Intended for healthcare professionals

Rapid Response:

Re: Why I decided to provide assisted dying: it is truly patient centred care

The author in this article tries to explain the patient side of the story with regard to euthanasia and the dilemma a physician had while coping with the introduction of voluntary euthanasia in Canada in June 2016.

Voluntary Euthanasia represents a fundamental shift in the medical profession’s role and understanding of the role of doctor to end a patient’s suffering. Euthanasia is categorized in different ways, which include voluntary (conducted with the consent of the patient), non-voluntary (conducted when the consent of the patient is unavailable), or involuntary (conducted against the will of the patient). It can also be categorized into Active and Passive euthanasia. Passive euthanasia (known as "pulling the plug") is legal under some circumstances in many countries such as India. Active euthanasia, however, is legal in only a handful of countries (e.g. Belgium, Canada, Switzerland) and is limited to specific circumstances and the approval of councillors and doctors or other specialists. Some physicians prefer palliative care over euthanasia. This option helps to relieve patients’ pain while allowing them to fulfil their natural life span. (Reference1)

The scenario of euthanasia in India is no different than from other countries where euthanasia is illegal. However on 7th March 2011 a paradigm shift happened as a result of the Indian Supreme Court’s judgement on involuntary passive euthanasia. On 9 March 2018 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state. The decision was made as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent Vegetative State (PVS) until her death in 2015 due to pneumonia after pulling the plug. The Law Commission of India gave certain recommendations on euthanasia. (Reference 2)

On 9 March 2018, the Supreme Court of India passed a historic judgement-law permitting Passive Euthanasia in the country. This judgment was passed in wake of Pinki Virani's plea in the Supreme court in December 2009 under the Constitutional provision of “Next Friend”. It is a landmark law which places the power of choice in the hands of the individual, over government, medical or religious control which sees all suffering as “destiny”. The Supreme Court specified two irreversible conditions to permit Passive Euthanasia Law in its 2011 Law: (I) Those who are brain-dead for whom the ventilator can be switched off and (II) Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out and pain-managing palliatives be added, according to laid-down international specifications. The same judgement-law also asked for the scrapping of IPC 309, the code which penalises those who survive suicide-attempts. In December 2014, the government of India declared its intention to do so.

In May 2016, the Ministry of Health and Family Welfare issued a draft bill for public comment in order to create a conscientious decision. The Indian public are divided on this issue. While the majority of the scientific community welcomes it, others who have religious beliefs oppose it. Some believe that legalizing euthanasia would damage the foundation of society's value of respect for human life. (Reference 3)

We realise that Euthanasia can be considered as a boon for patients who are terminally ill or bed ridden for whom doing small daily things become a task. It provides a respectful death instead of a life dependent on others and self pity. Euthanasia provides the ending of the suffering in a peaceful and dignified way, surrounded by the loved ones of the patient. It also ends the psychological, physical and monetary stress the patient’s family undergoes while attending to such patients. Arguments for and against are discussed widely. (Reference 4,5 and 6)

It may have a negative impact on a few patients who do not have the will power to fight a disease. They may think it is an easy route to escape the hardships of life. Laws need to be more stringent to rule out malpractices. Psychological evaluation of a patient needs to be assessed.

1. Ref.
2. Ref.
3. S12011/5/2011-Ms (pt. I)
4. Rattan Singh in “Right to life and personal liberty: Some arguments with special reference to Euthanasia” in Journal of legal studies; page no-87
5.AIR 1995Ibid; page no-84Id 17

Competing interests: No competing interests

05 February 2019
Smita Asthana
Scientist E
Vishakha Francis, Uma Kailash