Ethics of Letting Go

Most people are not afraid of death itself. What they fear is the possibility of a prolonged, dependent and undignified dying process.

Few medical debates make people as uncomfortable as euthanasia. Perhaps because it forces us to confront a truth that modern medicine has complicated. Today, technology allows us to keep the human body alive far longer than nature once intended. Ventilators, feeding tubes, dialysis and advanced critical care have dramatically extended life. But they have also raised an uncomfortable question: when does treatment begin to prolong suffering rather than life?

India recently revisited this question after the Supreme Court reaffirmed the legality of passive euthanasia under strict safeguards. This judgement reflects years of legal, medical and ethical deliberation. At the centre of the debate lies a simple yet profound idea: the right to die with dignity.

What is euthanasia?

Euthanasia refers to intentionally ending a person’s life to relieve unbearable suffering caused by severe or irreversible illness.

Broadly, there are two kinds of euthanasia – active and passive. The distinction is crucial. One actively causes death. The other allows nature to take its course when treatment no longer serves a meaningful purpose.

How euthanasia is carried out medically

In countries where euthanasia or assisted dying is legal, the process follows rigorous protocols.

Active euthanasia generally involves a sequence of medications administered by physicians. A sedative is first given to induce deep sleep, followed by drugs that suppress breathing and eventually stop the heart. Multiple medical opinions, psychiatric evaluation and documented consent are required.

Physician-assisted dying works slightly differently. Here, the doctor prescribes a lethal medication, but the patient must take it themselves. This model exists in places such as Switzerland and several states in the United States.

Passive euthanasia, the form permitted in India, usually involves withdrawing life support in patients with irreversible illness. Doctors may discontinue ventilators or artificial feeding while ensuring adequate pain relief and sedation. The focus shifts from aggressive treatment to palliative care and comfort.

India’s legal journey

The case that first brought this issue into public consciousness was the Aruna Shanbaug case in 2011. Shanbaug, a nurse at Mumbai’s KEM Hospital, remained in a persistent vegetative state for more than four decades after a brutal assault. While the Supreme Court rejected active euthanasia, it permitted passive euthanasia under strict judicial supervision.

A more decisive shift came in 2018 with the Common Cause judgment, where the Supreme Court ruled that the right to die with dignity is part of the fundamental right to life. The court also recognised living wills, allowing individuals to document their wishes regarding life support in advance.

More recently, cases such as that of Harish Rana, a paralysed man seeking permission for passive euthanasia, have again drawn attention to the real human suffering behind this legal debate.

Where euthanasia is legal

Several countries have legalised euthanasia or assisted dying under strict safeguards. These include the Netherlands, Belgium, Luxembourg, Canada, Spain and Colombia.

Other jurisdictions permit physician-assisted dying rather than direct euthanasia, including Switzerland and parts of Australia.

In the United States, assisted dying laws exist in states such as Oregon, Washington, California, Colorado, Vermont, Maine, New Jersey, Hawaii and New Mexico, along with the District of Columbia.

Media portrayal

The Hindi film Guzaarish, starring Hrithik Roshan, told the story of a paralysed magician who petitions the court for euthanasia, bringing the debate about autonomy and dignity into public conversation.

The ethical dilemma

For doctors, euthanasia is never a straightforward decision. Psychiatry plays an important role in ensuring that such requests arise from clear decision-making rather than untreated depression, coercion or temporary distress.

Ultimately, the debate around euthanasia is not about choosing death over life. It is about recognising that medicine must not only prolong life, but also preserve dignity when life reaches its most fragile stage.