Euthanasia and the burden of choice

Legal provisions vary by country and are entangled with deeply ethical and emotional dilemmas.

Harish Rana, who suffered an irreparable brain injury from a fall, remained unresponsive for over a decade, while his parents hoped against hope, exhausting all their earnings. When petitioned, a Supreme Court bench headed by Justices J B Pardiwala and K V Viswanathan allowed doctors to withdraw clinically assisted nutrition and hydration, which was being pursued, under a carefully structured palliative care plan.

Justice Pardiwala is said to have broken down while observing that “passive euthanasia” itself is an outdated expression; the more accurate phrase is “withdrawing or withholding medical treatment”.

In 1973, Aruna Shanbaug, a nurse in Mumbai, was sexually assaulted and strangled by a hospital wardboy. Oxygen deprivation in the brain left her in a vegetative state. She remained alive for 42 years without the judiciary intervening, despite being petitioned.

In 2018, a five-judge Supreme Court bench, in a separate case, held that the right to die with dignity is a fundamental right. The Court held that an individual’s right to execute advanced medical directives is an assertion of the right to bodily integrity and self-determination, and does not depend on any recognition or legislation by the State.

The parents of Karen Ann Quinlan, a 21-year-old American in a persistent vegetative state, asked her doctors to remove the respirator and let her die with dignity.

The request conflicted with medical ethics and challenged who had the right to decide when to end medical care. A court held that Karen had the constitutional right to refuse medical treatment since she had no reasonable possibility of recovery.

It ruled that her right to privacy, which afforded her the power to make that decision, could be exercised by her guardian and family on her behalf. Karen, despite being disconnected from the ventilator, continued to breathe for another nine years, finally dying in 1985.

While countries such as the United States and India are struggling with the idea of passive euthanasia, Europe has taken a major lead with active euthanasia.

The difference between the two is that in the latter, life is snuffed out medically, with drugs that stop the functioning of the heart. A stark case in 2024 involves Zoraya ter Beek, a Dutch woman who received approval for assisted dying due to mental suffering.

The final approval was granted under the Termination of Life on Request and Assisted Suicide Act, passed in the Netherlands in 2002.

Ter Beek cited chronic depression, anxiety, trauma, and an unspecified personality disorder. She is quoted in The Guardian as saying, “I finished ECT in August 2020, and after a period of accepting there was no more treatment, I applied for assisted dying in December that year. It’s a long and complicated process.

It’s not like you ask for assisted dying on a Monday and you’re dead by Friday. I was on a waiting list for assessment for a long time, because there are so few doctors willing to be involved in assisted dying for people with mental suffering. Then you have to be assessed by a team, have a second opinion about your eligibility, and their decision has to be reviewed by another independent doctor.”

A moral context

Mark van Dongen, a 28-year-old engineer in Bristol, the United Kingdom, was romantically involved with Berlinah Wallace, 45. 

In September 2015, following their split, Wallace threw sulphuric acid on the face of her former partner. Her action was described as driven by jealousy after van Dongen entered a relationship with another woman. 

He is reported to have run onto the street in his underwear, screaming for help until the paramedics arrived.

He was kept at a hospital in Bristol before he asked his father to take him to Belgium, where his family lived.

In Belgium, van Dongen applied for active euthanasia. Following an examination, it was confirmed as a case of “unbearable” physical and psychological suffering, making him eligible
for euthanasia under Belgian law.

The active euthanasia was carried out on January 2, 2017. Consequently, in 2018, a British court upheld Wallace’s acquittal on murder and manslaughter charges.

The Supreme Court of India has now advocated for a legislative framework on passive euthanasia.

Irrespective of the distinction between the active and passive modes,
the question which steers the debate across the world is complex and deeply moral – “Can we take away something that we have no power to give – life?”

The writer is an advocate in the Supreme Court and a former legal advisor to the Government of Karnataka with the rank of minister.

(Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.)