The Supreme Court’s long-awaited passive euthanasia ruling has moved India to the select group of nations where a more sensible approach to the problem is now possible, but it will not end the ethical debate on its desirability. After hearing the arguments by Common Cause, an NGO, four SC judges, in separate rulings, largely agreed with each other in the voluminous 538-page report. While this judgment doesn’t become a law till Parliament passes a bill in line with the court ruling, the boundaries have been set. Given the legal status of regulations worldwide and the opinion of medical and legal experts in the country, the court couldn’t have gone any further. The judges have set two key conditions. One, passive euthanasia (withdrawal of life support system from terminally-ill patients) is allowed, not active euthanasia (where a doctor is allowed to end a patient’s life through an overdose of medicine). Second, a person is allowed to draft a “living will” specifying he/she not be put on life support system in case of an incurable coma in future.
The judges quoted poets, philosophers and legal experts as well as past court rulings worldwide while delivering their verdict. The Chief Justice quoted Tennyson at the beginning: “There comes a phase in life when the spring of life is frozen, the rain of circulation becomes dry, the movement of body becomes motionless, the rainbow of life becomes colourless and the word life, which one calls a dance in space and time, becomes still and blurred and the inevitable death comes near.” Central to the ruling is the fact that “life sans dignity is an unacceptable defeat”, and it seeks to restore to those dying in great pain the palliative of passive euthanasia.
Justice Chandrachud took the insight a step further when he wrote: “The right not to accept medical treatment is essential to liberty. Medical treatment cannot be thrust upon an individual, however, it may have been conceived in the interest of the individual.”
However, active euthanasia doesn’t find favour as “there can be abuse by beneficiaries who desire the patient’s heart should stop so his property is inherited. The treating physicians are also scared of collusion that may invite the wrath of criminal law as well as social stigma.” The court didn’t equate the “right to live” guaranteed by Article 21 of the Constitution, with the “right to die”. Terminally-ill patients or those with deteriorating health should be able to execute “a document titled My Living Will and attorney authorisation” which can be presented to the hospital for appropriate action if the executant is admitted to hospital with serious illness “which may threaten termination of the life of the executant”.
The lead judgement by the Chief Justice goes into a lot of detail on advance medical directives. “There have to be safeguards”, enumerated as follows: “The advance directive can be executed only by an adult who is of a sound and healthy state of mind... must be voluntarily executed and without any coercion... should clearly indicate the decision relating to the circumstances in which withholding or withdrawal of medical treatment can be resorted to... should specify the name of a guardian or close relative who, in the event of the executor becoming incapable of taking a decision at the relevant time, will be authorised to give consent to refuse or withdraw medical treatment in a manner consistent with the advance directive... The document should be signed by the executor in the presence of two attesting witnesses, preferably independent.”
Another issue is the affordability of keeping people alive through advanced medical technology. Justice A.K. Sikri said while a majority of patients have little chance of recovery, “because of rampant poverty, where a majority of people aren’t able to afford health services, should they be forced to spend on medical treatment beyond their means and in the process compelling them to sell their house property, household things and other assets, which may be a means of livelihood?” There’s another problem with the new formulation. It can’t deal with state-sponsored violence and death. By making any form of suicide or abetment to suicide or any form of active euthanasia illegal and punishable by law, it largely equates suicide with murder. It doesn’t question the State’s monopoly to inflict death, either in war or in suppressing violent and militant movements. Suicide is death inflicted on oneself, unlike murder, but remains outside what is permitted by law. The State is the only body that has the right to inflict death on others.
