EUTHANASIA

Euthanasia is defined as the hastening of death of a patient to prevent further sufferings.

ACTIVE/PASSIVE EUTHANASIA: Active euthanasia refers to the physician deliberate act,
usually the administration of lethal drugs, to end an incurably or terminally ill patient’s life.
Passive euthanasia refers to withholding or withdrawing treatment which is necessary for
maintaining life.
There are three types of active euthanasia, in relation to giving consent for euthanasia,
namely voluntary euthanasia – at patient request, nonvoluntary – without patient consent,
involuntary euthanasia – patient is not in a position to give consent.
DIFFERENCE BETWEEN EUTHANASIA AND OTHER KINDS OF SUICIDES
Suicide is an act or instance of intentionally killing oneself. Therefore, suicide could be
termed as the intentional termination of one's life by self- induced means. Euthanasia or
mercy killing is committed on the basis of medical reasons, where the death of a terminally ill
person is brought about by another person, who believes that such person's existence is so
bad that he/she would be better off dead; also, when his actions are based on the conviction
that unless he intervenes and ends the ill person's life, it shall become so bad that he/she
would be better of dead. Considering this observation, it may be stated that the motive of the
person committing such acts of euthanasia is to benefit the one whose death is brought about.
Assisted dying can take two forms: euthanasia or assisted suicide. Broadly, euthanasia
describes the situation where the person who is asking for assistance to die has someone else
take the action that leads to their unnatural death (like injecting a lethal drug), and assisted
suicide is when the person is prescribed drugs that they must take themselves in order to die.
RIGHT TO DIE UNDER INDIAN CONSTITUTUION
P. Rathinam v Union of India
P. Rathinam and Nagbhushan Patnaik had filed petitions challenging the constitutional
validity of Section 309 of the Indian Penal Code. Section 309 punishes anyone who attempts
to commit suicide with simple imprisonment for up to one year. The Supreme Court drew a
parallel between the other fundamental rights – just as the right to freedom of speech under
Article 19 gives the right to speak but also includes the right to not speak, the right to live
under Article 21 includes the right to not live. Thus, Section 309 was held to be
unconstitutional.
Gian Kaur v State of Punjab
Gian Kaur and her husband Harbans Singh were convicted by a Trial Court under Section
306 of the Indian Penal Code. They were sentenced to six years imprisonment and fine of Rs.
2,000/- for abetting the suicide by Ms. Kulwant Kaur. Section 306 punishes anyone who
abets the commission of suicide, while Section 309 punishes anyone who attempts to commit
suicide. It was argued that, as held in P. Rathinam v. Union of India, the Article 21 right to
life includes the right to die. So, a person abetting suicide is merely assisting in the
enforcement of Article 21. A five-judge bench of the Supreme Court overruled P. Rathinam.
Aruna Ramachandra Shanbaug v Union of India
The ‘next friend’ of Ms. Aruna Shanbaug had filed a petition before the Supreme Court
asking it to direct the hospital to stop feeding the her and allow her to die peacefully. Ms.
Shanbaug was in a Persistent Vegetative State (PVS) since she had been sexually assaulted in
1973. The Court appointed a team of three doctors to examine Ms. Shanbaug and submit a
report about her physical and mental condition. Although the court did not allow the
withdrawal of medical treatment to Ms. Shanbaug, it discussed the issue of euthanasia at
length and allowed passive euthanasia. Invoking the Parens Patriae principle (Latin for
“parent of the nation”, where the Court can step in and serve as a guardian) it held that the
Court is the ultimate decider of what is best for the patient. It extended this power to the High
Courts under Article 226.
In Common Cause v UOI, the Supreme Court dealt with the question of whether the right to
life under Article 21 of the Indian Constitution encompasses within its ambit a ‘right to die
with dignity’. Answering in the affirmative, the Court emphasized the dynamic and
constantly evolving nature of fundamental rights. Individual dignity having been reaffirmed
as falling under Article 21 by the Puttuswamy I judgement, the Court interpreted the right to
live with human dignity as necessarily meaning a right to live a dignified life until the point
of death. In the Court’s eyes, this would include a dignified procedure of death. This allows a
terminally ill person or a person in a permanent vegetative state to seek passive euthanasia to
protect their right to a dignified death under Article 21. In order to give effect to this right, the
Court in Common Cause issued guidelines regarding Advance Directives (‘AD’) which are
documents that detail the choices of the patient regarding treatment decisions along with who
would be competent to take decisions on their behalf in case of their inability to do so. While
the guidelines were amended in February 2023 to facilitate easier implementation of ADs to
larger sections of society, they still place an onerous burden on each applicant. Each AD is
subject to the opinion of two medical boards, and the decisions of the boards can only be
challenged via writ petition under Article 226. The current position puts the onus largely on
the families of the patients, who are subjected to a rigorous bureaucratic process in order to
give effect to the ADs, which are notarised documents signed and testified in front of a
judicial magistrate.
In 2023, the SC amended the 2018 guidelines for Passive Euthanasia:
The Supreme Court tweaked the previous judgement to do away with the necessity of a
judicial magistrate to attest or countersign a living will. SC held that an attestation by a
notary or a gazetted officer would be sufficient for a person to make a valid living will.
Instead of the living being in the custody of the district court concerned, SC said that the
document will be a part of the National Health Digital Record which can be accessed by
hospitals and doctors from any part of the country.
If the hospital’s medical board denies permission to withdraw medical treatment, the family
members of the patient can approach the relevant high court, which forms a fresh board of
medical experts to enable the court to take a final call.
While the requirement of setting up two medical boards — one primary and other review —
to examine the medical condition of the patient has been retained, the SC has done away with
the rule mandating that the district collector set up the review board. The court said both
boards will be constituted by the hospital and there would be one nominee doctor of the
district medical officer in the review board. The medical boards must take a decision on such
cases preferably within 48 hours, it added.

OTHER COUNTRIES

DOCTRINE OF DOUBLE EFFECT

The double effect doctrine forbids the achievement of good ends by wrong means but it
permits actions with a double effect, both good and bad, under certain conditions. The act
performed is not itself morally evil. The good effect does not result from the evil effect. Only
the good effect is intended.
This doctrine says that if doing something morally good has a morally bad side-effect it's
ethically OK to do it providing the bad side-effect wasn't intended. This is true even if you
foresaw that the bad effect would probably happen. The principle is used to justify the case
where a doctor gives drugs to a patient to relieve distressing symptoms even though he knows
doing this may shorten the patient's life. This is because the doctor is not aiming directly at
killing the patient - the bad result of the patient's death is a side-effect of the good result of
reducing the patient's pain.
PRETTY V THE UK
Diane Pretty was suffering from motor neurone disease - a degenerative disease affecting the
muscles, for which there is no cure. She was paralysed from the neck down, had little
decipherable speech and was fed by a tube. Pretty wanted her husband to provide her with
assistance in suicide. However, under the UK law this act would make her husband
criminally liable. The European Court of Human Rights found no violation of articles 2 (right
to life), 3 (prohibition of torture), 8 (right to respect for private and family life), 9 (freedom of
thought, conscience and religion) and 14 (prohibition of discrimination) of the European
Convention on Human Rights. The Court concluded that Article 2 of the European
Convention does not include the right to die, whether at the hands of a third person or with
the assistance of a public authority. As regards Pretty's right to respect for private life under
Article 8, the Court considered that in this case the interference was justified as “necessary in
a democratic society” for the protection of the rights of others.
NICKLINSON AND LAMB V THE UK
In this case, the Supreme Court of the United Kingdom (“Court”) considered whether the
criminalization of assisting a suicide under English law, and a code for the prosecution of
those alleged to have assisted, infringed Article 8 of the ECHR. The Court decided that
Parliament should address the issue of decriminalizing of assisting a suicide.

This case involved three individuals, who wished to end their lives, but required assistance
for it. The laws of England on murder, manslaughter, and Section 2 of the Suicide Act made
assisted suicide illegal. Thec first appeal sought the Court to declare it lawful for the
appellants to commit assisted suicide or declare the position under English laws to be
incompatible with Article 8 of the ECHR. Additionally, the Policy for Prosecutors in respect
of Cases for Encouraging or Assisting Suicide, issued by the Director of Public Prosecution
(“DPP”) in 2010 (“the 2010 Policy”), provided a number of factors favoring and opposing
prosecution of those alleged to have assisted suicide. The second appeal was by the DPP on
the Court of Appeal’s decision that the 2010 Policy was not sufficiently clear.
Considering the moral, social and political questions involved in legalizing assisted suicide,
which were the subject of ongoing legislative debate, the majority decided that the Parliament
was the appropriate institution to decide on the question. Thus, it dismissed the first appeal.
Further, it allowed the second appeal (by the DPP), and refused to order the DPP to clarify the
terms of the 2010 Policy, leaving this to the DPP’s discretion.
AIRDALE NHS TRUST V. BLAND
The House of Lords affirmed the decisions of a Family Division Court and the Court of
Appeal, Civil Division, permitting physicians to withhold medical treatment from an
insensate patient in a persistent vegetative state, provided that the patient's death will
imminently follow the removal of life-sustaining treatment. In this situation, the medical
treatments to be withheld included artificial feeding and antibiotics to fight infection. The
court reasoned that this afforded the patient a peaceful and dignified death without suffering,
and fulfilled the course of nature. The court distinguished this circumstance from euthanasia,
a criminal offense in which a doctor actively participates in bringing about a patient's death.
In the future, doctors and families in similar situations were advised to petition the court
before taking any comparable measure because, in the absence of action by Parliament, each
instance requires case-by-case determination.
LAW IN US
Passive euthanasia is legalized uniformly all over in US. Involuntary Euthanasia is currently
illegal in all 50 states of the United States. Active euthanasia (Assisted suicide) is legal in 10
jurisdictions in the US: Washington, D.C. and the states of California, Colorado, Oregon,
Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington. The status of assisted
suicide is disputed in Montana.
LAW IN UK
Both Euthanasia and Assisted Suicide are illegal in the United Kingdom and could be
prosecuted as murder or manslaughter.