In India, passive euthanasia is legal under strict guidelines, while the U.K. bill permitting physician-assisted dying highlights global ethical debates, offering a comparative perspective on end-of-life care and medical intervention.

About Euthanasia

• Euthanasia is defined as “mercy killing” provided to a patient suffering from an incurable illness and unbearable pain.
• Active Euthanasia: Active euthanasia occurs when a doctor deliberately administers a lethal substance to end a patient’s life. 
  • In India, this practice is not legally permitted.
• Passive Euthanasia: Passive euthanasia involves withdrawing life-support measures, such as ventilators or feeding tubes, allowing the patient to die naturally. 
  • In India, this is legally allowed under specific conditions.

India’s Legal Journey With Respect To Euthanasia

• Aruna Shanbaug Case, 2011: This case involved a nurse who was in a permanent vegetative state for 42 years following a brutal attack. The Supreme Court ruled in favour of allowing Passive Euthanasia for her, recognizing the concept for the first time in India. 
  • It stipulated that life support could be withdrawn in exceptional cases with High Court permission.
• Common Cause Case, 2018: The Supreme Court declared that the Right to Die with Dignity is a Fundamental Right protected under Article 21. This judgment formally introduced the concept of the Living Will.
  • Living Will: This is a document written by a mentally competent person in advance, detailing their wishes regarding life support if they fall into a coma or similar state.
  • The procedure required two medical boards to be formed, and the Living Will had to be attested by a judicial magistrate.
• 2023 Update: The Supreme Court subsequently eased the procedure, stating that attestation by a judicial magistrate is no longer mandatory; simple attestation by a notary would suffice.

Challenges in Implementation

• Impracticality: The legal process for executing Passive Euthanasia remains highly difficult for the common person due to lack of awareness and complexity.
• Cruelty: The requirement for two medical boards and judicial oversight makes the process lengthy, which causes undue tension and cruelty to the patient and family.
• Doctor Hesitation: Doctors fear legal action due to the strict legal procedures, which leads to them taking more informal decisions (like advising families to remove ventilators) rather than following the formal legal route.
• Poor Infrastructure: India’s health infrastructure is generally weak, and palliative care options are insufficient, contrasting sharply with countries like the UK.
• Risk of Coercion: Vulnerable groups (elderly or differently-abled) face the risk of emotional blackmail, turning their “Right to Choose” into a “Duty to Die.”

Way Forward

• Digital Living Will: The Living Will should be digitally stored and verifiable using biometrics or Aadhaar, eliminating the need for complex notarisation processes.
• Ethics Committee: Replace the cumbersome requirement for two medical boards with a Hospital Ethics Committee. 
  • This committee should include senior doctors, a palliative doctor, and a neutral third party, and they would be responsible for making the final decision.
• Independent Audit: Instead of an ombudsman system, use Independent Medical Auditors to periodically audit cases where Passive Euthanasia was performed to ensure no wrongdoing occurred.
• Mandatory Safeguards:
  • A 7-day Cooling-Off Period must be enforced after the decision to allow the reversal of the decision if needed.
  • Proper psychological counselling for the patient and family.
  • Prioritise and exhaust all available palliative care options before proceeding with euthanasia.
• Training and Awareness: Medical education must integrate training on end-of-life care, including ethical and legal components.

Conclusion

Public awareness and education are crucial to normalize discussions on advance care planning; without trust and understanding, even the most well-intentioned laws cannot achieve their purpose.

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