Euthanasia, often referred to as "mercy killing," involves intentionally ending a person's life to relieve suffering.

The subject is highly debated globally, with different countries adopting varied stances. In India, euthanasia is a contentious issue, largely influenced by ethical, moral, and legal considerations.

The Indian context, particularly its legal stance, involves a nuanced understanding of concepts like active and passive euthanasia, physician-assisted suicide, and the role of Living Wills.

This article explores the legal framework, the Supreme Court’s rulings, and the evolving perspectives on euthanasia in India.

Understanding Euthanasia: Active vs Passive

• Active Euthanasia: This refers to the deliberate intervention, such as administering a lethal injection, to end a terminally ill patient's life. Active euthanasia is illegal in India and is viewed as equivalent to committing suicide under the Indian Penal Code (IPC).
• Passive Euthanasia: In contrast, passive euthanasia involves withdrawing or withholding medical treatment necessary for the survival of a terminally ill patient, allowing them to die naturally. Passive euthanasia has gained limited legal acceptance in India under strict guidelines and specific conditions.

Legal Milestones In Euthanasia In India

• 2002 Aruna Shanbaug Case: One of the landmark cases that brought the euthanasia debate into the public domain was that of Aruna Shanbaug, a nurse who remained in a vegetative state for over four decades. In 2011, the Supreme Court allowed passive euthanasia under specific guidelines. This judgement laid the groundwork for subsequent legal developments and allowed withdrawal of life support systems for terminally ill patients under judicial oversight.
• 2018 Supreme Court Judgement: A significant turning point in India’s legal stance on euthanasia came in 2018. A five-judge Constitution bench of the Supreme Court legalised passive euthanasia and recognised the validity of a "Living Will." The ruling allowed terminally ill patients or those in a permanent vegetative state to make an advance medical directive, specifying their choice to withdraw medical treatment if they reach a point where recovery is not possible.

Role Of The Indian Penal Code & The Indian Constitution

• Indian Penal Code (IPC): Under the IPC, active euthanasia is equated with homicide, punishable under Section 302. Assisting in active euthanasia is considered abetment to suicide, making it a criminal offense. However, passive euthanasia falls into a different category, where withholding or withdrawing medical treatment is permissible under the Supreme Court’s 2018 ruling.
• Constitutional Rights: The Supreme Court’s 2018 decision drew upon Article 21 of the Indian Constitution, which guarantees the "right to life." The Court ruled that this right also includes the right to die with dignity, thus supporting passive euthanasia for terminally ill patients. However, it stressed that strict guidelines must be followed to avoid misuse, including the need for approval from a medical board and a judicial magistrate.

Living Wills: A Crucial Development

• What is a Living Will?: A Living Will is an advance directive where an individual specifies their wish to refuse life-sustaining treatments if they are diagnosed with a terminal illness or enter a permanent vegetative state. This concept is relatively new in India but has become an essential aspect of the debate around euthanasia.
• Supreme Court’s Stance: The Court's acceptance of Living Wills in 2018 allowed terminally ill patients to make informed choices regarding their medical treatment. It provides a legal way for patients to exercise their autonomy and for medical practitioners to act without fear of legal repercussions. However, the process is highly regulated, requiring approval from a medical board and a judicial body.

Ethical & Moral Considerations

• Right to Die vs Right to Life: The debate around euthanasia often revolves around the conflict between the right to die with dignity and the sanctity of life. Proponents argue that terminally ill patients should not be forced to endure prolonged suffering when recovery is impossible. Opponents, however, believe that life should be preserved at all costs and that ending a life, even with consent, sets a dangerous precedent.
• Role of Family Members: In many cases, the wishes of terminally ill patients may differ from those of their families, leading to conflicts. In such situations, the family members’ perspectives become crucial, as they are often the ones petitioning for or against euthanasia. The legal process aims to balance the patient's wishes, the family's concerns, and the broader ethical implications.

The Role Of Medical Practitioners

• Medical Ethics: Medical practitioners play a critical role in implementing passive euthanasia and following Living Wills. They must adhere to strict medical ethics, prioritising the patient’s well-being and informed consent. A treating physician’s opinion is often central to initiating the euthanasia process.
• Formation of Medical Boards: For passive euthanasia, the Supreme Court has mandated the involvement of a medical board consisting of doctors from different specialties to evaluate the patient's condition. This ensures that the decision to withdraw life support is taken based on professional medical advice, thereby reducing the chances of abuse.

Procedure For Implementing Passive Euthanasia

• Step 1: Medical Board Review: A medical board reviews the patient's condition, determining whether they qualify for passive euthanasia based on terminal illness or a permanent vegetative state.
• Step 2: Judicial Approval: The board’s recommendation must be reviewed by a judicial magistrate before proceeding. This is to ensure legal oversight and prevent any misuse of the process.
• Step 3: Execution of Living Will: If a Living Will is in place, the medical board and the judiciary ensure that the directive is respected, allowing for the withdrawal of life support as specified.

Assisted Suicide: A Different Aspect of Euthanasia

• Physician-Assisted Suicide (PAS): PAS involves a doctor providing a terminally ill patient with the means to end their own life, such as a lethal drug. Unlike passive euthanasia, PAS requires active intervention, making it illegal under Indian law.
• Global Context: While some countries have legalised PAS, India maintains a strict stance against it, viewing it as a form of suicide. The Indian legal system emphasises the importance of providing palliative care and pain management for terminally ill patients rather than ending life.

Euthanasia & Indian Society

• Cultural Attitudes: In Indian society, the concepts of life and death are often viewed through the lens of religion and spirituality. These beliefs play a significant role in shaping attitudes toward euthanasia. The idea of withdrawing life support, leading to a patient's death, is often met with resistance from both the public and certain religious communities.
• Awareness and Education: There is a need for greater public awareness regarding the legal aspects of passive euthanasia and Living Wills. Many people, including medical professionals and family members, remain unaware of the legal framework, which can result in unnecessary suffering for terminally ill patients.

Key Legal Provisions & Acts

• Indian Succession Act: While primarily concerned with inheritance laws, the Indian Succession Act also touches upon the rights of patients and the execution of advance medical directives.
• Hindu Succession Act: This Act comes into play in cases where the deceased has left behind an inheritance. It often overlaps with the legal proceedings in cases of passive euthanasia, especially when disputes arise among legal heirs regarding the patient’s wishes.

Practical Challenges In Implementing Euthanasia Laws

• Bureaucratic Delays: One of the significant challenges in implementing euthanasia laws is the bureaucratic process. Approval from multiple bodies, including medical boards and judicial magistrates, can lead to delays, prolonging the suffering of terminally ill patients.
• Legal Complexity: The legal complexity involved in obtaining approval for passive euthanasia often discourages patients and their families from pursuing it. Simplifying the legal process while ensuring robust checks and balances could provide a more humane solution.

The Bottom Line: How Yellow Can Help

Euthanasia in India remains a complex issue, influenced by legal, ethical, and social considerations.

While the Supreme Court has taken significant steps toward recognising passive euthanasia and Living Wills, the journey toward broader acceptance continues.

The balance between a patient’s right to die with dignity and the sanctity of life remains delicate.

By focusing on creating a clear legal framework and fostering greater societal understanding, India can ensure that terminally ill patients receive the care, compassion, and dignity they deserve.

If you or a loved one is considering making a Living Will, Yellow can help. Our experts have more than 50 years of experience and can help you draft all legal estate planning documents, including health care advance directives.