Euthanasia is a combination of two words of Greek origin EU and Thanos. Eu means good and Thanos means death. It is the concept of good death. What it means is that when a person cannot be cured from any disease and no medications work on that person, the withdrawal of life support is what we call euthanasia. Euthanasia is further divided into two categories active and passive, former means causing death of any person using painless methods while the latter suggest that it is to withdraw the medications and treatments what we call as euthanasia.

In a country where basic human rights are often unaddressed, rampant illiteracy, lack of access to potable water, and inadequate medical care coexist, the debate on euthanasia may seem irrelevant to some. However, India's diversity across religious, educational, and cultural lines makes the issue more complex. The presence of a law, IPC, punishing individuals for attempting suicide adds another layer to the debate on euthanasia in India.

In India, active euthanasia is currently considered a criminal act. The attempt to commit suicide is addressed by Section 309 of the Indian Penal Code (IPC), while abetment of suicide is punishable under Section 306 of the IPC. The law only allows for the withdrawal of life support for those who are brain dead, with the involvement of family members. The Honourable Supreme Court has affirmed that the right to life, guaranteed by Article 21 of the Constitution, does not encompass the right to die. The court emphasized that Article 21 is aimed at safeguarding life and personal liberty and cannot be interpreted to include the termination of life. Despite this, several pro-euthanasia groups, particularly the Death with Dignity Foundation, continue to advocate for the legalization of an individual's right to choose their death.

Legal Evolution of Euthanasia in India: Landmark Cases and Constitutional Interpretations

In the case of State of Maharashtra v. Maruty Sripati Dubal[i], the Bombay High Court ruled that under Article 21, the Right to life encompasses the Right to die in and of itself, as a result, the Court invalidated and declared as ultra vires section 309 of the Indian Penal Code, 1860.

In P. Rathinam v. Union of India[ii], the Supreme Court decided that Section 309 of the Penal Code is against the right to life and thus unconstitutional.

In Gian Kaur v. State of Punjab[iii], the court reviewed the earlier case of P. Rathinam v. Union of India. It ruled that the right to life under Article 21 does not include the right to die. While the Constitution guarantees a dignified life, it doesn't permit euthanasia or assisted suicide. The court clarified that while dignified death is allowed in cases of terminal illness where natural death is imminent, intentionally shortening a natural life span isn't permissible. The court upheld Section 309 of the Indian Penal Code, stating that the right to life with dignity doesn't include the right to end one's life prematurely.

Aruna Shanbaugh's Case: Redefining Legal Boundaries in India

A major development took place in this field on 7 March 2011. The Supreme Court, in a landmark judgment, allowed passive euthanasia. In the case of Aruna Ramchandra Shanbaugh v. Union of India[iv], a petition was filed in the Supreme Court seeking permission for passive euthanasia for Aruna Shanbaugh, a rape victim who had been in a vegetative state for 38 years. Aruna, a nurse, was attacked and left in a vegetative state. The petitioner argued that there was no chance of her recovery and requested her release from suffering through passive euthanasia.

The Supreme Court discussed various aspects of euthanasia, including its types and legality, ultimately considering whether it was permissible under Indian law. In the Aruna Shanbaugh case, the Supreme Court legalized passive euthanasia and provided detailed guidelines. However, it mandated strict conditions, including High Court approval following due process. The Court ruled that passive euthanasia is permissible for patients in persistent vegetative states, with the Court deciding in the patient's best interest, considering input from close relatives, friends, and medical experts.

In the Aruna Shaunbaugh case, the Court referenced the Vishakha[v] judgment while allowing passive euthanasia for patients in permanent vegetative states. It clarified that while Article 21 doesn't grant a right to die, passive euthanasia under specific circumstances is permissible, reiterating the stance from Gian Kaur that the "right to die" isn't inherent to "right to life", hence active euthanasia isn't accepted, but passive euthanasia is.

The Seventeenth Law Commission of India's 2012 in its 241st report clarified that under common law, a competent patient's informed decision to allow nature to take its course isn't considered attempted suicide. Similarly, doctors who omit treatment in such cases aren't guilty of abetting suicide or culpable homicide under relevant sections of the Indian Penal Code.

Present Scenario
In the Common Cause v. Union of India[vi] case, Common Cause, a registered society, filed a writ petition under Article 32 of the Indian Constitution before the Supreme Court. They sought to declare the "right to die with dignity" as a fundamental right within the broader scope of the "right to live with dignity" guaranteed under Article 21 of the Constitution. The petition also requested the court to establish procedures allowing individuals, especially those with deteriorating health or terminal illnesses, to create documents that hospitals could use to guide treatment decisions in case of serious illness. These documents, often called "living wills," outline the individual's preferences for end-of-life care.

The Five-Judge Constitution Bench deliberated on various aspects of euthanasia and the right to life. They referred to the Gian Kaur case, highlighting that the right to die with dignity is recognized when a person's life is nearing its end, particularly for terminally ill patients or those in a permanent vegetative state with no hope of recovery. The court noted that while passive euthanasia involves withholding treatment necessary to preserve life, active euthanasia involves a deliberate act to end a patient's life. They observed that many countries have legalized passive euthanasia either through legislation or judicial interpretation, often with specific conditions and safeguards.

The judgment emphasized that the right to life and liberty under Article 21 encompasses the right to live with dignity, which extends to facilitating a dignified process of dying for terminally ill patients. The court endorsed using advanced directives, allowing individuals to express their preferences regarding end-of-life care, and affirmed the right of self-determination in such matters. Despite the high regard for the sanctity of life, the court recognized that in cases of terminally ill patients with no hope of recovery, the individual's preferences should be given priority, as reflected in their advanced directives.

An Advanced Directive is a legal document where a person specifies their medical treatment preferences if they cannot make decisions due to illness. If someone states they don't want life-sustaining treatment if terminally ill, their wish can be respected. The Court outlined rules for Advanced Directives, including who can make one, what it should include, how it should be documented and stored, when and by whom it can be enforced, what if a Medical Board rejects it, and how it can be revoked or deemed inapplicable.

The Indian Constitution's Article 21 protects the right to life, emphasizing the importance of human dignity, as affirmed in K.S. Puttaswamy v. Union of India[vii]. While "right to life" excludes "right to die," "right to live with dignity" encompasses "right to die with dignity," especially for terminally ill patients.

Living Will Norms for Passive Euthanasia: Amendment in Case of Common Cause v. Union of India

Common Cause v Union of India [2023] [viii]

In response to a request for clarification from the Indian Society of Critical Care Medicine regarding the Common Cause case, the Supreme Court simplified the procedure for executing Living Wills and Advanced Directives in a judgment dated 24.01.2023. This was done because the original directions were too complex and difficult to enforce. On January 24, a Constitution Bench simplified the guidelines for withdrawing treatment from terminally ill patients. This change was made considering the Supreme Court's decision in Common Cause v Union of India (2018), which established the right to die with dignity as a fundamental right under Article 21.

In its 2018 judgment, the Court recognized the right of individuals to create Advanced Medical Directives (AMDs) as an assertion of bodily integrity and self-determination. AMDs contain end-of-life instructions for situations where patients cannot communicate their wishes. The Court outlined a detailed procedure for validating AMDs, mandating the formation of two medical boards, one by the treating hospital and the other by the District Collector, comprising doctors with at least 20 years of experience in the field.

In its January 2023 judgment, the Court adjusted the requirements for validating Advanced Medical Directives (AMDs). It reduced the experience requirement for doctors on the medical boards from 20 years to five years, removed the need for the Chief Medical Officer on the second board, and eliminated the requirement for AMDs to be countersigned by a Judicial Magistrate of the first class. Additionally, both boards were instructed to reach a decision "preferably" within 48 hours of the case being referred to them.

Conclusion
The advancement of medical science in India has brought forth ethical considerations regarding end-of-life issues, especially concerning the prolongation of suffering through artificial means. Euthanasia have become significant debates in the country, with both proponents and opponents actively engaged. While a landmark Supreme Court judgment in 2018 bolstered the autonomy of individuals by upholding passive euthanasia, legislative action on the matter remains absent. Concerns persist regarding potential misuse and the involvement of medical practitioners in euthanasia cases. Despite these debates, the concept of euthanasia is slowly gaining acceptance, aligning with the principles of human rights and individual autonomy.

The debate surrounding euthanasia in India continues to evolve, with legal frameworks and societal attitudes undergoing development. While the Supreme Court's judgments have provided clarity and guidelines, legislative action is necessary for a comprehensive approach to euthanasia laws. Balancing the rights of individuals with the need for safeguards and discretion remains a challenge. Ultimately, the civilization's concern for the well-being of all its members, even the most vulnerable, reflects its ethical maturity. As discussions on euthanasia persist, it underscores the need for a thoughtful and nuanced approach that respects individual autonomy while upholding ethical principles and societal values.

End-Notes:

1. State of Maharashtra v. Maruty Sripati Dubal (1986) 88 Bom LR 5
2. P. Rathinam v. Union of India (1994) 3 SCC 394
3. Gian Kaur v. State of Punjab (1996) 2 SCC 648
4. Aruna Ramchandra Shanbaugh v. Union of India AIR 2011 SC 1290
5. Vishakha v. State of Rajasthan AIR 1997 SC 301
6. Common Cause v. Union of India (2018) 5 SCC 1
7. K.S. Puttaswamy (Retd.) & Anr. v. Union of India & Ors. (2017) 10 SCC 1
8. Miscellaneous Application 1699 of 2019 and Writ Petition (Civil) No. 215 of 2005 decided on 24.01.23

Written By: Mantasha Khan