EUTHANASIA, is the practice of intentionally ending a life to eliminate pain and suffering. Different countries have different euthanasia laws. In India, Section 309 of the Indian Penal Code (IPC) deals with the attempt to commit suicide, and Section 306 deals with the abetment of suicide-both actions punishable. Only those who are brain-dead can be taken off life support with the help of family members. Earlier, in Indian law euthanasia was not permitted. 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 9th March 2018, the Supreme Court of India (SC) legalized passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state. This decision was made as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent Vegetative State (PVS) until her death in 2015.
Let us go back- In 2011, the SC, while dismissing the plea for mercy killing in a particular case, laid down comprehensive guidelines to process cases relating to passive euthanasia. Thereafter, the matter of mercy killing was examined in consultation with Law and Justice Ministry. Earlier, even the High Court (HC) had rejected active euthanasia by lethal injection. For this to be practiced, HC said for active euthanasia the law has to be passed, with proper legislation. Active euthanasia is still illegal in India, and in most countries.
In 2018 the SC declared through a five-judge Constitution bench that, if strict guidelines are followed, the government would honor ‘ living wills’ allowing consenting patients to be passively euthanised if the patient suffers from (i) The brain dead for whom the ventilator can be switched off (ii) Those in a PVS for whom the feed can be tapered out and pain-managing palliatives are added, according to laid-down international specifications.
Before euthanasia become practicable in India, there existed the possibility of signing a ‘leaving against medical advice’ (LAMA) which transferred from the physician to the patient the full responsibility for the discontinuation of his living therapies.
Forms of ‘active euthanasia, including the administration of lethal injection or compounds, is legal in a number of countries and jurisdiction including Luxemburg, Belgium, and the Netherlands, as well as the US states of Washington and Oregon. Elsewhere in the world active euthanasia is almost always illegal.
Earlier the SC laid down the following guidelines:
1 A decision has to be taken to discontinue life support either by the parents or the spouse or other close relatives or in the absence of any one of them, such a decision can be taken even by a person or a body of persons acting as a next friend. It can also be taken by the doctors attending the patient. However, the decision should be taken bona fide in the best interest of the patient.
2 Even if a decision is taken (as per guideline 1), such a decision requires the presence of two witnesses and countersigned by the first class judicial magistrate, and should be approved by a medical board set up by the hospital.
Now in the latest development, the SC on 17th January 2023 decided to ‘tweak’ its 2018 verdict on passive euthanasia to make the procedure and guidelines fixed by it workable, and said that it may fix a time frame within which medical boards would have to submit reports to remove life-support systems from a terminally ill patient. Admitting that the procedure prescribed by the SC was very onerous (difficult and needing a lot of effort) and time-consuming, a five-judge bench sought suggestions from two senior advocates and the Central government, to make it workable without compromising the safeguards put in place by the SC, five years ago, while legalizing passive euthanasia.
It was felt that the time was crucial for terminally ill patients, and the whole purpose of passive euthanasia was defeated due to the time taken by the process. It has so happened that after this law was enacted, there has not been a single case of passive euthanasia because of this lengthy procedure. The SC further observed that dying in peace was dying with dignity, and the suffering of the patient should not be prolonged due to the long process.
It seems that the SC has realized its mistake, and the step to rectify the same is a welcome sign.
Waiting for your views on this blog.
Anil Malik
Mumbai, India
18th January 2023