Euthanasia

Context: The Supreme Court has rejected a petition to establish a medical board for the Harish Rana passive euthanasia case.

What is the Concept of Euthanasia?

The term ‘euthanasia’ originates from Greek, where ‘Eu’ means ‘good’ and ‘Thanatos’ means ‘death,’ together translating to ‘good death.’

Euthanasia refers to the act of accelerating a patient’s death to alleviate further suffering.

Active and Passive Euthanasia

Active Euthanasia: Active euthanasia happens when medical professionals or another person intentionally take actions that directly cause the patient’s death.

In active euthanasia, the doctor acts to cause the patient’s death.

There are three types of active euthanasia based on the nature of consent:

• Voluntary Euthanasia: Performed at the patient’s request.
• Nonvoluntary Euthanasia: Carried out without the patient’s consent.
• Involuntary Euthanasia: Administered when the patient is unable to give consent.

Passive Euthanasia: Passive euthanasia occurs when the patient dies because medical professionals either fail to take necessary measures to sustain the patient’s life or cease doing something that is maintaining the patient’s life.

In passive euthanasia, the doctor allows the patient to die by refraining from taking measures to sustain their life. In both cases, the doctor’s actions are carried out to lead to the patient’s death.

Examples of passive euthanasia include:

• Turning off life-support machines
• Disconnecting a feeding tube
• Withholding life-extending surgeries
• Not administering life-extending medications

Status of Passive Euthanasia in India

Aruna Shanbaug Case (2011)

Aruna Shanbaug, a nurse, was severely assaulted in 1973 and remained in a vegetative state for decades.

A vegetative state (VS) is a condition characterized by severe brain damage, where the person is alive but lacks awareness of themselves or their surroundings.

The Supreme Court rejected a petition to end Shanbaug’s life-support treatment but legalized passive euthanasia under specific conditions.

This case marked the first judicial acknowledgement of passive euthanasia in India.

Common Cause Case (2018)

This case challenged the legal framework established by the Supreme Court in the Aruna Shanbaug case.

Petitioners sought clear guidelines and recognition of patients’ rights to refuse life-sustaining treatment through advance directives.

The Court permitted the creation of “living wills,” allowing individuals to outline their wishes regarding life support in advance.

This ruling affirmed that passive euthanasia is a legal practice, aligning with the right to die with dignity under Article 21 of the Indian Constitution.

 Methods to Implement Passive Euthanasia

• Withdrawal or Stopping of Life Support Equipment: This involves discontinuing the use of equipment like ventilators or dialysis machines that are sustaining the patient’s life. For instance, if a patient on a ventilator has a terminal condition with no chance of recovery, the medical team might decide to turn off the ventilator.
• Discontinuing Treatment for a Long-Term Life-Threatening Disease: This refers to halting treatment for a severe, long-term illness that shows no improvement or likelihood of future improvement. For example, if a patient with a long-standing life-threatening health condition is no longer receiving treatment due to its ineffectiveness.

Counterarguments to Euthanasia

Emanuel highlights that opponents of euthanasia commonly present the following four arguments, which are addressed as follows:

• Not all deaths are accompanied by pain.
• Alternatives to euthanasia include stopping active treatments while effectively managing pain with medication.
• It is ethically significant to differentiate between active and passive euthanasia.
• Legalizing assisted suicide could lead society to an unacceptable state with severe negative consequences. For instance, in Oregon in 2013, the top reasons for requesting euthanasia were not related to physical suffering but rather to a loss of self-respect and concerns about burdening others.

Ethical Arguments

• Euthanasia might lead to a diminished respect for the sanctity of life in society.
• Advocates of euthanasia could be perceived as implying that some lives—particularly those of the sick or disabled—are less valuable than others.
• The practice of voluntary euthanasia could potentially lead to involuntary euthanasia and the killing of individuals deemed undesirable.
• Euthanasia might not always be in the best interests of the individual.
• The implications of euthanasia extend beyond the patient, affecting the rights and perspectives of others as well.

 Arguments from Religion

Religions oppose euthanasia for various reasons:

• Divine Will and Sacred Texts: Euthanasia is seen as contrary to God’s will and teachings in the Bible, which generally prohibit killing. Religious texts often assert that taking life goes against divine directives and challenges God’s omnipotence.
• Sanctity of Life: Life is considered sacred in many religious beliefs. According to these views, humans are uniquely created in the likeness of God, and therefore, every human life should be preserved and protected regardless of circumstances.
• Karma and Suffering: In Hinduism and Buddhism, mortal existence is viewed as part of an eternal cycle of birth, life, death, and rebirth. Suffering is seen as potentially beneficial for spiritual growth, and shortening life disrupts this karmic process. Voluntary euthanasia could lead to involuntary euthanasia and the killing of those deemed undesirable.
• General Religious Opposition: Most religions oppose euthanasia, with some forbidding it outright. The Roman Catholic Church, for instance, is a prominent opponent. Religions generally advocate for providing care and protection for those who are vulnerable due to illness or disability rather than resorting to euthanasia.
• Principle of Non-Harm (Ahimsa): Both Buddhism and Hinduism emphasize the principle of non-harm, asserting that all life is sacred. This principle extends beyond humans to all living beings, advocating against harming or killing individuals even if they request it.

Practical Justifications

• Palliative Care Alternatives: Euthanasia may be unnecessary if adequate palliative care is provided.
• Control Issues: It is challenging to regulate euthanasia effectively.
• Impact on Terminal Care: Legalizing euthanasia might lead to diminished care quality for terminally ill patients.
• Medical Effectiveness: Euthanasia could complicate efforts by medical professionals to save lives.
• Financial Considerations: In the future, euthanasia might be seen as a cost-effective option for managing terminally ill patients.
• Innovation in Care: Legalizing euthanasia might reduce motivation to explore innovative treatments for terminal illness.
• Care Quality Concerns: The focus on euthanasia could diminish the drive to provide high-quality care for the terminally ill.
• Power Imbalance: Euthanasia grants excessive power to doctors.
• Pressure on the Vulnerable: Vulnerable individuals may face undue pressure to opt for euthanasia.
• Family Influence: Older individuals might experience moral pressure from self-interested family members.
• Resource Allocation: There may be a moral obligation to use medical resources more efficiently.
• Perception of Options: Patients abandoned by their families might see euthanasia as their only remaining choice.

Conclusion

• In India, active euthanasia is completely prohibited by the judiciary. However, passive euthanasia is allowed under certain conditions. The Supreme Court has acknowledged the right to a dignified death for individuals in a persistent vegetative state (PVS) with no prospect of recovery. Consequently, passive euthanasia has been recognized as part of the Right to Life under Article 21 of the Indian Constitution.

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