INTRODUCTION
The right to life does not only mean the right to exist, but the right to live with dignity.1 This constitutional ethos is entrenched in the Indian jurisprudence and it has changed the perception of life as a biological survival to a value-based concept which includes autonomy, dignity and individual choice. 2Passive euthanasia is the borderline of this change in modern legal discourse, and the crucial question is, will permitting a person to die naturally under the circumstances of irreversible pain be an act of disrespect of the sanctity of life, or will it be a respect of the very idea of the dignity that life tries to defend?
Passive euthanasia, which can be defined as the withdrawal or withholding of life sustaining medical care, is a subtle area that is ethically very complicated.3 It does not aim to take away life, but lets nature take its course of death when medical science does not provide any chance of survival. By so doing, it revisits the conventional beliefs which equate sanctity of life with preservation of life regardless of its quality or condition. 4
Constitutional interpretation and judicial activism have greatly influenced this debate in India. Article 21 of the Constitution which was first formulated as a protection against arbitrary deprivation of life has been broadly understood to mean right to live with dignity. 5This interpretative proliferation preconditioned the acknowledgment of the fact that dignity should be extended to the end of life too. In a series of landmark cases, the Supreme Court has slowly transitioned its opposition to the right to die to the right to die with dignity in under certain conditions.6
This question received a national spotlight in Aruna Ramchandra Shanbaug vs. Union of India, a case in which the Court became the first to allow passive euthanasia under stringent conditions. 7Further established in Common Cause v. Union of India, a Constitution Bench made no doubt that the right to die with dignity was one of the fundamental rights and upheld the use of advance directives or living wills. 8These decisions indicate a change in the paternalistic to a framework of rights-based decisions that focus on individual autonomy.
This problem is compounded in a society where medical innovations have enabled it to extend life indefinitely, in most cases ignoring whether life is quality or not. Persistent vegetative patients, those with terminal illnesses and sufferers of unbearable pain may find themselves in a situation where life becomes synonymous with pain. The refusal of passive euthanasia in this case can be the refusal of unwarranted and protracted suffering and therefore the violation of the very dignity, which the Constitution is intended to safeguard.
The paper at hand attempts to critically discuss the fact that passive euthanasia is a right to die with dignity and not an assault on the sanctity of life. It states that passive euthanasia acknowledgement should be in line with the constitutional morality, ethical standards and the developing world morality.9 The article examines judicial precedents, ethical reasons and comparative views to show that passive euthanasia does not reduce the worth of life instead it reinstates the dignity of life by recognising the boundaries of medical intervention and the significance of free choice.
UNDERSTANDING PASSIVE EUTHANASIA
Passive euthanasia is the intentional act of refusing or removing life sustaining medical care so that a patient may die a natural death. 10This can involve stopping ventilators, artificial feeding and hydration, or other types of medical assistance that artificially extend life. 11A distinction must be made between passive euthanasia, and active euthanasia, in which an actual action is undertaken to take away life, such as a lethal injection.
There is a legal and ethical difference between the two types. Passive euthanasia is founded on the concept of letting die, whereas active euthanasia is the concept of causing death. 12The former is the belief in the natural progression of illness and the constraints of medical science, the latter poses serious questions concerning purposeful murder.
Passive euthanasia is legal in the Indian context with stringent legal protection, but active euthanasia is not. This difference guarantees that even though one is not compelled to endure suffering at such a long time, the law still maintains the sanctity of life by not allowing one to intentionally kill.
Moreover, passive euthanasia is directly associated with the idea of informed consent and refusal of treatment.13 Even in the case of a competent patient, denying medical intervention, which may lead to death, is a right. This is a continuation of the principle of bodily autonomy and personal liberty, which are safeguarded by Article 21. 14
CONSTITUTIONAL FRAMEWORK IN INDIA
Passive euthanasia has legal basis in India based on the broad construction of Article 21 that secures the right to life and personal liberty. The judiciary has over the years understood this provision to encompass the different aspects of dignity, privacy, and autonomy.
Jurisprudence on the right to die has undergone numerous historic cases:
In P. Rathinam v. Union of India The Supreme Court declared the right to life to be the right to die.15
This was ruled wrong in Gian Kaur v. State of Punjab where the Court stated that right to life did not encompass right to die, yet stated that right to die with dignity may be right under Article 21 in some situations.16
The turning point was in the Aruna Ramchandra Shanbaug v. Union of India case when the Court permitted passive euthanasia under judicial supervision. Lastly, the Court in Common Cause v. Union of India acknowledged the right to die with dignity as a fundamental right and legalized living wills. 17
All these judgments provide the assertion that the notion of dignity does not only apply to life but the dying process as well. The autonomy of individuals is also enhanced by the acknowledgement of living wills whereby a person is able to make advance decisions concerning medical care.18
ETHICAL JUSTIFICATIONS FOR PASSIVE EUTHANASIA
Various ethical principles that support the legal systems of the present support passive euthanasia.
The principle of autonomy acknowledges the right of the individual to make choices regarding his or her own body and life. 19Refusing an individual the right to deny life-sustaining treatment but not to reduce the individual to a patient of medical action.
Second, the principle of beneficence entails medical practitioners acting in the best interest of the patient. In circumstances where treatment does not promise recovery, and will only enhance the suffering, discontinuing it might be more helpful than continuing it. 20
Third, passive euthanasia is justified using the principle of non-maleficence-do no harm- in situations where further treatment will result in unwarranted pain and suffering.21 The prolongation of life under any condition can be harm rather than good, in some conditions. 22
Lastly, the principle of dignity states that life must be respected and self-worth is valued.23 The perpetuation of life-support machines when a human being is diminished to a level of being unconscious or unworthy of meaningful existence may be a breach of this dignity. 24
ADDRESSING CONCERNS: SANCTITY OF LIFE
The first criticism of passive euthanasia is the violation of the principle of sanctity of life. The flaw with this statement is that it ignores the qualitative element of the sanctity of life itself. While sanctity implies existence, it must also include dignity, independence, and absence of pain or suffering.
There are various laws in India that help deal with such problems. Any decision about passive euthanasia must go through strict guidelines including a proper medical opinion, the process of obtaining consent, and sometimes even judiciary intervention. Such procedures prevent abuse and misuses.25
Furthermore, the ban on active euthanasia ensures the preservation of life and the principle of sanctity of life in general.
COMPARATIVE PERSPECTIVE
Comparison between various laws on euthanasia shows that a significant number of countries have understood the significance of dignity in end-of-life issues. For example, countries such as the Netherlands and Belgium have legalized both active and passive forms of euthanasia provided certain requirements are met. Some other countries like the US allow physician assisted suicide in some of its states. 26
In contrast to this, India allows passive euthanasia only but with several provisions for safety measures.
THE ROLE OF LIVING WILLS
Living wills are a great step forward in acknowledging patient autonomy because they allow the person to indicate his or her choice in matters of medical treatments, which in turn ensures that his or her dignity remains intact regardless of his or her inability to make decisions. 27
The acknowledgment of living wills in the case of Common Cause v. Union of India is a move towards a patient-centered health care system. It makes the job easier for family members and doctors by knowing what the patient wants.
SOCIETAL AND MEDICAL IMPLICATIONS
Legalization of passive euthanasia implies other aspects that would be considered important for the community and doctors. First, it promotes the transformation into patient-oriented treatment that takes into account patients’ consent and freedom of choice. Second, it demonstrates the necessity to introduce palliative care in such cases.28
However, it also means the need to regulate the process in terms of legislation. Despite judicial guidelines being extremely useful, they do not help to deal with difficulties in practice.
CONCLUSION
It is important to realize that the practice of passive euthanasia can be seen as an ideal solution to the problems faced in contemporary times, both from a constitutional perspective and from a moral point of view. Passive euthanasia does not compromise on the sanctity of life; instead, it helps redefine the concept of the sanctity of life by emphasizing dignity. 29
In this context, it needs to be stated that the development of the Indian legal system has reached such a level that the significance of autonomy and dignity is recognized, which is reflected in the case of Common Cause v. Union of India. It is evident that by allowing passive euthanasia through strict regulations, an ideal solution has been developed by law. 30
Finally, it must be realized that the acceptance of passive euthanasia is an acceptance of the sanctity of dignified life.
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Footnotes
1. Maneka Gandhi v. Union of India, (1978) 1 S.C.C. 248 (India).
2. Common Cause (A Regd. Soc’y) v. Union of India, (2018) 5 S.C.C. 1 (India).
3. Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 S.C.C. 454, 518-19 (India).
4. Gian Kaur v. State of Punjab, (1996) 2 S.C.C. 648,664-65 (India).
5. Maneka Gandhi v. Union of India, (1978) 1 S.C.C. 248, 281-82 (India).
6. Common Cause (A Regd. Soc’y) v. Union of India, (2018) 5 S.C.C. 1, P 199 (India).
7. Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 S.C.C. 454, 518 (India).
8. Common Cause (A Regd. Soc’y) v. Union of India, (2018) 5 S.C.C. 1, P 198 (India).
9. Airedale N.H.S. Tr. V. Bland, [1993] A.C. 789,865 (H.L.)(appeal taken from Eng.).
10. India Counsil of Medical Research, Consensus Guidelines on “Do not Attempt Resuscitation” 8 (2020).
11. Law Commission of India, 196th report: Medical Treatment to Terminally III Patients (Protection of Patients and Medical Practitioners) P 2.3 (2006).
12. Law Commission of India, 241st Report: Passive euthanasia- A Relook P 4.5 (2012).
13. American Medical Association, code of Medical Ethics $ 5.3 (2016).
14. Council of Europe, Guide on the Decision- Making Process Regarding Medical Treatment in End-Of-Life Situation 15 (2014).
15. P. Rathinam v. Union of India, (1994) 3 S.C.C. 394,410 (India).
16. Gian Kaur v. State of Punjab, (1996) 2 S.C.C. 648, 664-65 (India).
17. Aruna Ramachandra Shanburg v. Union of India, (2011) 4 S.C.C. 454, 519-20 (India).
18. Common Cause (A Regd. Soc’y) v. Union of India, (2018) 5 S.C.C. 1, P 198 (India).
19. Tom L. Beauchamp & James F. Childress, Principles of Biomedical Ethics 101 (7th ed.2013).
20. Id.at 202.
21. Id.at 150.
22. World Health Organization, WHO Guidelines on the Provision of Palliative Care 12 (2018).
23. Indian counsil of medical research, Consensus Guidelines on Do Not Attempt Resuscitation 6-7 (2020).
24. American Medical Association, code of Medical Ethics $ 5.3 (2016).
25. Council of Europe, Guide on the Decision-Making Process Regarding Medical treatment in End-of-Life Situation 14-15 (2014).
26. Termination of Life on Request and Assisted Suicide (Review Procedures) Act,2002, art.2(Neth.).
27. Or. Rev. Stat. $ 127.800-897 (2023).
28. World Health Organization, WHO Guidelines on the Provision of Palliative Care 5-6 (2018).
29. Law Commission of India, 241st Report: Passive Euthanasia- A Relook P 6.6 (2012).
30. Common Cause (A Regd. Soc’y) v. Union of India, (2018) 5 S.C.C. 1, P 198 (India).