Euthanasia : A dignified death or an assisted kill??

“By establishing a social policy that keeps physician-assisted suicide and euthanasia illegal but recognizes exceptions, we would adopt the correct moral view: the onus of proving that everything had been tried and that the motivation and rationale were convincing would rest on those who wanted to end a life. Physician-assisted suicide and euthanasia have been profound ethical issues confronting doctors since the birth of Western medicine, more than 2,000 years ago.”

— Ezekiel Emanuel

 

 

The term “euthanasia” is brought from the Greek word “euthanatize” meaning “well death”. In recent years, there has been crying debate round the globe over the issue, whether euthanasia is legalized. Before going ahead on this issue, it is desirable here to first be introduced with this terminology. Euthanasia is basically killing of patients by doctors at the instance of the patient in order to free him/her of excruciating pain or from terminal illness. Euthanasia may be either active or passive. Active euthanasia contemplates putting individuals to painless death for merciful reasons, as when a doctor administers a lethal dose of medication to a patient, while passive euthanasia involves not doing something to prevent death, as when doctors refrain from using devices necessary to keep alive a terminally ill patient or a patient in a persistent vegetative state.

Classification of Euthanasia:

Euthanasia can be broadly classified into three types, according to whether a person gives informed consent: voluntary, non-voluntary and involuntary. There is a debate within the medical and bioethics literature about whether or not the non-voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia, irrespective of intent or the patient’s circumstances. In the definitions offered by Beauchamp and Davidson and, later, by Wreen, consent on the part of the patient was not considered as one of their criteria, although it may have been required to justify euthanasia. However, others see consent as essential.

1) Voluntary Euthanasia:

Voluntary euthanasia is conducted with the consent of the patient. Active voluntary euthanasia is legal in Belgium, Luxembourg and the Netherlands. Passive voluntary euthanasia is legal throughout the US per Cruzan v. Director, Missouri Department of Health. When the patient brings about his or her own death with the assistance of a physician, the term assisted suicide is often used instead. Assisted suicide is legal in Switzerland and the U.S. states of California, Oregon, Washington, Montana and Vermont.

2) Non-voluntary Euthanasia:

Non-voluntary euthanasia is conducted when the consent of the patient is unavailable. Examples include child euthanasia, which is illegal worldwide but decriminalised under certain specific circumstances in the Netherlands under the Groningen Protocol.

3) Involuntary Euthanasia:

Involuntary euthanasia is conducted against the will of the patient where the patient is somewhat forced to be sanctioned under the protocol.

 

 

Historically, the euthanasia debate has tended to focus on a number of key concerns. According to euthanasia opponent Ezekiel Emanuel, proponents of euthanasia have presented four main arguments. a) that people have a right to self-determination, and thus should be allowed to choose their own fate; b) assisting a subject to die might be a better choice than requiring that they continue to suffer; c) the distinction between passive euthanasia, which is often permitted. And active euthanasia, which is not substantive (or that the underlying principle–the doctrine of double effect–is unreasonable or unsound); and d) permitting euthanasia will not necessarily lead to unacceptable consequences. Pro-euthanasia activists often point to countries like the Netherlands and Belgium, and states like Oregon, where euthanasia has been legalized, to argue that it is mostly unproblematic.

Similarly, Emanuel argues that there are four major arguments presented by opponents of euthanasia: a) not all deaths are painful; b) alternatives, such as cessation of active treatment, combined with the use of effective pain relief, are available; c) the distinction between active and passive euthanasia is morally significant; and d) legalising euthanasia will place society on a slippery slope, which will lead to unacceptable consequences. In fact, in Oregon, in 2013, pain wasn’t one of the top five reasons people sought euthanasia. Top reasons were a loss of dignity, and a fear of burdening others. In the United States in 2013, 47% nationwide supported doctor-assisted suicide. This included 32% of Latinos, 29% of African-Americans, and almost nobody with disabilities.

 

 

Supreme Court’s verdict on Euthanasia legalization in India:

Declaring the right to die with dignity as a fundamental right, the Supreme Court in a landmark judgment on Friday, 9th March, 2018,  passed  an order allowing passive euthanasia in the country.According to an Indian Express report, a five-judge bench of the apex court headed by the Chief Justice of India Dipak Misra and comprising Justices A.K. Sikri, A.M. Khanwilkar, D.Y. Chandrachud and Ashok Bhushan, issued guidelines in recognition of  “living will” made by terminally-ill patients.These guidelines include who can execute the will and under what conditions can the medical board endorse passive euthanasia.

The apex court further stated that its guidelines and directives shall remain in force till a legislation is brought to deal with the issue. The court was issuing its verdict on a PIL filed by NGO Common Cause in 2005. According to LiveLaw, noted lawyer Prashant Bhushan had argued in the case that when a medical expert suggests that a patient suffering from a terminal disease has reached a point of no return, she should have the right to refuse artificial life support – medically referred to as passive euthanasia – to avoid prolonged agony.

In relevance to the verdict Justice Chandrachud said: “Life and death are inseparable. Every moment our bodies undergo change… life is not disconnected from death. Dying is a part of the process of living.”

SC’s earlier decisions:

The bench had earlier reserved its judgment on October 11, 2017. It observed that the right to die in peace could not be separated from Right to Life under Article 21 of the constitution. A five-judge bench, headed by Justice J. S. Verma, in Gian Kaur vs State of Punjab in 1994 had held that both assisted suicide and euthanasia were unlawful. The bench stated that the right to life did not include the right to die, hence overruling the two-judge bench decision in P. Rathinam vs Union of India which struck down section 309 of Indian Penal Code (attempt to suicide) as unconstitutional. In the Gian Kaur case, the apex court held that Article 21 speaks of life with dignity, and only aspects of life which make it more dignified could be read into this Article, thereby pointing out that the right to die was inconsistent with it.

 

However, later in Aruna Ramchandra Shanbaug vs Union Of India, the Supreme Court in March 2011 held that passive euthanasia could be given a nod in case of exceptional circumstances and under strict monitoring of the apex court. Aruna Shanbaug had been in a vegetative state for since 1973, and on her behalf, Pinki Virani, a social activist, journalist and writer, had filed a writ petition claiming that her right to life guaranteed by the constitution had been violated.

Shanbaug was raped on the night of 27 November, 1973, by Sohanlal Bhartha Walmiki. He was a ward boy who worked on contract at the KEM Hospital. Sohanlal attacked her while she was changing clothes in the hospital basement. He choked her with a dog chain and sodomised her. The asphyxiation cut off oxygen supply to her brain. After the brutal assault Shanbaug was admitted to the same hospital. For 42 years, she was in the same Ward 4 in a comatose state.

 

 

Euthanasia comes when all lifecare interventions fall short of ensuring better life for a person who is in vegetative state. A living will is a written document allowing a patient to give instructions in advance. It is about the treatment to be administered when patient is terminally ill or unable to express informed consent. It also includes withdrawing life support if a medical board declares that all lifesaving medical options have been exhausted. The Centre had opposed the concept of a living will, stating that there was risk of misusing such a provision. And that it may not be viable as a part of public policy.

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