Of passive euthanasia and living will
Though the Centre had advocated for passive euthanasia before the five-judge Constitutional Bench of the Supreme Court, it had not supported granting of permission to make a 'living will', apprehending the misuse of it. It is interesting that an awakened judiciary in India, spurred by the vexing case of Aruna Shanbaug, has poked the otherwise cold legislators and an indifferent Union government to face the issue of euthanasia. The immediate issue is whether the law should permit passive euthanasia, the ending of artificial life which has been elongated by medical intervention when a person is in a persistent somatic state. Interestingly, Suetonius – while coining the word 'euthanasia' in 14 BC – when Emperor Augustus was dying calmly in the arms of his charming wife Livia, meant 'dying with dignity'. But, really, there is no dignity in the way several people now die routinely after what is known as 'heroic measures' to keep a person alive. However, those measures are often brutal, intended to force the collapsing body to breathe, feed, hydrate and keep it alive, at any cost. If patients were in a condition to protest, they might, but they are not. Surprisingly, when the family members of a dying patient get too eager for an extension of life, the doctors think of their business as nobody can sue them for not doing enough for a dying patient. And, even if the doctors are dutifully trying to save lives in critical cases, one cannot justify the extraordinary means, such as ventilators and feeding tubes – on the grounds that the clinic is technologically well-equipped. Sadly, most of the 'noble' doctors today do not find some remedy for the best interest of their patients – especially the poor and the vulnerable, and perhaps the gullible too.
The Supreme Court has rightly provided grist for new thinking by compelling the law-makers to recognise the validity of passive euthanasia, the withdrawal of medical sustenance if a patient is in an irreversible vegetative condition. It is saying, in effect that, it is not enough for doctors to provide textbook treatment to a patient; they must serve the patient's best overall interest, sometimes by not continuing life-extending treatment mindlessly. Uncertain of gold-digging doctors and fragile relatives, the court has gone to great lengths to suggest numerous precautions, including multiple doctors from different disciplines and exacting review by judicial eyes. It has, in advance, taken care of traditional objections, such as fraud and inhumanity, and laid the groundwork for a rational legal framework. Though the court has already taken a good first step in starting a discussion on euthanasia cautiously, it has out-rightly rejected active euthanasia, without seriously considering its relevance for India. One must not forget that India not only has a large population but it also has a regressive record of different accidents, including traffic and industrial mishaps, where a large number of the victims are bedridden prisoners in their broken bodies. For such people, there is no escape from a living hell, and the constitutional promise of the right to live is a cruel joke.
The court had already recognised, in the Shanbaug case, that the right to live includes the right to die with dignity. The Supreme Court has done a commendable job by commencing a debate on an issue, which is nothing less than a person's right to choose his own life, including its end. And, for those – who plead with Article 21 of the Indian Constitution, which makes the right to life a fundamental right – should also remember that death is also subject to judicial processes – including legal caveats and conventions. It is this judicial process that allows a government or the court to order a soldier to the battlefield, even if it means death. Similarly, it is the same process that allows a court to condemn a convicted criminal to death. Now, the question is, would any law on the living will or even euthanasia open the floodgates to more reckless killings? Remember, euthanasia is already being practised quietly, by many doctors in consultation with the family of the patients. Interestingly, wherever euthanasia has been legalised, the number of deaths has not risen at an alarming rate. Instead, one can hope that the living will or Advance Directive (legalised in most developed countries), will minimise the abuse of this stealthy euthanasia. The ball of euthanasia, though, is now in the Apex Court, allowing for death with dignity could be a judicial milestone in India. Let the people die calmly like Augustus, in the arms of their Livias!