In the days of yore, human beings who fell sick had less recourse to the medical field to resuscitate them back to health and vigor and the usual practice was to provide them with anesthetics to ease their pain until death. With the evolution of the human race and the advent of modern medicine, most illnesses now have a cure and ailing patients can seek medical help to undeniably revive themselves back to health. But there are still certain illnesses or situations from which there is no coming back. Cancer is a terminal illness that still does not have a cure and there are some unforeseeable situations in some individuals’ lives where they are met with some daunting or harrowing circumstances which leave them permanently disabled or in a vegetative state. In these grave times, such affected individuals decide, or in case they are unable to make such a decision, the doctors who care for them, witnessing the suffering of such individuals helplessly, make the decision to put an end to their sufferings by a term called euthanasia.
The word Euthanasia is derived from the Greek words, ‘Eu’ meaning good and ‘Thanatos’ meaning death; thus, the word Euthanasia literally means good death. This article will focus on what euthanasia is and its related terms, what the legal standing in India is regarding the same, and the different perspectives of the Indian Judiciary.
What is Euthanasia?
Euthanasia is the voluntary ending of one’s life due to its incurable nature, by the commission or omission of certain acts, considering the endless suffering caused to them. Alternatively, it is also commonly called ‘mercy killing’. Euthanasia is broadly divided into two categories, one being passive euthanasia and the other, active euthanasia. The basic difference between the two is that, in the former, death is allowed to happen to the affected individuals naturally, without any interference by the doctors. In the latter, there is active participation in hastening the death of such individuals, by the administration of lethal external sources.
Based on consent, when an ailing patient directly requests or pleads for the commission of euthanasia, it becomes voluntary in nature and when such patient is incompetent to make such a decision, for example, a patient in a prolonged coma, such decision, after thoroughly assessing the condition, is made for them and constitutes the involuntary action.
There are also the concepts of Physically Assisted Suicide (PAS) and Advanced Medical Directive which are, in the first case, Physically Assisted Suicide in which the doctor or nurse, at the consent and behest of the ailing patient, provides for just the right amount of lethal dosage to be injected or consumed by the patient himself/herself directly and in the second case, Advance Medial Directive, also known as a living will, is a request or directive given by the ailing patient to stop their medical treatment in regards to their terminal illness. This must be voluntarily done in advance by the patient.
India’s Legal Standing
The Indian Penal Code (IPC) outright invalidates and criminalizes any act or omission in pursuance of euthanasia as per Sections 305, 306 and 309 of the same. These Sections are discussed in brief as under: –
- Section 305: Abetment of suicide of child or insane person.
This Section provides that if any child or person in an intoxicated/delirious state or any clinically proven insane person commits the act of suicide, any other person who might have been involved, either directly or indirectly, in the commission of such act shall be punished with a maximum imprisonment term of ten years including the liability to pay fine. In the context of euthanasia, any doctor or family member who agrees to the commission of such act in case of individuals, barring children and clinically insane people, who are unable to make such decision for themselves, will be held liable for the same under this Section. Thus, the involuntary action of causing euthanasia is criminalized by this Section.
- Section 306: Abetment of Suicide.
This Section removes the portion of incapacity of the individual to decide his/her own death, as was the case in the aforementioned Section, keeping the penalty imposed to be the same as Section 305. Thus, in the context of euthanasia, this invalidates and criminalizes even those acts which are specifically requested by the affected individuals, in effect, the voluntary consent given by such individuals.
- Section 309: Attempt to commit suicide.
This Section criminalizes the act of suicide or the attempt made thereof in its entirety. This means, in the context of euthanasia, that if the affected individuals decide on their own accord to end their own life while they are competent enough to make such a decision, such persons shall attract the penalty on themselves by virtue of Section 309. This penalty includes a simple imprisonment term of 1 year at the maximum or the payment of fine or with both, at the discretion of the court.
As it is seen from the aforementioned clauses of the Indian Penal Code, Indian Law has outlawed the practice of euthanasia completely. There was a report made by the Law Commission of India in 2006, specifically the 196th Report on terminally ill patients which advocated for the legalization of passive euthanasia and Physically Assisted Suicide (PAS) in a very strict and controlled environment. This was specifically for the patients who had terminal illnesses and were in a Permanent Vegetative State. The Supreme Court, in the case of Aruna Ramchandra Shanbaug Vs Union of India, refused the Report but permitted the passive euthanasia as will be discussed in brief in this Article below.
Interestingly, the Indian Judiciary have had differences of opinion on this topic while dealing with cases regarding the same since quite a few years.
Stand of the Indian Judiciary
The stand of the Indian Judiciary will be discussed by the various cases throughout the decades in brief as mentioned hereunder: –
- Maruti Shripati Dubal vs State of Maharashtra (1986)
The Petitioner, in this case, was a police officer who was involved in a car accident after which he became clinically unstable. He was diagnosed with schizophrenia and had a history of mental illness which included depression. He deliberately poured kerosene and lit himself on fire but survived the ordeal. He was charged with attempted suicide under Section 309 of the IPC. It was deliberated in the Bombay High Court whether Section 309 was constitutionally valid and the Court, in its judgement held that Section 309 was violative of Articles 19, 21 and 14 of the Indian Constitution. Thus, Section 309 was invalidated by the Bombay High Court as being unconstitutional in this case.
- Rathinam vs Union of India (1994)
Petitions were filed in the Supreme Court of India challenging the constitutional validity of Section 309 of the IPC. The core question asked in this case was whether Section 309 was violative of Articles 14 and 21 of the Constitution and whether Article 21, while protecting the life and liberty of an individual, included the right to die or not. The Court, in pursuit of answers for the same, discussed and deliberated these substantial questions, giving special regards to an Article written by a former Chief Justice of the Delhi High Court, Shri V.S. Deshpande, titled ‘To Be or Not to Be’ wherein he concluded by saying that if Suicide was done as a cowardly act to escape the responsibilities of life, then it would be constitutionally valid and in consonance of Article 21 of the Constitution but if there was an individual who was terminally ill and wanted to end his life to relive himself of immeasurable physical and mental pain and to relive his caretakers of the burden of constantly caring for him with no hope of returning to normality, then prosecution of such an individual would be like adding insult to injury.
The Supreme Court held and reiterated that Section 309 was indeed violative of Article 21 as the right to life, as stipulated in Article 21 included the right to live with dignity rather than just a mere animal existence as was held in the case of Maneka Gandhi vs UOI. In regards to Section 309, if an individual is constantly suffering from agonizing physical and mental pain, it is equivalent to a mere animal existence, in which case such individual can choose to end their life with dignity. It was held that Section 309 was an inhumane provision as this caused further mental agony and public shame to an individual who was already living in misery and mental agony. As for Article 14, the Court found Section 309 to be in consonance with the same.
- Gian Kaur vs State of Punjab (1996)
In this case, Gian Kaur and her husband were found guilty of abetting the suicide of their daughter. They were charged under Section 306 of the IPC. The Supreme Court deliberated whether Section 306 and 309 of the IPC were constitutional or not.
The judgement in this case overturned the judgements of Maruti Shripati Dubal vs State of Maharashtra & P. Rathinam vs Union of India by concluding that the ‘right to life’ enshrined under Article 21 includes the right to live with human dignity but does not include the ‘right to die’ as and by way of early termination of life which was upheld in the Rathinam Case.
- Aruna Ramchandra Shanbaug vs Union of India (2011)
The Petitioner Aruna Shanbaug was a hospital nurse at King Edward Memorial Hospital in Parel, Mumbai where she was sodomized by a sweeper in the same hospital which left her in a Permanent Vegetative State (PVS) for 36 years. The Supreme Court delivered the judgement whereby passive euthanasia was permitted under specified conditions and strict monitoring. A procedure was laid down by the Supreme Court for carrying out of the passive euthanasia process after taking prior consent from the High Courts of the State and was affirmed by the Supreme Court that the procedure so laid down was to be a temporary arrangement of approval of passive euthanasia until the Parliament passes a law on the subject. Aruna Shanbaug was still denied passive euthanasia stating that the situation did not warrant it. But this is an important case as for the first time, passive euthanasia was approved by the Supreme Court, albeit by the following of a strict a strict procedure on a temporary basis.
- B. Karibasamma Vs Union of India (2012)
The Petitioner, in this case was a 70-year old woman who was a retired school teacher. She was a diabetic patient and had a physical health condition known as ‘Intervertebral Disc Prolapse’ or Slip Disc due to which she was under constant pain and distress which also caused her constant mental anguish. She was living this life of unending torment for the past 10-11 years prior to the filing of this Petition. All the Doctors she had referred to informed her that only an invasive surgery would help her condition which would not be possible due to her age and health condition. Due to the fact that her situation could not be helped or improved by way of medical intervention, she chose to end her life. The Karnataka High Court, while mulling over the facts of the case, took into consideration the judgement passed in the Aruna Shanbaug Case and the procedure so laid down in that case was followed after which the Karnataka HC delivered the judgement whereby the Petitioner was denied the administration of euthanasia as she was declared not terminally ill nor in a Permanent Vegetative State.
- Common Cause vs Union of India (2018)
Common Cause is a registered NGO which had filed a PIL in the Supreme Court of India, when the government did not respond to a letter written by the same NGO to the Ministry of Law and Justice and the Ministry of Health and Family Welfare with regard to passive euthanasia. The contention argued by the Petitioner was that the Right to Life with Dignity should encompass the right to die with dignity as a life with dignity should carry on till the person’s last breath. The NGO contended that modern medicine unnaturally extended a terminally ill person’s life span where there was no hope for a cure causing undue torment and anguish to the patient as well as their family. Another contention that was made by the NGO was the legalization of living will or Advanced Medical Directive.
The Apex Court, in this case held that an individual has the right to die with dignity which is inherently a part of the fundamental right guaranteed under Article 21 of the Constitution. Therefore, the Court permitted passive euthanasia by way of consented withdrawal of life saving devices. The Court also authorized the use of Advanced Medical Directive or ‘living will’ which gave the right to such affected individuals to decide when to pull the plug on their never-ending torment.
Euthanasia is the concept of mercy killing, which was coined by the Greek, meaning a good death. This is different from suicide as suicide is an act of cowardice and escape from the realities and responsibilities of life whereas euthanasia is the consented, voluntary death granted to individuals who have terminal illnesses or are in permanent vegetative states. This is a release from the constant pain and torment an individual endures due to their terminal illnesses. Euthanasia is broadly divided into active and passive euthanasia; passive euthanasia is where the patients are allowed to die peacefully without any medical intervention to prolong their life unnaturally but active euthanasia is where some external methods are used to hasten a person to their deaths. In the legal context, the written law laid down by the Parliament directly outlaws and criminalizes the act of euthanasia by way of Sections 305, 306 and 309 of the Indian Penal Code which are penal provisions for the abetment of suicide and attempt to commit suicide.
The Indian Judiciary, on the other hand have had conflicting views regarding the legalization of Euthanasia. But, as can be seen by a bare perusal of the various judgements passed by the Indian Courts, the Courts have mostly been in favour of passive euthanasia and the concept of living will or Advanced Medical Directive. Inference can be drawn from the judgements that euthanasia is an extremely tricky and sensitive issue where if it is completely legalized, it can be used and interpreted by people to kill off terminally ill patients with ulterior motives. Therefore, stringent regulations and strict monitoring of the procedure should be observed when pulling off euthanasia at the consent and behest of the patients. Even when they are unable to provide their consent, their best interest must be taken into consideration. Thus, the Courts have put in place certain procedures and methods to be observed, in case the need is felt for a person to be euthanized. Even so, the consent of the High Courts will be needed, whereby they will assess the conditions and situations the terminally ill patients are in, as per the directives given by the Supreme Court, and then make a decision whether to allow for euthanasia or not. These will apply until proper legislations are passed by the Parliament regarding the procedures of euthanasia.
- Euthanasia in India (legalservicesindia.com)
- Euthanasia — Indian View | SCC Blog (scconline.com)
- Gian Kaur vs The State Of Punjab on 21 March, 1996 (indiankanoon.org)
- Aruna Ramchandra Shanbaug vs Union Of India & Ors on 7 March, 2011 (indiankanoon.org)
- Common Cause (A Regd. Society) vs Union Of India on 9 March, 2018 (indiankanoon.org)
- Is euthanasia legal in India – iPleaders
- Legality Of Passive Euthanasia In India: Right To Die With Dignity (bnblegal.com)