Knowledge Nugget: Euthanasia and Living Will — What UPSC aspirants must know

Key takeaways:

1. Euthanasia refers to the practice of an individual deliberately ending their life, oftentimes to get relief from an incurable condition, or intolerable pain and suffering. Euthanasia, which can be administered only by a physician, can be either ‘active’ or ‘passive’.

2. The distinction between ‘active’ and ‘passive’ euthanasia has been made by the Supreme Court in Aruna Ramchandra Shanbaug vs Union of India & Ors. In 2011, the SC recognised passive euthanasia for Aruna Shanbaug, a nurse who had been sexually assaulted in Mumbai in 1973, and had been in a vegetative state since then. This was the first time passive euthanasia was allowed in India.

3. The court, while ruling out passive euthanasia in this case, held that Shanbaug was still alive as she did not require life support. However, the court recognised the legality of passive euthanasia, though it clarified that this could only be done with the approval of a High Court.

4. In 2018, the top court recognised the legality of “passive euthanasia” for terminally ill patients, reiterating that the “right to die with dignity” was an aspect of the right to life under Article 21 of the Constitution of India.

5. A five-judge Bench led by then Chief Justice of India Dipak Misra had laid down detailed guidelines for passive euthanasia, both in cases where the patient left an “advance directive” or “living will” stating that life support should be withdrawn if they slipped into terminal illness, and where no such directive was left behind.

6. In January 2023, another five-judge Bench modified the court’s 2018 order to make the process of withdrawal of treatment for terminally ill patients less stringent and more workable. The changes included the introduction of timelines for each board to make its decision, and limiting the role of the judicial magistrate in the process.

7. Last year, Justice M S Sonak, who serves on the Goa Bench of the Bombay High Court, became the first person in Goa to register a “living will” – an advance medical directive for his family for when he cannot make his own decisions.

8. Just like wills on how one’s property is to be distributed, living wills are written documents made by a person of age 18 years or older with decision-making capacity, expressing their will on how they would wish to be treated if they lose such capacity.

9. The document should detail at least two surrogate decision-makers — anyone whom the person trusts, from family to neighbours, who can make decisions on behalf of the person if they lose decision-making capacity. The document becomes legal when it is signed in the presence of an executor and two witnesses, and attested before a notary or gazetted officer.

10. In August 2024, the Ministry of Health and Family Welfare issued draft guidelines (similar to the SC’s guidelines) on the withdrawal of medical support for terminally ill patients. The guidelines provide a pathway for state governments and hospitals to put in place key mechanisms required by the Supreme Court’s order. These include:

• Setting up of Primary and Secondary Medical Boards at the level of the hospital, which will determine when further medical treatment may not be beneficial to a terminally ill patient;
• Nomination of doctors by the district Chief Medical Officer or equivalent to hospital-level Secondary Medical Boards, which will confirm or reject the opinion of the Primary Medical Boards.

BEYOND THE NUGGET: Assisted dying in other countries

1. The UK’s Terminally Ill Adults (End of Life) Bill, 2024, only allows those above 18 years of age who are terminally ill to opt for assisted death. It explicitly excludes persons with disabilities and mental disorders, requires the patient to receive permission from a High Court judge, and has multiple “periods of reflection” during which an individual can change her mind. The law also requires a person to be a resident of the UK for at least 12 months before filing an application.

2. Active euthanasia is banned in Switzerland. However, assisted dying and assisted suicide are legal as long as the person ends their life without any “external assistance” and those who help them do not have “any self-serving motive”. The country’s laws on assisted dying and assisted suicide have made it a preferred destination for “death tourism,” wherein people come there to end their lives.

3. In the Netherlands, euthanasia and assisted suicide are legal if someone makes a voluntary request, and the condition is assessed by doctors. Every person who requests assisted dying is assessed by two doctors – the second checking the evaluation made by the first.

Post Read Question

Consider the following statements:

1. In India, active euthanasia was legalised in India in 2018.

2. The Supreme Court provided for the living wills in case of euthanasia for a person of age 21 years or older.

Which of the above-mentioned statements is/are correct?

(a) 1 only

(b) 2 only

(c) Both 1 and 2

(d) Neither 1 nor 2

(Sources: ‘Can’t keep him like this for all time to come’: SC to speak with parents of man before deciding on passive euthanasia plea, Euthanasia, Debate around assisted death: Should individuals have a right to die?)

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