Euthanasia: Law needed

Aruna Shanbaug passed away in peace after remaining in a vegetative state for almost 42 years. She slipped into a persistent vegetative state (PVS) after being strangulated and sodomised by a cleaner of the KEM Hospital in Mumbai on November 27, 1973. She remained in that state till she breathed her last on 18 May, 2015.

In her untold suffering, she became the face of an interminable debate on euthanasia in India. It was in her case, Aruna Ramchandra Shaun-baug v. Union of India (March 7, 2011), that the apex court dwelt on the issue at length, and allowed passive euthanasia (withdrawal of life support) with the permission of the high court concerned.

Permission can be given on the request of the patient if s/he is in a position to give consent, or if the patient is in a PVS, the consent of the next of kin or friend is required. The high court will then appoint a committee of doctors to give its recommendation and grant permission after examining all facts.

However, in the instant case, the Supreme Court declined to allow the petition for passive euthanasia for Aruna who had been in a PVS for over 37 years then, as the staff members of the KEM Hospital looking after her fondly, a rarity in the present world, opposed termination of her life. Thus, she left behind a great legacy to the Indian medico-legal jurisprudence.

The issue is intractable, defying any acceptable solution as miracles do take place. There are instances galore when patients comatose for years or even decades have bounced back into consciousness. In February 2010, a scientific study gave a startling result when a man in a deeply unconscious state for five years was able to communicate with doctors using his thoughts. According to scientists, it is a “game changer” for care of vegetative-state patients.

In 1996, in Gian Kaur v State of Punjab, the Supreme Court was seized of the issue of criminalisation of attempted suicide. In this case, the court also grappled with the problem of vegetative illness but held that euthanasia and assisted suicide were not lawful in India.
Justice J S Verma, on behalf of five judges, recorded: “This category of cases may fall
within the ambit of the ‘right to die’ with dignity as part of right to live with dignity, when death due to termination of natural life is certain and imminent and the process of natural death has commenced.

These are not cases of extinguishing life but only of accelerating conclusion of the process of natural death which has already commenced. The debate even in such cases to permit physician assisted termination of life is inconclusive.”

The reasoning was similar in a case in Canada where the appellant was inching towards death from a progressive and incurable disease of the motor neurons and had made a public declaration that she should be entitled to assistance in ending her life if her condition became unbearable.

In Aruna’s case, the Supreme Court observed that criminalisation of suicide was “anachronistic”, and recommended to parliament to delete Sec 309 of the IPC which makes the attempt to commit suicide a crime. The parliament is yet to take a call on it.

However, another bench of the Supreme Court has expressed doubts over the law laid down in Aruna’s case with respect to passive euthanasia and even questioned the wisdom of leaving it up to parliament to decide on euthanasia. The court referred it to a larger constitutional bench where the matter is pending.

‘Good death’

“Euthanasia” is a Greek term which means “good death”. But there is no unanimity over what is a good death. The debate acquired a new dimension when the Netherlands became the first country in the world to enact a law in 1984 legalising physician-assisted suicide and voluntary active euthanasia.

This move has attracted severe criticism with critics alleging that it has led to many dire consequences including a breakdown of trust in the medical profession. Belgium was the next to legalise euthanasia, in 2002. Switzerland allows suicide assisted by doctors and those with medical training, though euthanasia is not legal.

Section 306 of the IPC makes the abetment to suicide a criminal offence punishable with imprisonment for a term which may extend to 10 years, and is also liable to a fine. So, voluntary active euthanasia or physician-assisted suicide is not permissible under the IPC.
Euthanasia is the act of a physician or other third party ending a patient's life to relieve him/her from severe pain and suffering. Voluntary euthanasia refers to the action taken by the physician and the patient, who both agree with the informed consent of the patient to end his/her life.

The Supreme Court has given divergent views on the issue in different cases. However, it is high time parliament deliberates on it seriously and comes out with a comprehensive law so that there is no scope of its misuse. If parliament fails to do it, the constitution bench of the Apex Court should dwell upon it and lay down the law.