Life has come full circle for the End of Life Care laws, starting from Aruna Shanbaug case to the review petition filed by 'Common Cause' an NGO, and decide by the Supreme Court recently. While the judgement has given some clarity to certain aspects related to end of Life Care several other aspects remain unclear.
Understanding Euthanasia
Euthanasia is defined as the painless killing of a patient suffering from an incurable disease or an irreversible coma. It is the process whereby a human life is ended by another, in order to avoid distressing effects of an illness.
Voluntary Euthanasia is induced at the will of an individual by his / her request, which has so far been prohibited in most of the jurisdictions. Some exceptions are : Netherlands, Belgium Italy, some states of United States of America and Switzerland, with several conditions imposed. By giving a legal status to the living will, India has moved a step closer to voluntary Euthanasia conducted passively.
Involuntary Euthanasia on the other hand, is conducted when the dying individual is incapable of giving or refusing consent for the act. The consent of a third person usually a close relative or friend is taken for the involuntary euthanasia. This type of Euthanasia, though a subject of controversy, is allowed in certain circumstances. It is allowed in those cases generally, where the patient is in persistent vegetative state and the possibility of leading normal life becomes impossible for him.
Active Vs Passive
Depending on the way, life is terminated, Euthanasia is classified into active and passive.
In active Euthanasia a poisonous / toxic substance is administered to bring death which may even be an overdose of a prescribed drug. Active euthanasia is illegal in most jurisdictions. Dying person actually dies from something other than the disease.
On the other hand, passive Euthanasia is caused by withdrawing the life support system or omission of medical care. It is refraining from the action that would delay death, thereby allowing natural death to occur. So the death is caused by disease and not external factors.
Euthanasia is not a Form of Suicide
Euthanasia is different from suicide and assisted suicide in that there is a third person intervention in termination of life. Thus, two concepts are both factually and legally distinct. In assisted suicide, the third party only assists in the termination of life by a person and he does not per se terminate the life, otherwise he would attract the charge of homicide or murder.
A Doctor’s Dilemma
Doctors are faced with an additional dilemma, that of certifying the genuinity of the living will. The court has put the onus on doctors. Doctors in general and their professional bodies have hailed the verdict as it is perceived to support them in their ethical and moral dilemma of pulling the plug.
In 2002, the Indian Medical Council (professional conduct and ethics) regulations laid down the guidelines for withdrawing life support. There are defences available to the doctors in sections 81 and 88 of IPC.
Section 81 is the most important provision when it comes to decisions of termination of life. It is significant as it applies not only in cases of passive Euthanasia but also in cases of active Euthanasia, since it permits causing harm with an intention to avoid greater harm.
The decision to end life of terminally ill patients is taken deliberately to spare the patient and his family from greater harm of futile prolongation of the dying process, a process that is attended with lack of dignity, adding expensive and often painful treatment.
The doctor cannot be accused of criminal intent in taking such decisions which are very much in the interest of the patient and family. However, consent of the patient is the most important requirement in availing this defence as he is the best person to decide what is greater harm to him.
One of the debatable question here is, can there be a harm to a person greater than his death?
However, giving opportunity to the patient to decide on the extent of harm would be a logical answer to this question.
Till a new law is made by the legislature, court’s will must prevail.
(Dr Ashwini Setya is a Gastroenterologist and Programme Director in Delhi’s Max Super Speciality Hospital. His endeavor is to help people lead a healthy life without medication. He can be reached at ashwini.setya@gmail.com)
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