UK House Of Commons has passed a bill legalising assisted dying for terminally ill adults, marking a major shift in end of life legislation.

About Assisted Dying

• Assisted dying refers to the practice where a person, typically suffering from a terminal illness or unbearable suffering, is helped to end their own life, usually with medical assistance. 
• It has two main forms:
  • Assisted Suicide: A doctor provides the means (like prescribed lethal medication), but the patient takes the final action to end their life.
  • Euthanasia: A doctor or medical professional directly administers a substance to end the patient’s life, typically to relieve suffering.
    • Active Euthanasia: Involves direct action to end life (e.g., administering a lethal injection).
    • Passive Euthanasia: Involves withdrawing or withholding life-sustaining treatment (e.g., turning off a ventilator). 

Key Provisions of the UK’s Assisted Dying Bill

• Eligibility Criteria: The bill allows only adults aged 18 or above, mentally competent to apply. 
  • They must be diagnosed with a terminal illness and have a life expectancy of six months or less. 
• Medical Assessments: Two independent doctors must assess the applicant to confirm that the eligibility criteria are met and absence of coercion.
• Oversight Panel: This panel  is responsible for ensuring procedural integrity and safeguards and must approve the application.
• Reflection Period: A mandatory waiting period of 14 days must be observed after the final approval and before the prescription is issued. 
  • This period may be reduced to six days if the applicant’s death is imminent.
• New Criminal Offence: Life imprisonment for administering the drug unlawfully. And 14 years in prison if death is induced through coercion.

Legal Position Of India 

• Active euthanasia (where a person is directly administered a substance to cause death) is not permitted in India and is treated as culpable homicide under Bharatiya Nyaya Sanhita, 2023
• Passive euthanasia (withholding or withdrawing life support) is allowed in limited circumstances, following the Supreme Court’s 2018 judgment in Common Cause v. Union of India.
• Landmark Cases: 
  • Aruna Shanbaug Case Vs Union Of India (2011): The Supreme Court allowed passive euthanasia in principle for patients in permanent vegetative state but required High Court approval on a case-by-case basis. 
    • It was the first recognition of euthanasia in India but limited in scope.
  • Common Cause v. Union of India (2018): The Supreme Court held that the right to die with dignity is part of Article 21. 
    • It legalised passive euthanasia nationwide and recognised the validity of living wills, with detailed safeguards.
    • It permitted the creation of a  living will (advance directive), allowing terminally ill patients to express their wishes regarding end of life decisions.
• In 2023, the Supreme Court modified the guidelines to make the right to die with dignity more accessible, however, active euthnaasia remains illegal due to concerns over misuse.

Global Examples

• Netherlands, Luxembourg and Belgium: These countries allow both Euthanasia and assisted suicide for anyone who faces unbearable suffering and have no chance of improvement.
• Switzerland: It has banned euthanasia but allows assisted dying in the presence of a doctor or a physician.
• Canada: Announced that euthanasia and assisted dying would be allowed for mentally ill patients by March 2023. However, the decision has been widely criticised and the move may be delayed.
• The United States:  USA has different laws in different states. Euthanasia is allowed in some states like Washington, Oregon and Montana.
• France: It has recently approved a similar bill in its national assembly.

Arguments For Euthanasia

• Right to Die with Dignity: Individuals should have the autonomy to choose a dignified end to life, especially when suffering is unbearable.
• Relief from Pain and Suffering: It offers an escape from prolonged physical and mental agony in terminal or irreversible conditions.
• Respect for Autonomy: Allowing euthanasia respects a person’s right to make decisions about their own body and life.
• Avoids Prolonged Vegetative States: It prevents medically futile treatments that only prolong biological existence without consciousness or quality of life.
• Reduces Family and Healthcare Burden: It can ease emotional, financial, and logistical strain on families and overstretched healthcare systems.

Arguments Against Euthanasia

• Sanctity of Life: Life is considered sacred in many cultures and religions, and deliberately ending it is seen as morally wrong.
• Possibility of Misuse: There is a risk of coercion, abuse, or pressure on vulnerable individuals to choose euthanasia.
• Medical Ethics: It conflicts with the Hippocratic Oath and the principle of “do no harm” that doctors pledge to uphold.
• Palliative Care Alternative: Advances in palliative care can manage pain and improve quality of life without ending it.
• Slippery Slope Concern: Legalising euthanasia might lead to broader and unsafe applications, including non-voluntary or involuntary cases.

Ethical Debate in Assisted Dying

• Autonomy vs. Sanctity of Life:  Should individual choice override the belief that life is sacred?
• Relief from Suffering vs. Risk of Abuse : Can ending suffering justify assisted death, or could it lead to exploitation of the vulnerable?
• Medical Ethics vs. Compassionate Care : Should doctors preserve life at all costs, or support dignified dying?
• Right to Die vs. Slippery Slope:  Does legalisation risk expansion to non-voluntary or unethical cases?
• Palliative Care vs. Euthanasia : Can quality palliative care replace the need for assisted dying?

Way Forward

• Need for Broader Discussion: India must address Assisted Dying within the framework of healthcare ethics, legal oversight and cultural sensitivity.
• Strengthen Palliative Care: Expand access to quality palliative and end-of-life care so that euthanasia is not chosen due to lack of alternatives.
• Safeguards and Oversight: Establish independent medical boards, mandatory psychological assessments, and grievance redressal mechanisms to prevent misuse.

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