Medical Council of India, in a meeting of its ethics committee in February 2008 in relation to euthanasia opined: Practicing euthanasia shall constitute unethical conduct. However, on specific occasions, the question of withdrawing supporting devices to sustain cardio-pulmonary function even after brain death shall be decided only by a team of doctors and not merely by the treating physician alone. A team of doctors shall declare withdrawal of support system. Such team shall consist of the doctor in-charge of the patient, Chief Medical Officer / Medical Officer in-charge of the hospital, and a doctor nominated by the in-charge of the hospital from the hospital staff or in accordance with the provisions of the Transplantation of Human Organ Act, 1994.[15]
    

2. Difference Between Suicide And Euthanasia:

   Between Suicide and Euthanasia, there is a conceptual divide. Suicide occurs when a person kills himself intentionally by stabbing, poisoning, or other means. Without a doubt, suicide is a deliberate effort to end one's life. It is the act or occurrence of someone purposefully killing themselves, usually owing to sadness or other factors such as dissatisfaction in love, failure in exams, or difficulty finding a decent job. Euthanasia, on the other hand, is the action of another person to terminate the life of a third person. A third party is either actively or passively engaged in Euthanasia, meaning he assists or abets the death of another person. It is also worth noting that there is a distinction between 'assisted suicide' and 'euthanasia' in this situation. Assisted suicide is when someone knowingly assists someone else in committing suicide, such as by giving them the tools to do so. A 'physician-assisted suicide occurs when a doctor assists a patient in killing himself (by prescribing fatal drugs). As a result, since the patient is the one who commits suicide, the patient has complete control over the process that leads to death. The other person only assists (for example, providing the means for acting). Euthanasia, on the other hand, maybe active, such as when a doctor administers a deadly injection to a patient, or it may be passive, such as when a doctor removes the patient's life support system.[16]
   
   Euthanasia and suicide are different, distinguishing euthanasia from suicide, Lodha J. in Naresh Marotrao Sakhre v. Union of India[17], observed:
   
   "Suicide by its very nature is an act of self-killing or self-destruction, an act of terminating one's own act and without the aid or assistance of any other human agency. Euthanasia or mercy killing on the other hand means and implies the intervention of other human agency to end the life. Mercy killing thus is not suicide and an attempt at mercy killing is not covered by the provisions of Section 309. The two concepts are both factually and legally distinct. Euthanasia or mercy killing is nothing but homicide whatever the circumstances in which it is affected."
    

3. Judicial Precedents:

   1. A question as to whether the right to die is included in Article 21 or not came up for consideration for the first time in Maruti Shripati Dubal v. State of Maharashtra[18], in the Bombay High Court. The petitioner works for the Bombay City Police Force as a police constable.
      
      He has served as a policeman for 19 years as today. In 1981, he was involved in a car crash and also sustained injuries on the head; losing sanity after this and remains so to some extent to this day. He had been receiving psychiatric treatment since January 1982, and his symptoms were characterized as "Giddiness Chabrat (fright), impaired sleep and hunger, nervousness, disorientation, etc." in July 1982. In August of 1982, he was diagnosed with schizophrenia.
      
      Hallucinations plagued him. The petitioner's first contention was that an attempt to commit suicide cannot constitute an offence and section three hundred and nine makes it an offence so it was violative of articles nineteen and twenty-one of the Constitution. The second argument was that the section in question illogically treated all forms of an attempt to one's life the same way and had the same punishment, not thinking about the severity of the incident and what amount of damage was caused to the body. The third and final argument was that an attempt at suicide should not be considered an offence.
      
      The Court, while striking down Section 309 IPC said that the right to life includes the right to die. In this case, a mentally deranged Bombay Police constable tried to set himself on fire in the corporation's office as he was refused for a permission to set up a shop. The Court observed, "No deterrence is further going to hold back those who want to die for a special or political cause or to leave the world either because of the loss of interest in life or for self-deliverance."
       
   2. In P. Rathinam v. Union of India[19] a Division Bench of the Supreme Court also supported the High Court ruling striking down Section 309 as unconstitutional on the grounds that it amounted to punishing the victim twice over.
       
   3. In 1996 in Gian Kaur v. State of Punjab[20] The appellants Gian Kaur and her husband Harbans Singh were found guilty by the Trial Court under Section three hundred and six of the Penal Code, 1860 and each sentenced to six years of rigorous imprisonment and a fine of Rs. 2,000 or in default, further R.I. for nine months, for abetting the commission of suicide by Kulwant Kaur. Above-mentioned both these rulings were overruled. A five-member Constitution Bench held that the right to life does not include "the right to die" or "the right to be killed".
      
      The right to die is inherently inconsistent with the right to life as is death with life. Delivering this verdict, the Court observed, "The right to life is a natural right embodied in Article 21 of the Constitution but suicide is an unnatural termination or extinction and incompatible and inconsistent with the right to life."
       
   4. In the case of Aruna Ramchandra Shanbaug v. Union of India[21], Aruna Ramchandra Shanbaug, a staff nurse at King Edward Memorial Hospital in Parel, Mumbai was attacked by a hospital sweeper on November 27 in the late afternoon. She was pulled back with a dog chain that the sweeper had wrapped around her neck. After realizing that she was menstruating, he attempted to rape her but instead sodomized her.
      
      A cleaner discovered her asleep on the floor on November 28, 1973, with blood all over her. The dog chain's restriction caused her brain's oxygen supply to halt, causing harm. Her teeth have decayed, which is painful, she can hardly swallow any liquid food so she is given mashed food, she has stopped menstruating and her urine and excreta are discharged on the bed itself, and she is completely unaware of her surroundings and is unable to respond to stimuli, 36 years have passed since then, and she is still bedridden.
      
      The petitioner requested to stop feeding Aruna and allow her to pass away gently because she is no longer a living being and is in a Permanent Vegetative State from which there is no recovery. The medical professionals believed that euthanasia was not required at this time because Aruna was not experiencing a terrible or wretched life.
      
      The court held that, Aruna could breathe on own and did not require outside assistance to do so, the main problem that compounded the situation was that she cannot provide her agreement for such a significant move. This required careful consideration and wisdom. The key concern was who can decide on the patient's behalf because the goal was to decide in the patient's best interest.
      
      However, it was also essential to consider the public interest and the state's interest because adopting such laws may have unintended consequences, of which the misuse of the law will be the most significant. Informed consent (assent where the patient is aware of the repercussions of his treatment, such as his chances of life, etc.) and the patient's right to privacy about his or her own body were other issues that the Supreme Court addressed. The right to live with dignity also encompasses the right to die with dignity, according to the court's interpretation of the Gian Kaur case verdict.
      
      Under this ruling, a permanently vegetative person may be permitted to end his life prematurely, and doing so would not constitute a crime. However, in this case, it was unclear who would decide to stop providing life support. So, the right to choose between Aruna's welfare and benefits lies with the hospital and not with Pinki Verani. However, the court, permitted passive euthanasia for specific cases, subject to the approval of the High court and the opinion of an expert medical counsel.
       
   5. In Common Cause v. Union of India[22], a writ petition was filed by the appellant society praying for declaring 'right to die with dignity' as a fundamental right within the fold of 'right to live with dignity' guaranteed under Article 21 of the Constitution and to issue direction to the respondent, to adopt suitable procedures, in consultation with the State Governments wherever necessary, to ensure that the persons with deteriorated health or terminally ill should be able to execute a document viz. 'my living will & attorney authorization' which can be presented to the hospital for appropriate action in case of the executant being admitted to the hospital with serious illness which may threaten termination of his life or in the alternative, issue appropriate guidelines to this effect and to appoint an Expert Committee consisting of doctors, social scientists and lawyers to study into the aspect of issuing guidelines regarding execution of 'Living Wills'.
      
      The Court referred the matter to a Constitution Bench of the same Court be holding as under:

16. In the light of the above discussion, it is clear that although the Constitution Bench in Gian Kaur upheld that the 'right to live with dignity' under Article 21 will be inclusive of 'right to die with dignity', the decision does not arrive at a conclusion for validity of euthanasia be it active or passive. So, the only judgment that holds the field in regard to euthanasia in India is Aruna Shanbaug, which upholds the validity of passive euthanasia and lays down an elaborate procedure for executing the same on the wrong premise that the Constitution Bench in Gian Kaur had upheld the same.

17. In view of the inconsistent opinions rendered in Aruna Shanbaug and also considering the important question of law involved which needs to be reflected in the light of social, legal, medical and constitutional perspective, it becomes extremely important to have a clear enunciation of law. Thus, in our cogent opinion, the question of law involved requires careful consideration by a Constitution Bench of this Court for the benefit of humanity as a whole."

630. In view of our conclusions as noted above the writ petition is allowed in the following manner:

1. The right to die with dignity as fundamental right has already been declared by the Constitution Bench judgment of this Court in Gian Kaur case which we reiterate.
2. We declare that an adult human being having mental capacity to take an informed decision has right to refuse medical treatment including withdrawal from life saving devices.
3. A person of competent mental faculty is entitled to execute an advance medical directive in accordance with safeguards as referred to above.

Analysis Of Implementation Of The Dutch Act I.E. Termination Of Life On Request And Assisted Suicide (Review Procedures) Act, 2002.

Before Passing Of The Act:

Under the Penal Code of Netherlands, killing a person at his request is punishable by imprisonment for a maximum of 12 years or by a fine and assisting a person to commit suicide is also punishable by imprisonment up to 3 years or fine. In spite of the clear wordings of the Code, the Courts of Netherlands have come to interpret the law as providing a defense to charges of voluntary euthanasia and assisted suicide.

The defense allowed is that of necessity. The Dutch defense of necessity is of two types. The first is "psychological compulsion" while the second is "emergency". The latter applies when the accused chooses to break the law in order to promote a higher good. Both these types came to be allowed by the Supreme Court of Netherlands.[23]

The criteria laid down by the Courts to determine whether the defense of necessity applies in a given case of euthanasia, have been summarized by Mrs. Borst-Eilers as follows[24]:

1. The request for euthanasia must come only from the patient and must be entirely free and voluntary.
2. The patient's request must be well considered, durable, and persistent.
3. The patient must be experiencing intolerable (not necessarily physical) suffering, with no prospect of improvement.
4. Euthanasia must be the last resort. Other alternatives to alleviate the patient's situation must be considered and found wanting.
5. Euthanasia must be performed by a physician.
6. The physician must consult with an independent physician colleague who has experience in this field.

After Passing Of The Act[25]:

1. Euthanasia and assisted suicide are governed in the Netherlands by the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, 2002, which came into force in 2002. While both the practices are offences under the Penal Code (Art. 293-294, Sr.), the Dutch Act creates an exception for physicians who comply with the due care and reporting requirements it prescribes.
    
2. The Dutch Act does not differentiate between euthanasia and assisted suicide. "Euthanasia" is used as a compendious term that encompasses both practices. Much of the research concerning the Dutch regime uses the word euthanasia in this way. In order to describe Dutch law and practice accurately, in this section the word "euthanasia" is used as it is in the Netherlands � as a term that includes both euthanasia and physician-assisted suicide.
    
3. The Dutch Act is in part the codification of a permissive regime that had developed through a series of judicial decisions and professional guidelines issued over the preceding three decades.
    
4. The Postma decision[26], concerned the case of a physician who had administered a lethal dose of morphine to her 78-year old mother who was deaf and partially paralyzed, and had pleaded with her daughter repeatedly to end her life. The doctor was convicted of "death on request" but was sentenced to one week of probation instead of a possible 12-year term of imprisonment. The decision provoked legal discussion regarding the acceptability of active physician involvement in death. Subsequent court decisions confirmed that, under certain circumstances, euthanasia and assisted suicide could be justifiable even though they were offences under criminal law.
    
5. The underlying legal reasoning for accepting active physician involvement in death remained unclear until 1984 when the first voluntary euthanasia decision reached the Dutch Supreme Court: Schoonheim,[27] The Court reasoned that notwithstanding the prohibition of the practice in the Penal Code, a physician was able to invoke the defence of necessity when confronted with a conflict between his or her duties to preserve life on the one hand and to relieve suffering on the other. If, faced with such conflict, the physician chose a course of action that was objectively justifiable, he or she was not guilty of an offence. The Court held that the criteria for accepting the defence of necessity were to be derived from medical-ethical opinions formulated by the medical profession.
    
6. Unlike many jurisdictions which draw a moral or legal distinction between euthanasia and assisted suicide, the Netherlands treats both alike. "Euthanasia" refers to the termination of life upon request, thus encompassing both practices. Professor Legemaate explains that both the Dutch Act and the case law that preceded it treat euthanasia and assisted suicide the same way, and that the same requirements and procedures apply to each. A physician and patient may choose one or the other, depending on the circumstances at hand, the characteristics of the patient and his medical condition. In cases where a choice can be made, the Royal Dutch Medical Association advises physicians to favour assisted suicide for psychological reasons, but this is not a binding rule.
    
7. Under Article 2 of the Dutch Act, a physician who carries out euthanasia is exempt from prosecution under the Penal Code if he or she complies with a number of due care criteria. Specifically, the physician must:
   1. be satisfied that the patient's request is voluntary and carefully considered;
   2. be satisfied that the patient's suffering was unbearable, and that there was no prospect of improvement;
   3. have informed the patient about his or her situation and prospects;
   4. have come to the conclusion, together with the patient, that there is no reasonable alternative in light of the patient's condition;
   5. have consulted at least one other independent physician who must have seen the patient and provided a written opinion on the requirements of due care referred to in (a) to (d) above; and
   6. have terminated the patient's life or assisted with suicide with due medical care and attention.
8. The requirement for an independent consultation increasingly is being satisfied by consultations with specialized physicians participating in the SCEN (Support and Consultation Regarding Euthanasia in the Netherlands) Project. These physicians are available to advice doctors who are faced with a request for physician-assisted death, and to act as the independent consultant required by the Act. A non-binding best practices protocol has been implemented among SCEN physicians.
    
9. Five regional RRCs review and evaluate all cases of physician-assisted dying. Each RRC comprises an uneven number of members and must include a physician, a legal expert and an ethicist. The RRC must decide whether the reported instance of physician-assisted dying is within the limits of the Dutch Act or should be referred to the criminal authorities. It is only where the RRC has determined that the due care requirements have not been met that such a referral will be made. According to Dr. Kimsma, the conclusions of the RRCs are published online in the interests of transparency and public accountability.
    
10. The RRCs are required to issue a joint annual report which includes information related to number and nature of reported cases, and the opinions and considerations involved.
     
11. The Dutch Act is limited to the termination of life upon a patient's request. It does not extend to termination of life without request. A physician is not obligated to comply with a request for euthanasia.
     
12. Jurisprudence from Dutch courts remains relevant in defining the permissible scope of euthanasia. Two Supreme Court decisions of note are Chabot[28], and Brongersma[29]. In the former, the Court confirmed that mental, as well as physical, suffering can justify physician-assisted dying. It cautioned, however, that in such cases, the physician must be "extremely cautious". In Brongersma, the Court held that neither the previous rules nor the Dutch Act (the death occurred in 1998 but the case did not reach the Supreme Court until 2002) cover "tired of life" situations. Rather, physicians must limit themselves to requests for physician-assisted dying from patients suffering from a medically classifiable physical or psychiatric sickness or disorder.

Comparative Position Of Legality Of Euthanasia And Right To Die In India And Netherlands.

Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide (Review Procedures) Act" which was passed in 2001 and took effect in 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care.

These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. It legalizes euthanasia and physician-assisted suicide in very specific cases, under very specific circumstances.

Whereas, Euthanasia in India is not regulated by any specific legislation. Since March 2018, passive euthanasia is legal in India under strict guidelines. Patients must consent through a living will, and must be either terminally ill or in a vegetative state. On 9 March 2018 the Supreme Court of India legalized passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state.

Therefore, more or less, the law with regard to Euthanasia in India and Netherlands in strict and doesn't allow the usage to be done in any haphazard manner. The strict guidelines given by Hon'ble Supreme Court of India will have to be complied with, in India and the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, 2002 will have to be followed in case of Netherlands.

Suggestive Measures And Conclusion.
Death occurred by doing something or by not doing something of needy person their advantage is called euthanasia. Euthanasia likewise called mercy killing is a means of painlessly ending the lives of those who are either suffering from an incurable illness or remain in enormous discomfort. This type of assisted suicide is performed with the 'human' intention of alleviating one's discomfort as well as suffering. Often people state in their Wills, that if they ever enter such a scenario where it appears helpless or to much to bear, that the family members needs to allow him/her to die.

Following are certain suggestions that must be taken into consideration with regard to legality of Euthanasia:

• While drafting legislation on euthanasia in India, the best features of all euthanasia legislation available in the world should be taken into consideration. The shortcomings and loopholes should be defeated in order to draft a classic piece of legislation.
• Need to amend the Constitution of India and insert Art 21 B in Part III of the constitution Right to die with dignity for terminally ill patients.
• Law allows abortion under certain conditions, likewise death with dignity should also be allowed for terminally ill patients.
• Artificial life support systems and other life prolonging treatments should not be used to prolong death of terminally ill patients against their wish. Instead, such medical resources should be used to improve the health condition of the patients who have chances of recovery.
• Quality of life should also be maintained not only in the clinical decisions but also in the legal perspective.
• Life should be protected, but the protection should not result as a forced burden for terminally ill patients. In exceptional situations terminally ill patient should be allowed to die with dignity.
• Right to self-determination allows the patient to refuse medical treatment, but it should be extended to allow terminally ill patients to die through physician's assistance if needed.

Active euthanasia is still offence but passive euthanasia is permissible in India. Now Right to Die with Dignity is a Fundamental Right. Hence legalizing euthanasia in certain circumstances when death is caused by turning off the life support system, withdrawing life supporting devices from a terminally ill patient, who are going through intolerable agony which cannot be cured or enhanced, the passive euthanasia is permissible. Therefore hypothesis is proved that legalizing euthanasia is dignified liberty.

End-Notes:

1. School of Medicine, University of Missouri "Euthanasia", available at https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia (last visited on 10/05/2023)
2. Capt. N M Harris, "The Euthanasia Debate", J R Army Med Corps 2001: 147: 367-370, available at https://militaryhealth.bmj.com/content/jramc/147/3/367.full.pdf (last visited on 10/05/2023)
3. Carr, Claudia, "Unlocking Medical Law and Ethics", 2014 2nd Edn. (ISBN 9781317743514)
4. Zedlers Universallexikon, Vol. 08, p. 1150, published 1732�54
5. Markwart Michler, "Marx, Karl, Mediziner", Neue Deutsche Biographie (in German), (1990) vol. 16, Berlin: Duncker & Humblot, pp. 327�328, available at: https://www.deutsche-biographie.de/ppn116814357.html (last visited on 21/05/2023)
6. Appel Jacob, "A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906", Bulletin of the History of Medicine,78 (Vol.3):Pp 610�34.
7. Supra Note 15
8. Neha Dahiya, "All you need to know about Euthanasia", April 2022, available at https://blog.ipleaders.in/all-you-need-to-know-about-euthanasia/#Active_and_passive_euthanasia (last visited on 21/05/2023)
9. 305: Abetment of suicide of child or insane person.
10. 306: Abetment of suicide.
11. 309: Attempt to commit suicide.
12. 300: Murder.
13. 304: Punishment for culpable homicide not amounting to murder.
14. 92: Act done in good faith for benefit of a person without consent.
15. Vinod K. Sinha, S. Basu, and S. Sarkhel, "Euthanasia: An Indian perspective, Indian J Psychiatry, 2012 Apr-Jun; 54(2): 177�183"
16. Himanshu Tripathi and Zuna Parween, "Euthanasia", JCLJ (2022) 531
17. 1995 Cri LJ 96 (Bom)
18. 1987 Cri LJ 743 (Bom)
19. (1994) 3 SCC 394
20. (1996) 2 SCC 648
21. (2011) 4 SCC 454
22. (2018) 5 SCC 1
23. Jo Thomas, "Dutch Courts act on Right to Die", published in The NewYork Times, Nov. 28, 1984, available at: https://www.nytimes.com/1984/11/28/world/dutch-court-acts-on-right-to-die.html
24. Quoted in John Keown, "The Law and Practice of Euthanasia in the Netherlands", (1992) 108 LQR 51, at p. 56
25. Carter v. Canada (Attorney General), 2012 BCSC 886 (CanLl)
26. (District Court, Leeuwarden, 21 February 1973, N.J. 1973, No. 183)
27. Supreme Court, 27 November 1984, N.J. 1985, No. 106
28. Supreme Court, 21 June 1994, N.J. 1994, No. 656
29. 24 December 2002, Supreme Court, N.J. 2003, No. 167