Knowledge Nugget of the day: Euthanasia

3. In 2011, the SC reconised 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. The court made a distinction between ‘active’ and ‘passive’, and allowed the latter in “certain situations” (Aruna Ramchandra Shanbaug vs Union Of India & Ors). This was the first time passive euthanasia was allowed in India.

4. In 2018, the Supreme Court recognised the legality of ‘passive euthanasia’ for terminally-ill patients, holding that the ‘right to die with dignity’ forms a part of the right to life under Article 21 of the Constitution of India. The court also laid down detailed guidelines for passive euthanasia, both in cases where the patient left an ‘advance directive’ or a ‘living will’ stating that life support should be withdrawn if they fall terminally ill, and in cases where no such directive was left behind.

5. For long there was no dedicated legislation in India on withholding/ withdrawing life-sustaining treatment. However, the Supreme Court’s judgment, and now the draft guidelines published by the Ministry, make it clear that withholding/ withdrawing life-sustaining treatment is legal in India under a defined framework.

6. Withholding or withdrawing life-sustaining treatment refers to discontinuing life-sustaining medical interventions such as ventilators and feeding tubes, etc., when these no longer help the condition of the patient or prolong their suffering.  The withholding or withdrawal of life-sustaining treatment also includes ‘do-not-attempt-resuscitation’ orders.

It is crucial to note that when a do-not-attempt-resuscitation order is in place, every effort should be made to continue treating the underlying condition of the patient. The order is limited to not initiating resuscitation efforts.

7. Life-sustaining treatments are medical treatments that artificially replace bodily functions essential to the life of the person. These interventions are withheld or withdrawn with the intention of providing comfort care, allowing the underlying illness to take its course while providing symptomatic relief.

8. 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.

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BEYOND THE NUGGET: Living Will

1. To enforce the right to die with dignity, the Supreme Court in its 2018 judgment laid down the framework for making advance medical directives or living wills. However, the process was complex, and the court simplified it in its 2023 judgment.

2. 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.

3. 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.

4. 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.

Different countries, different laws

1. Netherlands, Luxembourg, and Belgium allow both euthanasia and assisted suicide for anyone who faces “unbearable suffering” that has no chance of improvement.

2. Switzerland bans euthanasia but allows assisted dying in the presence of a doctor or physician.

3. Canada had announced that euthanasia and assisted dying would be allowed for mentally ill patients by March 2023; however, the decision has been widely criticised, and the move may be delayed.

4. The United States has different laws in different states. euthanasia is allowed in some states like Washington, Oregon, and Montana.

5. The United Kingdom considers it illegal and equivalent to manslaughter. A proposal to legalize assisted dying for terminally ill patients in England and Wales was introduced earlier this month in Britain’s House of Commons which is set to be debated formally in Parliament on November 29.

(Source: The law and the ground realities of passive euthanasia in India, How to ensure dignity for the terminally-ill, The right to die with dignity — SC rulings and what the law says in India, What is a living will, and the new Supreme Court order for simplifying passive euthanasia procedure? )

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