India's top court recognises the right to die with dignity

Passive euthanasia Arguments for and against the procedure

In a historic decision taken on 9th March 2018, Friday, the Supreme Court had decided on right to die with dignity and said that persons with teminal illness can make "living will" for passive euthanasia.

So far, pulling the plug on a terminally-ill patient posed a grave moral and ethical dilemma to the family as also to the treating doctor and hospital who ran the risk of criminal prosecution for abetting murder.

The long-awaited ruling the matter was passed by a five-judge Constitution bench of the Supreme Court, headed by Chief Justice of India (CJI) Dipak Misra.

A PIL had been filed by NGO Common Cause in 2005 through their counsel Prashant Bhushan seeking certification for passive euthanasia and legal recognition for "living will" in India. The apex court has permitted an individual to draft a "living will" specifying that they not be put on life support if they slip into an incurable coma.

Though it ultimately refused to do so in 2011, it did pass a landmark judgment back then that opened the door for passive euthanasia in the rarest of rare cases. Second is the Durable Power of Attorney for Health Care (DPAHC) or Health Care Proxy and third is the Living Will (LW).

While the Centre was in agreement on the question of allowing passive euthanasia, it opposed the concept of living will.

"Active euthanasia" involves helping a person die on his or her request "through direct action". Many a times doctor can refuse the living will citing medical advancements as a reason giving a person a chance of living a normal life.

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The Press Trust of India news agency said that in each living will, a court-appointed medical panel will review the instructions before they can be carried out.

If the hospital medical board opines on executing the advance directive, another medical board will be set up, which may endorse the its execution if it concurs with the initial decision of the medical board of the hospital. "We may clarify that this economic principle has been applied in a limited sense only as a supporting consideration with the aim to promote efficiency". The living will allows a person to outline whether or not s/he wants his or her life to be artificially prolonged in the event of a devastating illness or injury. Also, it is important to make sure that the legal procedures connected are as friendly as possible.

Stating that active euthanasia - when death is brought about by an act - was not allowed in the country, Ms Virani said, "Passive euthanasia is allowed when a patient is in a persistent vegetative state (PVS) like the case of Shanbaug".

Passive euthanasia is a condition where there is a withdrawal of the medical treatment to expedite death of a terminally ill patient. It includes authorizing his/her family to withdraw life support system in case a medical board declared that they were beyond medical help.

The bench observed that "dignity" was the core which united fundamental rights because fundamental rights enshrined in the Constitution sought to achieve for each individual the dignity of existence.

A person's advance directive meant to die with dignity should take effect only when a medical board affirms that the person's medical condition was incurable and irreversible.

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