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“India should legalise voluntary active euthanasia”

The rights and wrongs of Euthanasia have been hotly debated across India over the last few months. The
Supreme Court’s ruling on the case of Aruna Shanbaug, a former nurse who was violently attacked in 1973
and has been in a ‘vegetative’ state ever since, has made the question of mercy killing the subject heated
national debate. Whilst the Supreme Court ruled that Aruna should live, supported as she is now by the
doctors and nurses who care for her at the King Edward Memorial hospital, the court also ruled that it will
allow ‘passive euthanasia’ – the withdrawal of medical treatment to allow patients to die - in certain

The ruling was an important one in the development of the law in this area. In a country that has been
avowedly ‘pro-life’, the acceptance of Euthanasia, albeit ‘passive’, has been deemed a watershed moment.
But while some have celebrated the ruling, a number of campaigners and commentators suggest that it
doesn’t go far enough. They argue that if the government is serious about giving Indian’s both choice and
dignity in end of life care, then it is time also to support ‘voluntary active euthanasia, where doctors
administer lethal medication’. Others warn that the road to hell is paved with good intentions, and question in
particular whether a country such as India, which lacks universal health care provision, should be endorsing

The euthanasia debate has been ethically and politically controversial in many countries in recent years.
Some argue the growing pressure for a ‘dignified death’ is the sign of a progressive and compassionate
movement for change, but others worry that our obsession with the right to die is both morbid and threatens
to involve government and the law in an area of life that should be a private affair. Is it time India recognised
the right of individual patients to decide on the time and manner of their own death? Or should we always be
morally wary of endorsing suicide, whatever the circumstances?

The Euthanasia debate in context:

What is euthanasia?
Debates over assisted suicide and euthanasia involve a complex array of distinctions. In India the discussion
around euthanasia has often been confused by the varied terms at play in the debate. Passive euthanasia
refers to the withdrawal of treatment, mainly intensive care support, when it is considered medically futile for
the patient; something that is routinely practised in the West and backed by law, but until the Shanbaug
ruling there was no equivalent in India. In contrast, when a doctor directly ends a patient’s life by
administering lethal medication at a patient’s request (based on informed consent) this is known as
‘voluntary active euthanasia’. When a doctor indirectly helps a patient to die by prescribing medication that
will enable him to end his own life, this is known as patient assisted dying, also commonly described as
physician assisted suicide. This debate focuses on the question of whether the time has come to allow
voluntary active euthanasia, the most controversial kind.

A dignified death?
Proponents of voluntary euthanasia argue that legalising the practice would allow terminally ill patients the
control and choice over their lives that they are currently denied. They argue that the right to a dignified life,
enshrined in the Constitution of India, should also incorporate the right of terminally ill individuals to die with
dignity at a time of their own choosing, rather than having to suffer needlessly. Activists such as Flavia
Agnes warn that we should be wary of ‘moral pontification from the pulpit about the divinity enshrined in the
right to life’. Others agree and underline that there must be limits to suffering we endure; indeed, quality of
life in cases of terminal illness is as important as life itself, and it is callous of both doctors and society to
suggest otherwise. Allowing patients who are enduring unimaginable suffering to die on their own terms
demonstrates both the autonomy of the patient and the mercy of the society in which they live. But others
argue that ‘dignity’ should not be reduced to ‘bodily integrity’, such that life is seen as no longer worth living
once someone is no longer able-bodied. Healthy people often say that they would not want to go on living
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with debilitating illness, but both patients and doctors testify that such feelings are subject to change, and the
very ill often decide that life is worth living after all. It is also important to recognise that dying takes place
within a social context. There is a danger that in allowing voluntary euthanasia, says Olivia Timms, we
abrogate our responsibility as a society to affirm the life of a dying or terminally ill person when they need it

What does this mean for doctors and healthcare?
The medical profession in India appears to be split on the question of euthanasia. Some suggest that helping
others to die by administering lethal medication goes against the idea stated in the Hippocratic Oath that
doctors should not cause harm. Some doctors feel that a change in the law would turn them into
‘executioners’ and so undermine and corrupt doctor-patient relations. Advocates counter that the role of
medicine has changed, and oaths of old are outdated, no longer reflecting the reality of medical practice,
where patients can be artificially kept alive against their best interests. In such cases, a doctor can act
humanely in helping a patient to die. Nevertheless, some query whether it even makes sense to be having a
debate about voluntary euthanasia in a country such as India. There is growing evidence, says medical
activist Padma Praskash, that access to healthcare is shrinking. Simple and effective healthcare is not only
limited, but where available is extortionately expensive. In such a situation, talk of the autonomy and choice
associated with voluntary euthanasia make little sense, especially when ‘passive euthanasia’ is being
inadvertently practised across the country because of the lack of resources. Medical practitioners also draw
attention to the lack of palliative care – offering relief from suffering - available to dying people in India,
arguing that were this available there would be very little need or demand for voluntary euthanasia. There is
also a danger that support for voluntary euthanasia could drown out calls for the provision of proper palliative

Who should decide?
“Euthanasia is an expression of the individual right to decide how and when he or she should die, rather than
allow the State to decide” says Dr Nagraj G. Huilgol, secretary of the Mumbai-based Society for the Right to
Die with Dignity. Over the years campaigners have drawn attention to the fact that decisions regarding their
lives and deaths are ultimately in the hands of the state. In a famous Canadian court case, Sue Rodriguez, a
woman who was terminally ill and sought to end her life by euthanasia asked “Whose body is this? Who
owns my life?” In India proponents such as a Times of India columnist and editor Jug Suraiya argue that by
denying terminally ill people the right to help in ending their own lives, the state is effectively saying that it will
be the final arbiter of our lives and conscience. But others argue that permitting assisted suicide in fact does
the very opposite and actually deepens the state’s involvement in our lives. Rather than freeing the decision
to die from the mechanisms of the state, legalised voluntary euthanasia would subject a terminally ill
person’s final choices to external arbitration and judgement. In the call for task forces, review boards and
medical and legal councils who will decide those who should be allowed to die, and those who should not,
argues British journalist Brendan O’Neill, we are in danger of replacing an intensely private and intimate
situation and decision, with a bureaucratic and legalistic process overlooked by the state.
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Essential Readings:
Is Euthanasia ethical? Times of India 27 March 2011

The fight for dignity in death Sudha Umashanker The Hindu 13 February 2011

Who has the last word? The Hindu 21 March 2011

Euthanasia: death with dignity? Medicare 8 February 2011

To die, to sleep no more Meena Menon The Hindu 13 February 2011

To die on one’s own terms can be a boon, but.... Prashant Aiyar The Hindu 13 March 2011

The right to a dignified death Editorial Livemint.com 3 March 2011

The origins of ending life mercifully V R Narayanaswami Livemint.com 18 October 2010

The right to death Sauravpran Goswami The Hindu 20 March 2011

The right to live and let die Editorial Livemint.com 20 December 2009

The triumph in the case of Aruna Shanbaug Juggle-Badhi blog Times of India 14 March 2011

A right to dignified death R N Bhaskar Livemint.com 8 September 2008

Questions about the right to die Rajeev Dhavan India Today 14 March 2011

Whose life is it anyway? Harmala Gupta Times of India 28 March 2011

Why talk of euthanasia is pointless in India Mahesh Vijapurkar Rediff.com 17 March 2011
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It is outrageous and impracticable in India Abdul Subhan The Hindu 13 March 2011

The sea inside Vijay Nagaswami Deccan Herald September 2009

Euthanasia: Where human life is concerned, one can’t be silent Olinda Timms Deccan Heald

Euthanasia: where angels fear to tread Professor B.M Hegde The Hindu 13 March 2011

Euthanasia: cost factor is a worry Sanjay Nagral Times of India 13 March 2011

Further Reading:
Euthanasia: A Global Issue Gerald A Larue Humanism today Vol 113

Constitutionality of the right to die - a brief analysis Legal Services India 26 March 2011
Legalisation of Euthanasia in India – a critical analysis Amandeep Kaur Law Herald 29 July 2009

The fight for dignity in death Sudha Umashankar The Hindu 2 February 2011

Euthanasia [mercy killing] P.N.Murkey & Konsam Suken Singh Journal of Indian Academic Forensic
Medicine Indian Acad Forensic, 30 (2) http://medind.nic.in/jal/t08/i2/jalt08i2p92.pdf

Death with dignity T.V. Jayan The Telegraph
For dignity in death Padma Prakash The Hindu 20 March 2011

The humanist case against euthanasia Brendan O’Neill Spiked 17 May 2010

Legalisation of Euthanasia in India – A Critical Analysis Law Herald 29 July 2009

Is India The World’s Worst Place to Die? World Policy Blog 6 August 2010

Whose Life is it Anyway? The Evolving Face if Euthanasia Shalaka R Joshi Journal of Associations of
Physicians India
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Key Terms:

Passive euthanasia

Voluntary active euthanasia

Physician assisted suicide

In the news:

‘Willing’ for death over a life on support Mumbai Mirror 11 August 2011

Passive euthanasia: 'Practice has existed in India for years' Times of India 8 March 2011

Aruna Shanbaug will live: Supreme Court Sify -     ar

Should the Supreme Court allow Aruna Shanbaug to die? DNA 17 December 2009

Comma, period? Outlook 28 February 2011

Euthanasia is murder: rights activist The Hindu 14 January 2009

Law on Euthanasia proposed in Kerala World News.com 9 March 2011

'Society must support palliative care' The Hindu 3 August 2011

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