Source: The Indian Express 

Introduction  

The recent case of Harish Rana has brought passive euthanasia back into the spotlight in India. Passive euthanasia means stopping life support for someone who is very sick and won't get better, letting them die naturally. The law on passive euthanasia has changed over time in India, and what it means for patients and their families. 

What was the Background and Court Observation of Harish Rana v. Union of India and Ors? 

Background 

• Harish Rana, a 30-year-old man, has been in a permanent vegetative state since 2013 after falling from the fourth floor of a building. 
• He suffers from quadriplegia with 100% disability and has been bedridden for over 10 years. 
• His elderly parents have been caring for him but are now struggling due to their age and lack of resources. 
• Rana's parents filed a plea seeking passive euthanasia for their son. 

Court Observation: 

• The Supreme Court also declined to entertain the plea for euthanasia. 
• The Supreme Court's reasoning:  
  • This was not a case of passive euthanasia as Rana was not completely dependent on life-support machines. 
• Rana was not being kept alive mechanically and could sustain himself without external aid. (was receiving nutrition through a feeding tube.) 
  • The court noted this would be considered active euthanasia, which is not permitted in India. active euthanasia, which remains illegal in India.   

What is Euthanasia? 

• Euthanasia is the practice of ending the life of a patient to limit the patient's suffering. 
• There are two types of Euthanasia 
  • Passive euthanasia (Legal in India) 
  • Active euthanasia (Still illegal in India) 
• Passive euthanasia is the practice of allowing a terminally ill person to die by withholding or withdrawing life-sustaining medical treatment. 
• Active euthanasia occurs when the medical professionals, or another person, deliberately do something that causes the patient to die, such as administering a lethal injection. 

What are the Landmark Judgments on Euthanasia in India? 

Aruna Ramchandra Shanbaug v. Union of India (2011) 

• Background: 
  • Aruna Shanbaug, a nurse at Mumbai's KEM Hospital, was sexually assaulted by a ward attendant in 1973. 
  • The assault left her with a brain injury, resulting in a 'persistent vegetative state' for decades. 
  • A journalist and author filed a petition at the Supreme Court in 2009. 
  • The petition sought to end life-supporting treatment for Shanbaug, arguing for her right to die peacefully. 
• Court Observations: 
  • The court ruled out passive euthanasia specifically for Shanbaug, stating she was still alive and didn't require life support. 
  • The ruling acknowledged the concept of 'right to die with dignity' as part of the right to life under Article 21 of the Indian Constitution. 
  • The Supreme Court distinguished between active and passive euthanasia, allowing passive euthanasia. 
  • This ruling allowed passive euthanasia for patients in a Permanent Vegetative State (PVS). 

Common Cause v. Union of India (2018):

• The Supreme Court of India in a landmark judgement recognised a person’s right to die with dignity, saying that a terminally ill person can opt for passive euthanasia and execute a living will to refuse medical treatment. 
• It also laid down guidelines for ‘living will’ made by terminally ill patients who beforehand know about their chances of slipping into a permanent vegetative state. 
• The court specifically stated that Dignity in the process of dying is as much a part of the right to life under Article 21.  
  • To deprive an individual of dignity towards the end of life is to deprive the individual of a meaningful existence. 

What are the Recent Modifications and Guidelines for Implementing Passive Euthanasia by the Supreme Court? 

• Modification of Advance Directive:  
  • An individual can change or withdraw their Advance Directive if mentally capable. 
  • Changes must be made in writing, following the same procedure as the original directive. 
• Applicability of Advance Directive:  
  • The directive may not apply if unforeseen circumstances arise that would have affected the person's decision. 
• Ambiguity in Advance Directive:  
  • If unclear, the directive will not be followed. 
  • Guidelines for patients without directives will apply instead. 
• Non-compliance with Advance Directive:  
  • If a hospital decides not to follow a directive, they must seek guidance from a Collector-appointed Medical Board. 
• Procedure for cases without Advance Directive:  
  • For terminally ill patients, a Primary Medical Board is formed. 
  • The Board consults with family and physicians, documenting discussions. 
  • If withdrawal of treatment is considered, a Secondary Medical Board reviews the case. 
  • The Judicial Magistrate First Class (JMFC) must approve the decision. 
  • The High Court is informed of life support withdrawal. 
  • Records are kept digitally and in hard copy for three years post-death. 
• Consent and Decision-making:  
  • Family members or guardians must be informed of treatment withdrawal implications. 
  • Written consent is required from next of kin/guardian. 
  • Multiple levels of medical review are mandated before treatment withdrawal. 
• Timeframes:  
  • The Primary Medical Board should decide within 48 hours of case referral. 
  • The hospital should inform JMFC within 48 hours of Secondary Board's decision. 
• Judicial Oversight:  
  • JMFC must personally verify patient condition and medical reports. 
  • JMFC's approval is required for treatment withdrawal. 
  • The High Court maintains records of all cases. 

What are the Laws on Euthanasia in Other Countries? 

• Netherlands:  
  • First country to legalize euthanasia 
  • Allowed under strict conditions established through court cases and legislation 
  • The Termination of Life on Request and Assisted Suicide Act (2001) legalized euthanasia and physician-assisted suicide 
• Belgium:  
  • Legalized euthanasia in 2002 
  • Permits voluntary and non-voluntary euthanasia for adults with unbearable suffering 
  • Allows foreigners to request euthanasia 
• Luxembourg:  
  • Enacted the Act on Euthanasia and Assisted Suicide in 2009 
  • Allows euthanasia for adults with irreversible suffering from serious, incurable conditions 
• Switzerland:  
  • Euthanasia is illegal, but assisted suicide is permitted under certain conditions 
  • Organizations like Dignitas provide assisted suicide services to eligible patients 
• Colombia:  
  • Legalized euthanasia in 1997 through a Constitutional Court decision 
  • Allows euthanasia under specific circumstances, including unbearable suffering due to terminal illness 
• United Kingdom:  
  • Allows passive euthanasia for patients in Permanent Vegetative State (PVS) 
  • Based on the Airedale NHS Trust v Bland (1993) case 
• Australia:  
  • Recognizes the right to refuse medical treatment and advance medical directives 
  • Decisions based on the individual's best interest 
• Canada:  
  • Legalized Medical Assistance in Dying (MAID) in 2016 
  • Available to eligible adults with grievous and irremediable medical conditions 
• United States:  
  • Several states have legalized euthanasia or assisted dying 
  • Examples: Oregon's Death with Dignity Act (1997), Washington's Death with Dignity Act (2008), California's End of Life Option Act (2015) 
• Spain:  
  • Legalized euthanasia and assisted suicide in 2021 
  • Available to adults with serious, incurable diseases causing unbearable suffering 
• France:  
  • As of 2023, considering legislation to legalize a form of assisted dying called "aid in dying" 

Conclusion  

Passive euthanasia remains a complex issue in India. Although Passive euthanasia is now allows it in certain cases, families still face difficult choices when caring for very ill loved ones. The high costs of long-term care often add to this burden. The court specifically stated that “Dignity in the process of dying is as much a part of the right to life under Article 21. Still active euthanasia is illegal in India.