Supreme Court on Dignified End of Life

by- Piyoosh Rautela

In response to the resounding echoes of the Supreme Court‘s stance on a dignified end of life or an individual’s right to choose the end of her life, the Government of Haryana has taken a bold step forward.

Recent directives from the state empower terminally ill individuals, devoid of hope for recovery, to exercise their right to a dignified death by outlining advance directives for the same.

In a global landscape where the endorsement of an individual’s right to control the timing and manner of her own death remains a contentious issue, Haryana‘s progressive move prompts a closer examination of the legal landscape surrounding euthanasia in our nation.

This article endeavors to unravel the essence of euthanasia, navigating through its ethical intricacies, global perspectives, and the nuanced directives issued by the Government of Haryana.

Dignified End of Life: Euthanasia explored

Euthanasia refers to intentional act of terminating the life of a person so as to relieve her from unbearable suffering as is the case with the patient in terminal stage of a painful illness requesting a physician-assisted death. This ethically charged practice encompasses both active and passive interventions.

Active euthanasia involves a deliberate act to end a person’s life, such as administering a lethal dose of medication, while passive euthanasia involves withholding or withdrawing life-sustaining treatment to facilitate a natural death.

Across cultures and religions, opinions on euthanasia vary, with some societies and nations like The Netherlands and Belgium embracing it as a humane choice while others reject it on moral or religious grounds.

Divergent Voices: Arguments for and Against

Champions of Euthanasia

Asserting Individual Autonomy: Euthanasia advocates, exemplified by organisations like Dignity in Dying, champion the cause as a recognition of personal autonomy in end-of-life decisions. They contend that individuals should possess the autonomy to dictate the timing and manner of their death—an inalienable right that extends to life’s final moments.

Alleviating Unbearable Suffering: In the realm of terminal illnesses, patients often endure relentless pain despite palliative care. Advocates argue that euthanasia serves as a merciful option for those facing excruciating pain with no hope of relief through conventional medical means.

Embarking on Dignified End of Life: The compelling case of Brittany Lauren Maynard (November 19, 1984 – November 1, 2014), an American activist confronting terminal cancer, resonates as a symbol of the euthanasia advocacy movement. Her decision to control the timing of her death and advocate for the legalization of assisted suicide drew international attention, underscoring the quest for a dignified departure.

Empowering for Dignified End of Life: Euthanasia proponents emphasise the opportunity it offers individuals to pass away with dignity, maintaining control over the final chapter of their lives. Advocates argue that this empowerment fosters a compassionate approach to life’s inevitable conclusion, allowing individuals to navigate their end on their terms.

Opponents of Euthanasia

Champions of Life’s Sanctity: Religious leaders from diverse faiths consistently emphasise the sanctity of life as a foundational principle in their opposition to euthanasia. Rooted in moral and spiritual teachings, these leaders argue that deliberately ending life contradicts the sacred nature of existence and runs counter to ethical precepts.

Navigating the Slippery Slope: Skeptics of euthanasia express apprehensions about the potential consequences of its legalization. They caution against a slippery slope, fearing that permitting euthanasia could open the door to non-consensual or involuntary actions in the future. The concern lies in the possibility of a broader societal acceptance of ending life under varied circumstances beyond the initial intentions.

Ethical Dilemmas in Medical Practice: Prominent medical associations, including the esteemed American Medical Association, align in their opposition to physician-assisted suicide. Their stance is grounded in a commitment to ethical standards within the medical profession. Euthanasia, they argue, disrupts the traditional role of healthcare professionals as healers, introducing complex ethical dilemmas that challenge the core principles of medical practice.

The Tapestry of Euthanasia Laws

The case of Dr. Jack Kevorkian, thrust into the limelight in 1998 due to his involvement in the voluntary euthanasia of Thomas Youk, a victim of Lou Gehrig’s disease, unfolded as a global focal point, casting a compelling light on the intricate facets of the euthanasia debate.

On the international stage, the legal status of euthanasia weaves a complex narrative, with nations adopting diverse stances. While some countries welcome euthanasia under specific conditions, others staunchly maintain prohibitions, creating a richly varied legal landscape.

Countries such as the Netherlands (April 1, 2002), Belgium (May 28, 2002), Canada (June 17, 2016), Luxembourg (March 19, 2009), Colombia (December 15, 2014), Spain (June 25, 2021), New Zealand (November 6, 2021), and certain U.S. states have embraced legalised forms of euthanasia. However, the parameters of legalization differ significantly.

In the Netherlands, euthanasia is permitted under stringent conditions, subject to rigorous scrutiny by both medical and legal authorities. Meanwhile, in Switzerland, assisted suicide finds acceptance under specific circumstances, facilitated by organizations such as Dignitas, which extend assistance to individuals seeking this alternative.

From nations with strict regulations to those with more permissive laws or unclear guidelines, the global panorama of euthanasia laws reflects a diverse array of approaches. It underscores the profound ethical complexities inherent in grappling with end-of-life choices on an international scale.

Legal Landscape of in India

The trajectory of the right to end one’s life in India unfolds through landmark judicial decisions that have shaped the legal stance on euthanasia.

The seeds of this legal discourse were sown in the case of P. Rathinam vs. Union of India (1994). Here, a Divisional Bench of the Supreme Court declared Section 309 of the Indian Penal Code, 1860, criminalizing suicide attempts as being unconstitutional. The Bench argued that it violated the Fundamental Rights enshrined under Article 14 and 21 of the Constitution, asserting that the right to die was inherent in the right to live.

However, this stance faced a reversal in the subsequent case of Gian Kaur vs. State of Punjab (1996), where a five-Judge Bench held that the right to live did not encompass the right to die under Article 21.

The legal narrative took a nuanced turn in the case of Aruna Ramachandra Shanbaug vs. Union of India and Ors (2011). The Court, under strict guidelines, allowed for passive euthanasia in exceptional circumstances.

The issue regained prominence with a petition by the civil society organisation, Common Cause. This petition sought a declaration that the right to die with dignity was integral to the right to live with dignity under Article 21 of the Constitution. The plea also urged the state to establish procedures for individuals in deteriorated health or terminally ill to execute advance medical directives or living wills.

This case, initially before a three-Judge Bench, was elevated to a Constitution Bench due to conflicting precedents. Arguments before the Constitution Bench highlighted the inherent autonomy in the right to privacy, the ethical concerns of prolonging suffering in a persistent vegetative state, the interconnection of the right to die with dignity and the right to live with dignity, and the common law right to refuse unwanted medical treatment.

The Constitution Bench reaffirmed the right to die with dignity as a fundamental right, echoing the precedent set in the Gian Kaur case. On the matter of living wills, the Court acknowledged the acceptance of Advance Medical Directives in the country. It emphasised that executing such directives was a crucial step in safeguarding the right to self-determination and bodily integrity. In cases where patients couldn’t express informed decisions, a ‘best-interest’ position could be applied, allowing a guardian to make decisions on their behalf.

This legal odyssey reflects the evolving perspectives within the Indian judiciary, balancing the sanctity of life with individual autonomy in the complex realm of end-of-life decisions.

Haryana Government‘s Framework for Dignified End of Life Choices

In a landscape where unanimity on euthanasia remains elusive, the Haryana Government has taken a noteworthy step by issuing directives that empower individuals, under specific conditions delineated by the Supreme Court, to exercise their right to die with dignity. This marks a significant leap, especially considering the ongoing global discourse on the subject.

Voluntarily Executed Procedure: The procedure mandated by the directives emphasises informed and written consent, free from undue influence or constraint. It explicitly requires articulation of the circumstances under which medical treatment can be withdrawn, ensuring clarity on the decision-making process. The document aims to prevent the prolongation of suffering, pain, and indignity, should the individual’s condition be terminal with no hope of recovery.

Clear and Unambiguous ‘Death with Dignity’ Document: The document, crucial to the process, must unambiguously indicate specific circumstances and instructions for withholding or withdrawing medical treatment. Additionally, it designates a person authorized to give consent in case the executor becomes incapable of deciding. The executor retains the authority to revoke instructions, ensuring ongoing autonomy.

Execution Procedure: Signed by the executor in the presence of two independent witnesses, the document undergoes attestation by a notary or gazetted officer. This ensures a voluntary, coercion-free execution with a comprehensive understanding of the implications. A copy is then handed over to a designated competent officer of the local government, who becomes the custodian of the document.

Giving Effect to the Document: In the event of terminal illness without decision-making capacity, the treating physician, upon awareness of the advance directive, verifies its genuineness using digital health records or consulting the custodian. This verification ensures the authenticity of the directive, paving the way for further proceedings.

Who Can Seek the Procedure: The directives restrict eligibility to mentally sound adults capable of comprehending the consequences of executing the document. This criterion underscores the importance of ensuring that the decision is made by individuals with the capacity for informed consent.

Weight of Instructions on Doctors: For the document to be effective, the treating physician must be fully satisfied about the terminal nature of the illness and the lack of curative possibilities. Only then are they to act upon the instructions, informing the person named in the advance directive about the nature of the illness, available medical care, and the consequences of alternative treatment options.

Procedure for Treatment Withdrawal: In cases where withdrawal of life support is deemed necessary, the nominee, family member, treating doctor, or hospital staff is mandated to seek permission from the High Court through a writ petition under Article 226 of the Constitution.

Medical Board Proceedings: A structured approach involves the constitution of a Primary Medical Board, followed by a Secondary Medical Board, to examine the patient and provide opinions on executing the advance directive. The wishes of the executor, if communicable, are ascertained, and consent is obtained if the executor is incapable of decision-making.

Revocation of Advance Directive and Absence Thereof: The directives allow individuals the freedom to withdraw or alter their advance directive in writing at any time. Clear guidelines are outlined for cases where directives are unclear or ambiguous, ensuring that medical boards make informed decisions. In cases where no advance directive exists, a Primary Medical Board is constituted to evaluate the option of withdrawal or refusal of further medical treatment.

These directives represent a meticulous framework, balancing individual autonomy with ethical considerations, as Haryana pioneers a compassionate approach towards end-of-life decisions.

Balancing Autonomy and Societal Concerns

As we navigate the complex landscape of euthanasia, the road forward beckons a delicate equilibrium, where individual autonomy harmonises with societal considerations. Striking this balance necessitates a thoughtful approach, weaving together education, awareness, policy adjustments, and safeguards that collectively contribute to a nuanced perspective.

Delicate Balance of Autonomy and Societal Concerns: The future trajectory of euthanasia discussions hinges on maintaining a delicate equilibrium. It involves recognising and respecting individual autonomy, allowing individuals agency over their end-of-life decisions, while also considering the broader societal implications. This balance ensures that personal choices align with the values and ethical fabric of the society at large.

Emphasis on Education and Awareness: A pivotal aspect of the way forward is an increased emphasis on educating individuals and communities about end-of-life options, including euthanasia. By fostering awareness, society can engage in informed discussions, demystify misconceptions, and empower individuals to make decisions aligned with their values.

Recommendation for Policy Refinements: The evolving discourse on euthanasia calls for continuous policy refinements. Policymakers must remain attuned to societal sentiments, ethical considerations, and medical advancements to ensure that legislative frameworks are adaptive and reflective of the evolving perspectives on end-of-life choices.

Implementing Safeguards: Crucial to the journey forward is the implementation of robust safeguards that serve as protective mechanisms, preventing potential abuses and ensuring that euthanasia is carried out with utmost care, adhering to ethical standards and legal frameworks. Stringent guidelines and oversight mechanisms contribute to building trust in the system.

Conclusion: Navigating the Intricacies with Compassion

In conclusion, the discourse on euthanasia traverses intricate paths, weaving together the threads of ethics, law, and compassion. It necessitates a collective journey marked by empathy and understanding. By navigating through the complexities surrounding end-of-life choices, society can cultivate an environment that not only acknowledges individual autonomy but also honors human dignity in the face of life’s inevitable conclusion.

As we embark on this collective journey, the challenge lies in fostering a compassionate dialogue that respects diverse perspectives, embraces ethical considerations, and, above all, prioritizes the sanctity of life and the dignity of each individual, even in their final moments.