Euthanasia | By Dr. Mahipal Singh Rathore

Table of Contents

What is Euthanasia?

The term is derived from the Greek word euthanatos which means easy death. Mercy killing, Assisted suicide The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma.

A person who undergoes euthanasia usually has an incurable condition. But there are other instances where some people want their life to be ended.
In many cases, it is carried out at the person’s request but there are times when they may be too ill and the decision is made by relatives, medics or, in some instances, the courts.
The issue has been at the centre of very heated debates for many years and is surrounded by religious, ethical and practical considerations

The ethics of euthanasia

Euthanasia raises a number of agonising moral dilemmas:
is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering?
under what circumstances can euthanasia be justifiable, if at all?
is there a moral difference between killing someone and letting them die? At the heart of these arguments are the different ideas that people have about the meaning and value of human existence.
Should human beings have the right to decide on issues of life and death?
There are also a number of arguments based on practical issues. Even if it was morally right, it could be abused and used as a cover for murder. Killing or letting die
Euthanasia can be carried out either by taking actions, including giving a lethal injection, or by not doing what is necessary to keep a person alive (such as failing to keep their feeding tube going). ‘Extraordinary’ medical care
It is not euthanasia if a patient dies as a result of refusing extraordinary or burdensome medical treatment. Why people want euthanasia
Unbearable pain?? less than a third of requests for euthanasia were because of severe pain.
Terminally ill people can have their quality of life severely damaged by physical conditions such as incontinence, nausea and vomiting, breathlessness, paralysis and difficulty in swallowing.
Psychological factors that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or dislike of being dependent. There are 3 types of euthanasia – Voluntary euthanasia – euthanasia performed with the patient’s consent Non-voluntary euthanasia – where the patient is unable to give their informed consent, for example child euthanasia Involuntary euthanasia – performed on a patient against their will Physician-assisted suicide entails making lethal means available to the patient to be used at a time of the patient’s own The bench defined Active euthanasia as “a positive act or affirmative action or act of commission entailing the use of lethal substances or forces to cause the intentional death of a person by direct intervention, e.g., a lethal injection given to a person with terminal cancer who is in terrible agony.” Passive euthanasia /negative euthanasia /nonaggressive euthanasia, was defined by the apex court, as that which “entails withholding of medical treatment for continuance of life, e.g. withholding of antibiotics where without giving it a patient is likely to die”

What is ‘living will’?

The “living will” is a person’s right to issue advance directive on the course of his/her treatment, including withdrawal of life support, should such a situation arise. PIL filed by NGO Common Cause in 2005 seeking robust system of certification for passive euthanasia and legal recognition for ‘living will’ in India.

Aruna Shanbaug case

Aruna Shanbaug, a nurse working at the KEM Hospital in Mumbai was sexually assaulted by a worker in 1973.
During the attack, Shanbaug was strangled with a chain, and the deprivation of oxygen left her in a vegetative state.
She was treated at KEM following the incident and was kept alive by a feeding tube for 48 years, until her death of pneumonia in 2015.
In 2009, Pinki Virani filed a petition in Supreme Court of India on behalf of Aruna Shanbaug . she argued that the “continued existence of Aruna is in violation of her right to live in dignity”.
On 7th March 2011, the Supreme Court made its decision, in which it issued a set of broad guidelines legalizing passive euthanasia in India.
These guidelines for passive euthanasia— the decision to withdraw treatment, nutrition, or water— establish that the decision to discontinue life support must be taken by parents, spouse, or other close relatives, or in the absence of them, by a “next friend”.
This decision requires approval from the concerned High Court.

Previous Cases

1996 – Supreme Court in Gian Kaur v. State of Punjab held both euthanasia and assisted suicide not lawful in India. The Court held that the right to life under Article 21 of the Constitution does not include the right to die.
2011 – In Aruna Ramchandra Shanbaug v. Union of India the Supreme Court held that passive euthanasia can be allowed under exceptional circumstances under strict monitoring
2014 – a three-judge bench of Supreme Court of India termed the judgment in the Aruna Shanbaug case to be ‘inconsistent in itself’ and referred the issue of euthanasia to its fivejudge Constitution bench

Common Cause vs. Union of India, March 2018

A Constitution Bench, led by Chief Justice of India Dipak Misra,, upheld that the fundamental right to life and dignity includes right to refuse treatment and die with dignity.
The fundamental right to a “meaningful existence” includes a person’s choice to die without suffering, it held. A living will may relieve grief-stricken relatives the moral burden of deciding whether life support should be withdrawn from a terminally-ill person. Doctors may also be spared of any accusation of foul play or negligence in cases where patients had penned down a living will.

The Guidelines for Living will

Adult of sane mind – execute it without any coercion after having full knowledge
Document has to be executed before a First Class Judicial Magistrate in front of witnesses.
It shall clearly state as to when medical treatment may be withdrawn or no specific medical treatment shall be given which will only have the effect of delaying the process of death that may otherwise cause him/her pain.
It should specify the name of a guardian or close relative who will be authorised to give consent to refuse or withdraw medical treatment

What if there is no living will?

In cases where there is no Advance Directive, the procedure and safeguards are to be same as applied to cases where Advance Directives are in existence, plus certain additional requirements.
Doctor may inform the hospital which, in turn, shall constitute a Hospital Medical Board which shall discuss with the family physician and the family members and record the minutes of the discussion in writing.
The family members shall be apprised of the pros and cons of withdrawal or refusal of further medical treatment to the patient and if they give consent in writing, then the Hospital Medical Board may certify the course of action to be taken.
Hospital shall inform the jurisdictional Collector who shall constitute a Medical Board comprising the Chief District Medical Officer as the Chairman and three experts from the fields of general medicine, cardiology, neurology, nephrology, psychiatry or oncology with experience in critical care.
If the board approves withdrawal of life support, intimation shall be given to JMFC and the family members of the patient.
Again, the Magistrate shall verify the medical reports, examine the condition of the patient, discuss with the family members of the patient and, if satisfied in all respects, may endorse the decision of the Collector nominated Medical Board .
In case of conflicting opinions – the nominee of the patient or the family member or the treating doctor or the hospital staff can seek permission from the High Court to withdraw life support.
The High Court may constitute an independent Committee of doctors
The High Court in such cases shall render its decision at the earliest
High Court shall ascribe reasons specifically keeping in mind the principle of “best interests of the patient’’ Justice Chandrachud observed that ‘’Modern medical science should balance its quest to prolong life with need to provide patients quality of life. One is meaningless without the other.’’

What is the Legislative arm of govt doing??

The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill was drawn up in line with the recommendations of the Law Commission of India. It states that life support can be withdrawn for patients in persistent vegetative state (PVS) or suffering an irreversible medical condition. The draft is against the concept of living will though

Scenario throughout the world
As of March 2018, euthanasia is legal in the Netherlands, Belgium, Colombia, Luxembourg, Canada and India.
Assisted suicide is legal in Switzerland, Germany, Japan, and in the US states of Washington, Oregon, Colorado, Vermont, Montana, Washi ngton DC, and California.
South Korea is also set to join as a euthanasia-legal country starting from February 2018, both active and passive.
An assisted dying scheme in the Australian state of Victoria will come into effect in mid-2019.