Right to die with dignity

The Supreme Court ruled on Friday that individuals have a right to die with
dignity, in a verdict that permits the removal of life-support systems for the
terminally ill or those in incurable comas.

The court also permitted individuals to decide against artificial life support,
should the need arise, by creating a “living will”.

SC was hearing a plea by NGO Common Cause to declare ‘right to die with
dignity’ as a fundamental right within the fold of right to live with dignity,
which is guaranteed under Article 21 of the Constitution.

• Living will

A ‘living will’ is a concept where a patient can give consent that allows
withdrawal of life support systems if the individual is reduced to a permanent
vegetative state with no real chance of survival.

It is a type of advance directive that may be used by a person before

incapacitation to outline a full range of treatment preferences or, most often,
to reject treatment. A living can detail a person’s preferences for tube-feeding,
artificial hydration, and pain medication when an individual cannot
communicate his/her choices.

In its verdict on Friday, SC has attached strict conditions for executing “a living
will that was made by a person in his normal state of health and mind”.

The US, UK, Germany and Netherlands have advance medical directive laws
that allow people to create a ‘living will’.

• Active and passive euthanasia

Active euthanasia, the intentional act of causing the death of a patient in great
suffering, is illegal in India. It entails deliberately causing the patient’s death
through injections or overdose.
But passive euthanasia, the withdrawal of medical treatment with the
deliberate intention to hasten a terminally ill patient’s death was allowed by
the Supreme Court in Friday’s landmark verdict.

Aruna Shanbaug case

In 2011, the Supreme Court, while hearing the case of Aruna Shanbaug, who
was in a vegetative state for more than 40 years, had legalised passive
euthanasia partially.

A nurse at KEM Hospital in Mumbai, Shanbaug was in a vegetative state since

1973 after a brutal sodomisation and strangling with a dog-chain during a
sexual assault. She died in 2015 while on a ventilator for several days after
suffering from pneumonia.

SC gave patients living in a vegetative state the right to have treatment or food
withdrawn, and laid down guidelines to process passive euthanasia in the case
of incompetent patients. The guidelines included seeking a declaration from a
high court, after getting clearance from a medical board and state government.

• Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill

In 2012, the union health ministry posted a draft of the Terminally Ill Patients
(Protection of Patients and Medical Practitioners) Bill on its website and invited
public reactions.

The Bill is popularly referred to as the Passive Euthanasia Bill although its draft
did not use the emotive word “euthanasia” to skirt complications around the
term, a health ministry official told HT in 2016. It says every advance medical
directive (also called ‘living will’) or medical power of attorney executed by a
person shall be taken into consideration in matter of withholding or
withdrawing medical treatment but it shall not be binding on any medical
practitioner.

The draft bill has a controversial clause that allows a minor aged above 16 to
take an informed decision and express a desire to withhold or withdraw
medical treatment and allow nature to take its own course

• Medical experts on euthanasia

Doctors have a mixed reaction to legalising euthanasia. They say the

government needs to take a careful approach before legalising passive
euthanasia when the measures to prolong the life of the patient are
withdrawn.

Most doctors, however, agree that euthanasia should be made legal in cases
where there is no scope of a patient recovering. But many feel that India is not
yet ready for a decision like this which requires a mix of sensitivity and
maturity.

• Misuse of law

A major concern is the misuse of the law. If it is legal to passively allow or

hasten death, what’s to say an aged parent won’t be hastened in favour of an
inheritance, or a spouse have treatment withdrawn for the sake of a hefty
insurance payout?

• Euthanasia in other countries

Euthanasia and physician-assisted suicide have been legal in The Netherlands
and Belgium since 2001 and 2002. In the US, Switzerland and Germany,
euthanasia is illegal but physician-assisted suicide is legal. Euthanasia remains
illegal in the UK, France, Canada and Australia