Euthanasia in the simplest sense involves intentionally ending a person's life to relieve ongoing suffering such as suffering from an irrecoverable or an incurable state of being and is a complex and evolving issue in the Indian landscape. While death with dignity is not only a legal issue but simultaneously a cultural and spiritual issue as well, a country secular as India possesses...
Euthanasia in the simplest sense involves intentionally ending a person's life to relieve ongoing suffering such as suffering from an irrecoverable or an incurable state of being and is a complex and evolving issue in the Indian landscape. While death with dignity is not only a legal issue but simultaneously a cultural and spiritual issue as well, a country secular as India possesses a different perspective on Euthanasia depending on religion and societal viewpoint.
Forms of Euthanasia
Euthanasia or otherwise known as mercy killing can be categorized primarily into two categories, namely - Active Euthanasia and Passive Euthanasia. Active euthanasia involves intentionally causing the death of a patient through direct action, typically through administration of a lethal substance or intervention. On the other hand, Passive euthanasia involves withholding or withdrawing medical treatment necessary for the continuation of life for a terminally ill or severely incapacitated patient. This is achieved through means of withholding treatment that would prolong life such as ventilators, antibiotics, or artificial nutrition and hydration. Passive euthanasia highlights the importance of informed decision-making, and compassionate care for terminally ill patients.
Euthanasia in the Indian Legal Landscape
Euthanasia in the Indian legal landscape has evolved over the years, shaped by judicial interpretations and legislative guidelines. In pre-independent India, voluntary euthanasia has been in practice for several decades in several communities especially when their illness forces them to be unproductive and make them feel like they are a burden to others in society. While there did not exist any particular law that exclusively mentioned 'Euthanasia' in the post-independent India, the right to life and to live with dignity was included through means of the Constitution of India, 1950, Article 21 states that, “No person shall be deprived of his life or personal liberty except according to procedure established by law.”
An important question that needed to be answered was whether this right to live also included the right not to live, i.e. the right to die. This question has been debated time and again through various judgments that have now resulted in the current framework.
In the case of Maruti Shripat Dubal vs State of Maharashtra (1987 Cri Lj 743), the Bombay High Court struck down Section 309 of IPC,1860 stating that the same was violative of Articles 14, 19 and 21 of the Indian Constitution. Subsequently in the case of P. Rathinam vs Union of India(MANU/SC/0433/1994), the Supreme Court had similarly struck down Section 309 of IPC, 1860 considering the same to be ultra vires of Articles 14 and 21. But however, in the case Gian Kaur vs State of Punjab (AIR 1996 SC 1257), the Supreme Court had reversed its judgment and held that Section 309 of IPC,1860 is constitutionally valid. The Supreme Court of India addressed the issue of euthanasia in the matter where the petitioners argued that the right to die should be considered a fundamental right under Article 21 (right to life and personal liberty) of the Constitution. The Supreme Court held that Article 21 does not include the right to die, and therefore euthanasia was not permissible under Indian law.
In recent times, the most elaborate debate on euthanasia stemmed from Aruna Ramachandra Shanbaug vs Union of India, where Aruna Shanbaug, a nurse who had been in a vegetative state for decades, became a central figure in the debate on euthanasia. The Supreme Court was asked to consider passive euthanasia. The Supreme Court ruled that passive euthanasia (withholding life support) could be permitted under certain conditions, but it required judicial approval. Although the Petition was dismissed, the judgment marked a significant shift towards allowing a form of euthanasia under strict guidelines.
Subsequently, in the Supreme Court Ruling in Common Cause v. Union of India (2018), the Supreme Court of India upheld the right to die with dignity and allowed passive euthanasia. It also recognized the validity of "living wills" or advance directives, giving individuals the right to refuse medical treatment in cases of terminal illness. This judgment was a progressive step, legalizing passive euthanasia under specific guidelines and requiring the appointment of a legal guardian and judicial oversight. This judgment was further clarified in Indian Society of Critical Cause vs Union of India (2023 LiveLaw (SC) 79), where specific directives were laid down.
Proposed Bills and Enactments surrounding Euthanasia
There were several bills introduced in the Parliament over the course of the past decade aiming to legalize euthanasia, and one such was the Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2016 where the bill aimed to regulate euthanasia and advanced directives such as living wills. This bill also makes provision for patients of sound mind to make an informed decision regarding withholding of medical treatment for themselves, ie. passive euthanasia and the bill as such is still pending before the Indian Parliament.
The primary difference between suicide and euthanasia is that while suicide is the act of deliberately ending one's own life, the actions are also carried out by the same individual, thereby the former does not fall under the purview of the latter. On the other hand, in passive euthanasia, withholding life supporting treatment due to the patient's prolonged illness that reduces the quality of life results in the death subsequent to the prolonged illness. In India, Suicide was criminalized under Section 309 of IPC with intent to reduce its attempts, however in the present times the significance of mental health is better understood. The criminalization of suicide or attempt to suicide punishes the individuals when they are vulnerable and distressed.
Similarly, in the context of the Bharatiya Nyaya Sanhita (BNS) Act, 2023, which replaced the Indian Penal Code (IPC) of 1860, the provisions regarding suicide have been updated. BNS Act, 2023 repeals Section 309 of the IPC, which criminalized the attempt to suicide. The new legal framework decriminalizes attempted suicide, reflecting a shift towards treating it as a mental health issue rather than a criminal act. Although attempt to suicide has been decriminalized, abetment to suicide still persists. Section 108 of the Act, states that, “If any person commits suicide, whoever abets the commission of such suicide, shall be punished with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine.”
This change aligns with the evolving global perspective on mental health and acknowledges the need for support and rehabilitation rather than punishment. The Bharatiya Nyaya Sanhita (BNS) Act of 2023 in India has significant implications for both suicide laws and indirectly affects the discourse around euthanasia. Regarding euthanasia, while the BNS Act itself does not directly address euthanasia provisions, the broader legal context and evolving attitudes towards individual autonomy and medical decision-making are pertinent. The decriminalization of suicide attempts under the BNS Act aligns with evolving perspectives on personal autonomy and the right to self-determination, principles that are also central to discussions surrounding euthanasia.
In conclusion, the evolving legislative landscape in India reflects a nuanced approach towards issues of euthanasia and suicide. The decriminalization of suicide attempts under the Bharatiya Nyaya Sanhita (BNS) Act of 2023 marks a significant shift towards recognizing mental health challenges and promoting supportive interventions rather than punitive measures. However, the complexities surrounding euthanasia persist, with passive euthanasia being legalized under stringent guidelines while active euthanasia remains prohibited. The Supreme Court through means of its repeated judicial decisions, have taken due consideration of the ailing individuals that seek to opt for euthanasia and has framed necessary guidelines, to ensure that the same is not mis-used. Thus, while not directly addressing euthanasia, the BNS Act reflects a legal environment that is gradually evolving towards more compassionate and patient-centric approaches to sensitive issues concerning life and death. Overall, the legal history of euthanasia in India demonstrates a gradual shift towards accepting certain forms of end-of-life decisions while maintaining strict regulatory measures to ensure ethical practices.
The author is an Advocate at Madras High Court. Views are personal.