Passive Euthanasia in India: How It Works and Who Qualifies

Passive euthanasia in India has emerged as an important issue in law, ethics, and healthcare. Passive euthanasia involves “withdrawing or withholding” life-sustaining medical treatment in cases of patients who are in a terminal state or in a vegetative state of existence. Rather than any specific act designed to bring about death, it enables patients to die naturally. The Supreme Court of India sanctioned passive euthanasia through landmark judgments, stating that the individual may have a right to die with dignity that is related to and embedded within the fundamental right to life contained in Article 21 of the Indian Constitution. This ruling was a monumental shift in end-of-life care.

Passive Euthanasia in India

Passive euthanasia in India was not always an acceptable practice by law. Passive euthanasia worked its way into recognition and acceptance in India through a series of monumental cases of the Supreme Court that changed India’s approach to end-of-life care.

The first important case to consider the legality of passive euthanasia was the Aruna Shanbaug case of 2011. Aruna, a nurse from Mumbai, was in a persistent vegetative state for 42 years after a horrific assault. A plea seeking permission to terminate her life was advanced for mercy killing, which the Supreme Court specifically denied in her case.

The case was still important, however, because the Court made an important and sweeping observation to legalize passive euthanasia in India in restricted situational use. The Court said that if they are a patient who is in a vegetative state with no option for recovery, it was permissible to take them off life support and passively terminate their life if authorized by the High Court and approved by a medical board.

The issue made great strides with the Supreme Court ruling in the Common Cause v. Union of India decision in 2018 that ruled that the right to die with dignity is a fundamental right under Article 21 of the Constitution and has a legal definition that introduced living wills to allow for the recording of life support choices in cases of terminal illness or irreversible coma. 

After those developments, more significant advancements were made in January 2023 when the Supreme Court released revised guidelines that helped lessen the burden of compliance for executing living wills while still reducing some of the bureaucracy and policies in place that would allow for easier person-centered decision-making and implementation.

Together, both of these rulings not only opened the door to future legal acceptance of passive euthanasia in India but also firmly rooted the principles of personal dignity, medical patient autonomy, and compassionate end-of-life care.

Understanding the Concept of Passive Euthanasia

Passive euthanasia in India means taking away or not providing medical treatments to a patient whose illness is terminal or who already is in irreversible insentience, which will only serve to prolong their death. The treatment may involve switching off a ventilator, turning off artificial feeding or hydration, or purposefully not undertaking a surgery that may extend life without increasing quality. The difference between passive euthanasia and active euthanasia is not about assisting patients to end their lives directly but rather letting nature take its course, which is acceptable when recovery is no longer possible. 

Passive vs. Active Euthanasia

There is a relevant distinction between passive and active euthanasia from both legal and ethical perspectives. 

Passive euthanasia is legal in India on the basis of the Supreme Court rulings on passive euthanasia. Passive euthanasia involves inaction—willfully not intervening either as a healthcare professional or as an individual to allow the patient to pass naturally.

Active euthanasia remains illegal in India. Active euthanasia involves taking direct action to end a person’s life, such as by providing them with a lethal drug.

This distinction is important to create appropriate discussion medically and legally about end-of-life care.

Cultural and Ethical Viewpoints 

The acceptance of passive euthanasia in India is fostered by the country’s cultural and religious diversity. 

Jainism and certain sects of Hinduism accept the idea of voluntary death as found in spiritual practices like Sallekhana or Prayopavesa, which are understandings of fasting to death in a tranquil mind. Conversely, Christianity and Islam oppose all forms of euthanasia and emphasize that life is sacred and it is only in God’s power for life to end. 

This results in a complicated moral situation in which passive euthanasia in India is dependent on spiritual, humanitarian, legal, and religious perspectives. This multitude of perspectives creates fitful ground in which to establish a universal law or draft a policy to accommodate all morally ethical perspectives. The Supreme Court has created a legal framework that does endorse euthanasia when many conditions are significantly pared off. However, the implementation of it occurs differently in various places or regions, creating a moral issue based on culture, individual values, and local sentiment.

But now that legal precedent is being confidently established and with the expectation of an increase in people’s involvement, people, especially healthcare professionals, are becoming more cognizant of advocating an understanding of dignified end-of-life. This will take time; there is an opportunity where passive euthanasia can be considered more acceptable ethically and morally, stemming from the values of the Constitution of India and the religious contemplations that stem from spirituality.

Legal Procedures and Safeguards

A living will is an important legal instrument that facilitates passive euthanasia in India. A living will is a written affirmation by a person of sound mind documenting their wish not to receive extraordinary or life-saving treatment if they are diagnosed with a terminal illness or suffer a permanent vegetative state. A living will is a living note; however, it should be executed correctly to be given legal effect. The document must include the signatures of two witnesses and be attested by a Judicial Magistrate First Class (“JMFC”).

Once the conditions set out in the living will arise, the hospitals that are treating the patient must create a primary medical board that is responsible for reviewing all aspects of the case. The primary medical board will create a secondary medical board, which is normally a government facility that confirms the diagnosis and makes an independent assessment of the patient’s condition. Passive euthanasia in India can only take place when a formal order to do so has been enacted by both medical boards.

In January 2023, the Supreme Court made new guidelines that simplified the process of implementing a living will. The guidelines made fewer formalities and gave families the ability to initiate the living will. All in all, these revisions were essential in moving us in the direction of guaranteed personal autonomy and our right to die with dignity.

Conclusion

Passive euthanasia in India is an important addition to the families’ legal and ethical discourse and offers patients the right to die with dignity while establishing legally adequate protections against misuse. In an evolving social context saturated with information and easier access, passive euthanasia is poised to be used as an expression of care and empowerment in the context of our patients’ end-of-life situations. Continued public education and education for healthcare professionals will help ensure passive euthanasia takes place with care, thoughtfulness, and responsibility.

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