From 'passive euthanasia' to 'living will': When India is playing with words, others take solid steps

It has been six years since the Supreme Court of India legalised passive euthanasia as a legitimate option to end lives. However, it is still dilly-dallying between the legal implications of granting a man "death". Ironically, suicide is a crime in the eyes of law, and so is granting death when a person is in a vegetative state. Doesnt't that inadvertantly take away from us the right to live? Don't get us wrong when we say that. But just imagine leading a life in a permanent vegetative state in India, a country which is still grappling with a stunted healthcare system, unable to cope up with even curable diseases. As far as the constitution goes, it also grants us a dignified and decent death. And a permanent vegetative state is nothing close to it.

The only hope that Indians, who have been experiencing such a difficult situation with one of their relatives, had was the concept of "living will" wherein patients could write down their will to be euthanised should a situation calls for choosing between living in a permanent vegetative state and being dead. 

The concept of 'living will'

Rather complicated, the concept allows a person to decide his death or removal of life support in case of an irrversible coma. It is a document prepared by a person in healthy mind, specifying that if in future , if he or she slides into a vegetative state because of an irreversible terminal illness then the existence should not be prolonged with the help of life support systems or other medical interventions.

This concept, in fact, spares an agonising decision by the relatives of the patient when they face a decision-making situation. However, on the flip side, the doctors in this case are guided solely by the "living will". Naturally, for a relative to pull the plug on a loved one in an irreversible condition is a very difficult decision, but not doing so will prolong the pain for the patient.

According to a report by the Times of India, appearing for petitioner NGO 'Common Cause', advicate Prashant Bhushan reportedly said, "Whether to take medicines is part of the choice under Article 21 guaranteeing right to life. Right to life includes right to refuse medical intervention when a board of doctors certifies that the person would not live without life support system. I am in favour of active euthanasia too. But living will is a corollary to passive euthanasia."

Passive euthanasia versus living will: The debate

While the Centre had already accepted the SC ruling in the Aruna Shanbaug case in March 11, 2011, both are hesitant to act upon the "living will" without judging the pros and the cons. The SC had said then that a specific category of relatives could move HC to seek permission for passive euthanasia, which also means withdrawal of life support system from a person in a permanent vegetative state. The SC had said that the request will be considered by the HC only if it has been approved by a board of medical experts. 

Narsimha, however, argues, "Living will may not be a good policy since there is constant advancement in medical science and who knows what a person thought today was incurable, could be easily manageable in the distant future." The court also suggested that it needed to consider the possibility of coersion or fraud by greedy relatives.

The easy way out

Some patients and relatives play with the regulations tactfully. For instance, there have been cases where doctors showed no hope of survival and the relatives took back the patient, thus administering passive euthanasia.

And justifying this move is the bench of Chief justices Dipak Misra and A K Sikri, A M Khanwilkar, D Y Chandrachud and Ashok Bhushan. The bench said, "There is no law that prevents a relative from taking discharge of a patient." It further added, "To die peacefully without suffering is a right under Article 21. But one can not commit suicide. However, one has a right to say while dying let me not suffer."

Countries that have legalised euthanasia

The issue is, why do we have to find a way out to decide on our deaths when the easiest way could be the government giving full permission for euthanasia. At least eight countries are said to have legalised the practice of either Euthanasia or physician-assisted suicide (PAS). These are Belgium, Canada, Columbia, Finland, Germany, Luxembourg, The Netherlands, Switzerland. 

Active euthanasia allows a doctor to administer overdose of medication that can end a patient's life, suffering from a terminal disease. Deliberately aiding or encouraging a person to commit suicide would also be considered as assisted suicide. There have been cases in these countries where the doctors have obtained powerful sedatives in large quantities with full awareness that these would be used for committing suicide. 

According to data published by , 54% of medical practitioners in the world support euthanasia. 86% of public support euthanasia for the terminally ill / on life support. It is rather heart-rendering to find that avoidable cases of suffering accounted for 55%. 

• india
• supreme court
• euthanasia
• suicide
• illness
• disease
• living will