The Supreme Court and Euthanasia

SC and the Modified guidelines for Euthanasia Judgment

From the moment a person is born in a nation like India, He/She is entitled to many rights. The Constitution of India offers all its citizens some basic freedom and such freedoms are guaranteed in the constitution in the form of six broad categories of fundamental rights. These fundamental rights include right to equality, right to freedom of speech and expression, assembly, association or union, movement, residence, and right to practice any profession or occupation, right to freedom of conscience, right to constitutional remedies, right to freedom of education etc. Among such rights is the Right to die with dignity.

Active euthanasia means to intentionally kill the patient by injecting lethal compounds of drugs by medical professionals. Active euthanasia is believed to be ethically unacceptable since it requires an unreasonable purposeful act of killing to meet the patient's desire.

Passive euthanasia on the other hand means letting a terminally ill patient die by simply withholding life-supporting treatment. Passive euthanasia is believed to be more humane.

In march 2018, a constitutional bench of the apex court had recognised the fact that among other fundamental rights, the right to die with dignity shall also be considered a fundamental right. In addition, it has also legalized passive euthanasia which includes withdrawing of life sustaining treatments given to terminally ill patients.

The Supreme Court has further laid down guidelines for such patients to enforce their rights with the help of an advance medical directive.

However the guidelines which were laid down by the Supreme Court were highly cumbersome and complicated.

As per the supreme courts guidelines of 2018, the the advance medical directive had to be signed by executor in the presence of two attesting witnesses and countersigned by jurisdictional judicial magistrate of first class (JMFC), however as per the latest guideline issued by the apex court in January 2023 which eases the passive euthanasia procedure by eliminating the requirement of the advance medical directive being signed by jurisdictional judicial magistrate of first class (JMFC), instead the document shall be attested before a notary or a gazetted officer.

Moreover the recent guidelines issued by the Supreme Court requires the hospitals under such conditions to constitute a primary medical board consisting of the treating physician and at least two subject experts of the concerned specialty with at least five years’ experience, who shall visit the patient in the presence of guardian or close relative and form an opinion preferably within 48 hours of the case being referred to it.

Furthermore it states that a Secondary Medical Board comprising one registered medical practitioner nominated by the Chief Medical Officer of the District and at least two subject experts with at least five years’ experience of the concerned specialty who were not part of the Primary Medical Board shall be constituted by the hospital. The secondary medical board shall also provide its opinion preferably within 48 hours of the case being referred to it.

In the 2018 Supreme Court judgment the hospital was to inform the jurisdictional Collector about the proposal. The jurisdictional Collector would then constitute a Medical Board.

Active Euthanasia and Passive Euthanasia- The Flaw

It is important to note that opinions may vary, and the arguments surrounding this issue are complex and highly subjective. It is essential to approach this topic with sensitivity and respect for differing perspectives.

It is often emphasized that passive euthanasia is a more humane way, however I can advocate the contrary.

Active euthanasia may provide a more humane and compassionate option in cases where passive euthanasia might prolong suffering. Passive euthanasia involves the withholding or withdrawal of life-sustaining treatment, such as removing a feeding tube or ventilator, to allow the person to die naturally. However, this approach may result in prolonged pain and suffering if the individual's condition is not naturally progressing towards death. Active euthanasia, on the other hand, can offer a quicker and more peaceful death, sparing the person unnecessary agony.

Let us consider an example of a patient suffering from stage IV of pancreatic adenocarcinoma. The patient has already undergone multiple surgeries, in addition to multiple rounds of chemotherapy and radiotherapy. Due to the rounds of chemotherapy that the patient has reduced dramatically. He/She is undergoing terrible pain since the last couple of months and is bedridden.

Withdrawing vital life-supporting care in such a case, where the patient is in excruciating agony, and allowing them to slowly pass away would not be helpful; instead, they will just make their anguish worse and prolong their suffering.

One of the most excruciating experiences I can imagine is watching a loved one writhe in agonizing pain as they pass away in an intensive care unit. This is a very different situation than watching a loved one suffer heartbreakingly for hours or even days. The doctors, close family members, medical experts, and most importantly the patient, may go through a dreadful ordeal as a result of this method. In a slightly different circumstance, the patient's pain can be dramatically lessened if medical personnel and doctors take immediate action by injecting the patient with a fatal substance.

In my opinion letting a terminally ill patient die by simply withholding life-supporting treatment can be extremely painful and might take substantial time.

In addition, Active euthanasia allows individuals to exercise their autonomy and have control over their own lives, including the timing and manner of their death. It respects the principle of individual dignity by granting patients the right to make decisions about their own bodies.

Lastly, one must bring into account the legalities, since it may influence if criminal charges are launched against the doctor. Nevertheless I strongly believe that this point cannot be utilized to demonstrate a moral distinction.

It is important to note that these arguments do not dismiss the ethical concerns or potential risks associated with active euthanasia. The decision to legalise any form of euthanasia should be subject to rigorous debate, taking into account multiple perspectives including medical and ethical.