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Euthanasia Debate: The Aruna Shanbaug Judgment

 Euthanasia is the practice of ending the life of a person in a painless way. It is also known also as mercy killing or assisted suicide, it is usually practiced on a terminally ill person. Euthanasia may be legal or illegal, depending upon a country’s jurisdiction. For example, euthanasia is legal in countries like Belgium, Norway, Sweden and Albania, under the condition that the patient is suffering from chronic pain along with an incurable disease. In the United States, euthanasia is illegal; whatever may be the condition of the patient.

Concept of Right to Life under Indian Constitution

“The Article 21 reads as follows: No person shall be deprived of his life or personal liberty except according to procedure established by law”.

According to this article Right to Life means the right to lead meaningful, complete and dignified life. It does not have restricted meaning. The object of the fundamental right under Article 21 is to prevent any restriction by the State to a person upon his personal liberty and deprivation of life except according to procedure established by law. 

In P. Rathinam vs. Union of India, the court observed “Life is not mere living but living in health. Health is not the absence of illness but a glowing vitality”.

 

In India, this issue again came to limelight during Aruna Shahbaug case where  friends and relatives of an ex-nurse who was in vegetative state from 40 years requested the Supreme Court to grant permission to end her misery by invoking euthanasia. However, whether is it appropriate to bring the life of an individual to end is right or not is still debated. It has its own debates both in favour of and against the process.

The Judgment in Aruna Shahbaug case

The Supreme Court of India laid down guidelines for euthanasia and made a distinction between ‘active’ and ‘passive’ euthanasia. It said that causing the death of a person who is in a permanent vegetative state, with no chance of recovery, by withdrawing artificial life support is not a “positive act of killing”, which could be permitted on a case-by-case basis.

“The withdrawal of life support by the doctors is in law considered as an omission and not a positive step to terminate life. The latter would be euthanasia, a criminal offense under the present law in UK, USA and India.”

The court also laid down guidelines for passive euthanasia such as that the matter must be referred to the High Court for a decision and that the doctor, or the parents or spouse of the patient must be the ones to petition for the withdrawal of life-support. In the absence of any of these, a person or a body of persons acting as ‘next friend’ can be permitted.

Whilst the Court has held that there is no right to die (suicide) under Article 21 of the Constitution and attempt to suicide is a crime vide Section 309 IPC, the Court has held that the right to life includes the right to live with human dignity, and in the case of a dying person who is terminally ill or in a permanent vegetative state he may be permitted to terminate.

Ethical Issues in Aruna’s case

Two of the cardinal principles of medical ethics are Patient Autonomy and Beneficence.

1.     Autonomy means the right to self-determination, where the informed patient has a right to choose the manner of his treatment. To be autonomous the patient should be competent to make decisions and choices.

2.     Beneficence is acting in what is (or judged to be) in patient’s best interest. Acting in the patient’s best interest means following a course of action that is best for the patient, and is not influenced by personal convictions, motives or other considerations.

However in the present case, as no indication of Aruna Shanbaug’s views or wishes with respect to life-sustaining treatments for a permanent vegetative state, any decision regarding her treatment will have to be taken by a surrogate i.e. the staff of the KEM hospital have looked after her for 37 years. If the doctors treating Aruna Shanbaug and the Dean of the KEM Hospital, together acting in the best interest of the patient, feel that life sustaining treatments should continue, their decision should be respected.

Argument in Support of Euthanasia

·         Right to dignified death: The right of a competent, terminally ill person to avoid excruciating pain and embrace a timely and dignified death. The exercise of this right is as central to personal autonomy and bodily integrity.

        Right to get relief from excruciating pain: Right guaranteed in the European Declaration of Human Rights provides the right not to be forced to suffer. It should be considered as much of a crime to make someone live who with justification does not wish to continue as it is to take life without consent.”

        Health care spending: Given the cost of health care expenditure, the expensive palliative care becomes a huge burden for the family members. That too when the chance of survival is meager.

Argument against Euthanasia

        Right to live does not entail  Right to death: The Supreme court in Gian Kaur case made it all clear that “right to die” with dignity at the end of life is not to be confused or equated with the right to die an unnatural death curtailing the natural span of life.

        Inhumane and cruel: When the patient is in a terminally ill condition the aforesaid acts or series of acts and/or such omissions will be cruel, inhuman and intolerable (especially when s/he is not in a stable mental state to give correct opinion or will give an emotionally charged opinion .In both the cases it will lead to injustice).

        Illegal: Withdrawing/withholding of hydration/food/medical support to a patient is unknown to Indian law and is contrary to law.

        Nature of Human society: Indian society is emotional and care-oriented. These kind of decisions are against Indian culture.

        Chances of Misuse: Again there was a great danger in permitting euthanasia that the relatives of a person may conspire with doctors and get him killed to inherit his property.

        Promising medical technology: The chances of a medical cure cannot be ruled out. Over time , medical science has evolved to find cure to so called incurable diseases (even AIDS). Hence even if there is a slightest chance of cure, the person should not be deprived of his/her life.

        Voluntary and non-voluntary Euthanasia: Voluntary euthanasia is where the consent is taken from the patient, whereas non voluntary euthanasia is where the consent is unavailable e.g. when the patient is in coma, or is otherwise unable to give consent. While there is no legal difficulty in the case of the former, the latter poses several problems.

Conclusion

Through the above judgment, The Supreme court not only showed a middle ground for the long standing debate of “Euthanasia”, but also directed the government to abolish obsolete and inconsistent laws like sec 309 of IPC (which criminalizes and punishes the person attempting suicide). Moreover, ethical questions like right to dignified death and euthanasia are difficult to be wholly addressed by the strict statutes of law. It needs a larger social conscience to arrive at a solution, which will reflect the ethical maturity and sensitivity of the society as a whole.

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