Euthanasia: do we need to decriminalize it?

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“Life and death are one thread, the same line viewed from different sides.” – Lao Tzu

Every person in this world wants a long life full of happiness and wishes for a painless death. However, for some people life can become a burden because of innumerable sufferings attached to it. Euthanasia may seem to be inhuman and against the law of nature but it can put a person at ease from his lifelong illness and helplessness.

The term “euthanasia” was coined by Sir Francis Bacon. It is derived from the two Greek words, “eu” and “Thanatos” meaning “good death”. Euthanasia refers to the practice of intentionally ending a person’s life in order to ease pain and suffering caused due to a condition which cannot be cured or is a terminal illness. It is also referred as “mercy killing” as it sets free an individual from endless misery.

Historical Overview

Euthanasia has been a topic of debate since the 1800s. In 1935, a society called “Voluntary Euthanasia Legislation Society” was founded by Charles Killick Millard. The society was later renamed to “Dignity in Dying”. This society started a movement to legalize euthanasia as it believes that the patient should be the deciding authority at the end of life regardless of whether he/she wants to lengthen the duration of his/her life or ask for medical help to die if terminally ill.

The first attempt to legalize euthanasia in Britain was the Voluntary Euthanasia (Legislation) Bill in 1936, introduced in the House of Lords. However, the Bill was opposed by the British Medical Association.

Classification of Euthanasia

Physician-Assisted Suicide (PAS), in this case, the physician deliberately provides medical assistance to a person who may experience constant and unbearable pain and suffering to end his/her life. The doctor conducts a comprehensive analysis of the medical condition and ascertains the most painless and effective method of death.

Voluntary Euthanasia, when an individual consciously decide that he/she wants to end his/her life with the help of another person. It requires full assent and understanding of concepts and processes.

Non-voluntary Euthanasia, wherein the decision to end a person’s life is made by another person, such as a family member or life partner. This happens when the individual is in a permanent state of unconsciousness and cannot be further treated.

Active Euthanasia, where a doctor can directly end a person’s life. Other names for this process are “Positive Euthanasia” or “Aggressive Euthanasia.” The doctor can intervene directly and prescribe a painless method to end a person’s life. The main factor in this remains the consent of the person suffering from irreparable pain. This is a way to die faster through high lethal doses of drugs or injections of lethal drugs.

Passive Euthanasia, also known as “Negative Euthanasia” or “Non-aggressive Euthanasia” is the practice of intentionally causing the death of a person by withdrawing the basic and necessary care, food or water. This is a deliberate disruption, which also means the removal of artificial life support facilities. It is considered a slower and more comfortable killer than Active euthanasia. It will only help when the individual is no longer mentally and physically alert. There are medical tests and scales such as the Glasgow Coma Scale (GCS) to ascertain the mental state of a person. In many countries and states, this is a legal right granted to people who generally are on medical life support.

Legal status of Euthanasia in India

The Indian Constitution under Article 21[1] guarantees ‘Right to Life’ to all its citizens. The constant, ever-lasting debate on whether Right to Life also entails ‘Right to Die’ still lingers in the air. Therefore, the concept of Euthanasia has received a mixed response in India. However, Passive Euthanasia is legal in India. On March 7, 2011, the Supreme Court of India legalized by means of the withdrawal of life support to patients in a permanent vegetative state. This decision was taken as a part of the verdict in the case, Aruna Ramachandra Shanbaug v Union of India[2] involving Ms. Aruna Shanbaug who was in a vegetative state for 37 years at the King Edward Memorial Hospital, Mumbai after been attacked by a sweeper in the hospital who wrapped a dog chain around her neck and yanked her back with it. Due to this, the supply of oxygen to the brain was cut and she fell into coma. The Supreme Court appointed a team of three doctors to examine Ms. Shanbaug and present a report on her physical and mental condition. Although the court did not allow the withdrawal of treatment to Ms. Shanbaug, it discussed the issue of euthanasia in detail and allowed Passive Euthanasia. The court defines “passive euthanasia” as the cessation of treatment with deliberate intention to cause the death of the patient. It considers Passive Euthanasia to be permitted if the doctors take action based on the notified medical opinion and withdraws life support in the best interest of the patient. Invoking the principle of Parens Patriae principle (Latin for “parent of the nation”, the court can step in and act as guardian). It believes that the court is the one that makes the final decision in the best interest of the patient. It extends this power to the High Courts by virtue of article 226[3].

Active Euthanasia, including the use of lethal compounds to end lives, is still illegal in India. Since India does not have a law on euthanasia, the Supreme Court’s guidelines are laws before, until the legislation is passed by the Parliament.

The following guidelines have been established:

  • The decision to discontinue life support must be made by a parent or spouse or other close relatives or in the absence of any of them, can even be made by a person or a group of persons acting as a next friend. It can also be taken by doctors who is responsible for the patient. However, the decision must be based on the patient’s best interest.
  • Even if a close relative, doctor or a next friend decides to withdraw the life support, the decision requires the approval of the concerned High Court.
  • When such a request is filed, the President of the High Court will immediately form a bench of at least two judges, who will decide whether to approve it or not. The bench will nominate a committee made up of three renowned doctors, who will provide reports on the patient’s condition.  Before the judgment is made, the report must be notified to close relatives and the State. After hearing the opinions of parties, the High Court can make a ruling.

Nations around the world on Euthanasia

Euthanasia is not only an issue which needs to be addressed in India, but a global concern. Many other nations debated on whether euthanasia should be legalized or not. Some of the nations are given below.

  • Netherlands

The Netherlands is the first name that comes to mind when we talk about euthanasia, because it is the first country in Europe to legalize the use of euthanasia and assisted suicide in the country. In April 2002, the Netherlands enacted a bill called the “Termination of Life on Request and Assisted Suicide (Review Procedures) Act” to regulate euthanasia. But this is allowed in very rare and special circumstances. According to the Netherlands Penal Code, if a person kills another person with his/her assent, then also he/she will be punished for 3 years. Doctors who use the practice of euthanasia on patients can only be exempted from prosecution if they meet the following conditions:

  1. There is no room for improvement in the patient’s health and the pain is excruciating.
  2. The patient himself requested euthanasia without being influenced by others.
  3. The victim fully understands his/her situation and other alternative options.
  4. Same problem needs to be discussed with another doctor to confirm everything.
  5. The individual must be killed by a doctor following the proper procedures.
  6. The minimum age required for euthanasia is 12 years.
  • United States of America

In USA, the concept of euthanasia is completely illegal. However, assisted suicide is legal in California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington with the help of the backing of “Death with Dignity Act”.

  • Australia

The practice of euthanasia is illegal in Australia. Although in June 2019, Victoria, a state in Australia, passed a law on assisted suicide applicable only under certain limited conditions. In 1997, Australia’s Northern Territories enacted a law on euthanasia, called the Euthanasia Law Act,1997. The law was legal in the Northern territories of Australia for only a brief period of time. Nonetheless, organizations such as Exit International wants the Government of Australia to restore the law related to euthanasia.

  • United Kingdom

The practice of Passive Euthanasia is legalized in England when a patient is in a permanent vegetative state i.e., removal of artificial life support facilities, feed tube etc. However, Active Euthanasia is illegal in the United Kingdom.

  • Switzerland

The Swiss Criminal Code of 1937 made “incitement or assistance to suicide from selfish motives” illegal (Article 115). Any positive effect of Voluntary Euthanasia (“manslaughter on demand”) is also prohibited, even if motivated by “respectable motives”, such as mercy killings (Article 114). However, assisted suicide with unselfish motives remains legalized. For example, as long as the recipient is actively involved in the drug administration, lethal drugs can be prescribed, but Active Euthanasia (such as the act of administrating lethal injection) is illegal.

  • Argentina

In 2012, the Argentine Senate passed a law which legalized euthanasia and allowed the removal of treatments which artificially lengthen the duration of life of the patient who is terminally ill. The assent for euthanasia can be given by the patient himself/ herself or his/her family members or relatives wherein he/she is not able to give his/her consent.

  • Canada

‘Physician Assisted Suicide’ is legal in Canada. Physician Assisted suicide is a type of euthanasia, in which patients who have reached the age of 18 and are suffering from terminal illness with foreseeable death are subject to voluntary active euthanasia. In order to prevent the rise of suicide tourism, euthanasia in Canada is conditional. Only those patients who can apply for Canadian health insurance can undergo euthanasia.

  • Chile

Passive Euthanasia is legal in Chile while Active Euthanasia is illegal in Chile. It is on the patient’s will to refuse the treatment or not while suffering from a terminal illness in Chile.

  • Belgium

In 2002, the Belgian parliament legalized the practice of euthanasia.

  • Finland

Passive euthanasia is legal in Finland but while Active euthanasia is illegal.

  • Germany

Passive euthanasia is legalized in Germany only on the will of the patient to refuse the treatment. However, Active euthanasia is not legalized.

  • Latvia

Both Active and Passive euthanasia are illegal in Latvia.

  • Ireland

Both Active and Passive euthanasia are illegal in Ireland.

Arguments for legalizing Euthanasia

Proponents of euthanasia believe that society has an obligation to recognize the rights of patients, and respect the decision of those who choose euthanasia. Some people believe that euthanasia respects the individual’s right to self-determination or privacy. If it is to protect basic social values, interference with this right can then only be a legitimate reason, which is not the reason as patients suffer unbearable pain and demand euthanasia when they have no alternatives left. This is not the case. Not allowing euthanasia will come down to forcing people to suffer against their will. This will be cruel and a denial of their human rights and dignity.

Everyone is entitled to live with at least the minimum dignity. When living condition is even below the minimum; he/she must be allowed to end this tortuous life. In such cases, alleviating suffering rather than protecting lives should be the primary goal of healthcare providers.

Proponents of Active Euthanasia argue that since society has recognized the patient’s right to passive euthanasia, Active Euthanasia should also be permitted. While discussing the legalization of Active Euthanasia, its supporters emphasized that in this case, the condition has become too burdensome for the patient and the patient’s pain management is insufficient. And only death seems to alleviate the pain. Furthermore, in view of the increasing pressure on hospitals and medical facilities, it is argued that the same facilities should be used to benefit other patients who have better opportunities for recovery, and that these facilities are of greater value to them. Therefore, when one has to choose between a patient who cannot recover and one who can be saved, prefer the latter as the former will die in ease.

Arguments against legalizing Euthanasia

Opponents of euthanasia see it as a euphemism for murder and insist that euthanasia is not the right to die, but the right to kill. They emphasized that healthcare providers have a professional obligation to prohibit killing and insist that euthanasia is incompatible with the role of care, nursing, and treatment. On the contrary, with the rapid development of medical science, people who are sick today are likely to be cured tomorrow. Therefore, society has no right to kill them today, depriving them of their chances of recovery in the future.

Furthermore, patients do not always want to die. The patient’s family members can also decide whether to let the patient live in. In addition, even where the consent of the patient is present, it can be obtained by force. The possibility of using physical force here is very small but emotional and psychological force can overwhelm depressed or dependent people. If the choice of euthanasia is considered to be as good as the decision to receive care, many people will feel guilty because they did not choose to die. Additionally, economic considerations, coupled with concern about “becoming a burden” can become a powerful force that can lead a person to “choose” euthanasia or assisted suicide.

It is also often pointed out that the legislation related to euthanasia is full of ambiguous terms that can easily be abused. For example, the term “terminally ill” is not bound by a fixed definition. Even in the medical world (not to mention the legal world), there are disputes about who is terminally ill, so the category can cover a very wide range of patients.

Opponents also argued that allowing doctors to perform Active Euthanasia would cause intolerable abuse and abuse of power to determine life and death risks. They recognize that special cases of Active Euthanasia are sometimes morally justified. However, they insisted that authorizing the practice of killings would cause more and less benefit.

Conclusion

Today, in addition to questions of justice and morality, legal status of Euthanasia is debated around the world. After seeing the ability of the law to reevaluate previous indomitable behavior on the sanctity of life, the people showed some enthusiasm to support their views (Vij Krishan, 2008). Opponents to euthanasia have stated that they have good, strict and ethical commitments that cannot be ignored. They argue that no one has the right to deprive an individual of life, not even the individual himself. The idea of ​​sacred life is sacred, experts have made a pledge (The Hippocratic Pledge); protect life at all costs; neither the patient’s death nor the underlying method can be legalized (Pillay, 2010). Euthanasia can be helpful for people who are really severely tortured, but on the same side, it can be dangerous if it is used incorrectly, so euthanasia must be carried out under principled supervision. In any case, the connotative consequences of euthanasia should be reviewed periodically with the development of society, and medical treatment should be provided to the disabled and those who cannot be cured and ultimately lead to death.

References

Sabaat Fatima, Euthanasia: should mercy killing be allowed, Ipleaders (Oct. 4, 2020), https://blog.ipleaders.in/euthanasia-mercy-killing-allowed/

Urvashi Trivedi, Euthanasia: Should it be legalized in India?, Latest Laws (July 3, 2020), https://www.latestlaws.com/articles/euthanasia-should-it-be-legalized-in-india/

Esha Jhunjhunwala, Euthanasia: Should it be Lawful or Otherwise?, (2010), Esha Jhunjhunwala.pdf

Mariya Paliwala, Euthanasia: Does Right To Life Include Right To Die?,  Ipleaders (Nov. 19, 2019), https://blog.ipleaders.in/euthanasia-right-life-include-right-die/


[1] The Constitution of India, 1950, Art.21.

[2] Aruna Ramachandra Shanbaug v Union of India, (2011) 4 SCC 454.

[3] The Constitution of India, 1950, Art.226.

Author: Radhika Jhanwar, University of Petroleum and Energy Studies, Dehradun

Editor: Kanishka VaishSenior Editor, LexLife India.

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