RSTV – Passive Euthanasia: Death with Dignity

Guests:

1. J Sai Deepak, Advocate, Supreme Court ;
2. Satya Prakash, Legal Editor, The Tribune ;
3. Dr Rakesh Kumar Gupta, Former President, Delhi Medical Association ;
4. Vipul Mudgal, Director and Chief Executive of Common Cause

 Context

• The Supreme Court has given legitimate approval to passive euthanasia in a landmark judgment, permitting ‘living will’ by patients on pulling back therapeutic help if they slip into irreversible extraordinary lethargies.
• Every one of the judges was reliable that the ‘living will’ should be permitted since a man can’t be allowed to continue persevering in a lethargic state when he or she doesn’t wish to live.
• Supreme Court, on a different plea, permitted willful passive euthanasia.
• But the passive euthanasia was permitted based one clause-i.e., approval from “next relative or friend”.
• Considering the Aruna Shanbaug landmark ruling that had its origin in a two-year-old petition by journalist Pinky Virani.
• In its judgment, the court declined to recognize Virani as the “next friend” of Aruna Shanbaug and instead vested the “surrogate authority” on the KEM hospital and staff to decide her fate
• Since the KEM Hospital staff wished that Aruna Shanbaug is allowed to live, Virani’s petition to withdraw life support was declined. However, the court further stipulated that the KEM hospital staff, with the approval of the Bombay High Court, had the option of withdrawing life support if they changed their mind
• Shanbaug had put in 42 years in a vegetative state after she was assaulted by a ward boy on November 27, 1973.

 Petitioner

• NGO ‘Normal Cause’ moved toward the court looking for a bearing for acknowledgment of ‘living will’ and hoped that when a medicinal expert said that a man tormented with the fatal illness had achieved a final turning point, at that point she ought to be given the privilege to reject being put on life support
• Right to life includes right to die with dignity. A man can’t be compelled to live with the help of the ventilator. Keeping a patient alive by simulated means against his/her desires is an onslaught on his/her body.

Passive euthanasia: 

• Passive euthanasia is the acts of hastening the death of a terminally-ill patient by altering some form of support and letting nature take its course.
• Passive euthanasia can involve turning off respirators, halting medications, discontinuing food and water so the patient dies because of dehydration or starvation.
• Passive euthanasia can include giving the patient large doses of morphine to control pain in spite of the likelihood that the painkiller can cause fatal respiratory problems.

Active euthanasia: 

• Active euthanasia involves helping the patient to die on the basis of a request by either the patient of those close to him or her, usually direct family members.

Living Will:

• A Living Will is a document that allows a person to explain in writing which medical treatment he or she does or does not want during a terminal illness.
• A terminal illness is a fatal illness that leads ultimately to death.
• A Living Will takes effect only when the patient is incapacitated and can no longer express his or her wishes. The will states which medical treatments may be used and which may not be used to die naturally and without the patient’s life being artificially prolonged by various medical procedures.

 Origin of the Debate

• The affidavit traces back to how the debate on legalizing and regulating euthanasia began with a Lok Sabha private member’s Bill – The Euthanasia (Regulation) Bill, 2002 – which was examined by the Health Ministry.
• The debate kick-started again four years later, following the 196th Law Commission Report on euthanasia and the drafting of the Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2006.

 Government’s stand-in 2006

• The Ministry’s experts under the Director General Health Services took a stand against euthanasia for reasons that it amounted to “intentional killing” and against the Hippocratic oath.

 Government in 2011

• The affidavit said the Government’s perceptions about euthanasia changed in 2011 when the Supreme Court issued comprehensive guidelines allowing passive euthanasia in the tragic case of the bed-ridden former Mumbai nurse Aruna Shanbaug. In her case, the staff of KEM Hospital took care of her till her natural death last year.
• The apex court’s guidelines, accepted by the Government, led to the Law Commission’s 241st Report recommending a re-look at passive euthanasia in 2012.

 Government in 2016

• The Law Commission subsequently took full two years to draft a new law on the subject – The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill. The Ministry had received the draft Bill in April 2014 and begun its task to fine-tune the law.
• Ready to formulate legislation on passive euthanasia, but not active euthanasia as it can be misused.

Debate- a moral dilemma

Arguments For Euthanasia- According to euthanasia opponent  Ezekiel Emanuel, proponents of euthanasia have presented four main arguments: 

1. That people have a right to self-determination, and thus should be allowed to choose their own destiny.
2. Assisting a subject to die is a better option than continuing to suffer.
3. The distinction between passive euthanasia( which is frequently allowed) and active euthanasia is not substantive (the underlying principle–the doctrine of double effect is unreasonable)
4. Allowing euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often take examples of countries like the Netherlands, Belgium, Luxembourg etc where euthanasia has been legalized to justify that it is mostly trouble-free.

Other arguments-

Arguments based on rights

1. People got an explicit right to die
2. Death is a private subject and if there is no harm done to others then, the state and other people have no right to interfere (libertarian case)

Practical arguments–

1. Death is a private subject and if there is no harm done to others then, the state and other people have no right to interfere(libertarian case)
2. Allowing people to die may free up scarce health resources(this is a possible argument, but so far no authority has seriously proposed it)

 Arguments Against Euthanasia

Similarly, Emanuel argues that there are four major arguments presented by opponents of euthanasia:

1. All deaths are not painful.
2. Termination of active treatment, combined with the effective use of pain relief are available as alternatives to euthanasia
3. The distinction between active and passive euthanasia is morally significant and
4. Legalising euthanasia will put society on a slippery slope, which will lead to unacceptable consequences. (In Oregon 2013, the pain wasn’t one of the top five reasons that people sought euthanasia for.In fact, it was a loss of dignity and a fear of burdening others).

Other arguments-

Ethical arguments

1. Euthanasia could weaken society’s respect for the sanctity of life.
2. Accepting euthanasia would mean that some lives (those of the sick or disabled) are worth less than others.
3. Voluntary euthanasia could start on a slippery slope that may lead to involuntary euthanasia and the killing of people who are thought undesirable.
4. Euthanasia might not be in a person’s best interests.
5. Euthanasia affects rights of  other people and not just those of the patient

 Religious arguments- Religions are opposed to euthanasia for a number of reasons.

a) Euthanasia is against the will and word of God. (God has forbidden it)

• Virtually all religions in their scriptures say ‘you must not kill’. Therefore carrying out any of these would be against God’s command, and would be an attack on the sovereignty of God

b) Euthanasia weakens society’s respect for the sanctity of

• Human life is sacred. Human lives are special because God created them. Human beings are made in God’s image. Therefore human life should be protected and preserved, whatever happens

c) law of karma–Suffering may have value (Freedom from worldly life)

• Hinduism and Buddhism see mortal life as part of a continuing cycle in which we take birth, live, die, and are reborn over and over again.
• During each cycle of life and death, human beings make progress towards their ultimate aim, which is liberation.
• Thus, shortening life interferes with the law of karma.

d) Voluntary euthanasia could start on a slippery slope that may lead to involuntary euthanasia and the killing of people who are thought undesirable

e) Most religions disapprove of euthanasia. Some absolutely forbid it.

For example, the Roman Catholic church is one of the most active organizations in opposing euthanasia.

f) Virtually all religions state that those who become vulnerable through illness or disability deserve special care and protection, and proper care of life is a much better thing than euthanasia.

g) Non-harm – the principle of ahimsa-Hinduism and Buddhism regard all life as precious.(not just human life).They say that we should try to avoid harming living things and therefore this also rules out killing people, even if they want to die.

Practical arguments

• Proper palliative care could make euthanasia unnecessary.
• Euthanasia cannot be properly regulated
• Permitting euthanasia will lead to less good care for the terminally ill.
• Permitting euthanasia could undermine the commitment of doctors and nurses to save lives.
• Euthanasia may become in future a cost-effective way to treat the terminally ill.
• Allowing euthanasia could discourage the search for a new mode of treatments for the terminally ill.
• Euthanasia could discourage the motivation to provide good care for the dying.
• Euthanasia gives too much authority to doctors.
• Euthanasia exposes vulnerable people to pressure to end their lives.
• Moral pressure on elderly people by selfish families.
• Moral pressure to free up medical resources.
• Patients may feel euthanasia is the only way out when they are abandoned by their families.