Intro- gist of full article

Def black law dictionary or farlex

Euthanasia commonly called ‘assisted suicide’ is derived from the Greek

"euthanatos", with 'eu' meaning well, and 'thanatos' meaning death. Thus it
means "good death". The word Euthanasia was first used
by Francis Bacon in the 17th Century to refer to an easy,
painless and happy death as it is the duty and
responsibility of the physician to alleviate the physical
suffering of the body of the patient.

Passive euthanasia: Passive euthanasia, also called negative euthanasia or non-

aggressive euthanasia, entails the withholding of common treatments, such as
antibiotics, necessary for the continuance of life. Passive euthanasia occurs when the
patient dies because the medical professionals either don’t do something necessary to
keep the patient alive, or stop doing something that is keeping the patient alive, such
as:

a. Switch off life-support machines

b. Disconnect a feeding tube
c. Dont carry out a life-extending operation
d. Dont give life-extending drugs

Active euthanasia : Active euthanasia is defined as “a positive act or affirmative

action or act of commission entailing the use of lethal substances or forces to cause
the intentional death of a person by direct intervention, e.g., a lethal injection given to
a person with terminal cancer who is in terrible agony.”

The Supreme Court of India on March 9, 2018 ruled in favour of allowing passive
euthanasia with guidelines. In a historic decision, the SC declared passive euthanasia
and the right of persons, including the terminally ill, to give advance directives to
refuse medical treatment permissible.
The Constitution Bench of Chief Justice Dipak Misra and Justices AK Sikri, AM
Khanwilkar, DY Chandrachud and Ashok Bhushan delivered its verdict on a PIL filed
by NGO ‘Common Cause’ in 2005 seeking robust system of certification for passive
euthanasia and legal recognition for “living will” in India.
Advocate Prashant Bhushan argued for the petitioner- ‘Common Cause’ and P.S.
Narasimha, the Additional Solicitor of India, argued for Union of India (respondent) .

‘Living will’ refers to a written document that allows a patient to give explicit
instructions in advance about the medical treatment to be administered when he or she
is terminally ill or no longer able to express informed consent. It
includes authorizing their families to switch off life support in case a medical board
declared that they were beyond medical help.

A question that keeps coming in everyone’s mind is what prompted this ruling?
Last year (2017), the central government had informed the apex court that it was
assessing the drafting of a bill to allow passive euthanasia. Termed the Medical
Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners)
Bill, the draft was released by the Union Health Ministry in 2016 based on the Law
Commission of India’s Report No. 241 (August 2012). The government at that time
however, said it did not support granting people the right to make “Living Wills”,
which would let them decide whether they want to be put on life support in case of
terminal illness.

This ruling also draws from the Aruna Ramchandra Shanbaug vs Union Of India
& Ors (March 7, 2011) case, filed in the Supreme Court by a “next friend” of nurse
Aruna Shanbaug. In this case, the petitioner pleaded that former nurse Aruna
Shanbaug, who had been brutally sexually assaulted in Mumbai KEM hospital in
1973 and had slipped into a permanent vegetative state as a result, be allowed to die
peacefully by putting a stop to the mashed food that she was being fed, which helped
her to stay alive. sThis case would typically fall under the passive euthanasia
category. Shanbaug had been in a vegetative state for 36 years, and stopping life-
supporting treatment to her would result in her life ending peacefully, as opposed to
her undergoing constant pain since close to three-and-a-half-decades.

In India attempts have been made to include Right to Die in the Right to Life and
Liberty which is one of the most interpreted Fundamental Right in the Constitution.
Article 21, bestows on every person the fundamental right to life and personal liberty
which has inturn become an inexhaustible source of many other rights.” “Article 21 of
the constitution of India guarantees Protection of Life and Personal Liberty. It states:
“No person shall be deprived of his life or personal liberty except according to
procedure established by law.”

However the Court held that the right to life and liberty as envisaged under Article 21
of the Constitution is meaningless unless it encompasses within its sphere ‘individual
dignity’ i.e Right to life with dignity. With the passage of time, the Court has
expanded the spectrum of Article 21 to include within it the right to live as well as die
with dignity as component of right to life and liberty.
The Court made reference to the Gian Kaur’s case and held that ‘right to life with
dignity’ would mean the existence of such right up to the end of natural life which
also includes right to a dignified life upto the point of death including a dignified
procedure of death.

The Bench also held that the right to live with dignity also includes the smoothening
of the process of dying in case of a terminally ill patient or a person in Persistent
Vegetative State (PVS) with no hope of recovery.

Chief Justice Misra spoke about how societal pressure and fear of criminal liability by
relatives and medical doctors can ultimately lead to the suffering and the undignified
death of the patient.

The court said it was time to dispense with such shared suffering and sense of guilt
and face the reality. Doctors who attended on the terminally ill were under pressure
and dithered in letting the patient go, apprehending criminal liability and fear of being
drawn into the "vortex" of a possible family struggle for inheritance.

Chief Justice Misra, in a common judgment with Justice A.M. Khanwilkar, said it was
time to "alleviate the agony of an individual" and stand by his right to a dignified
passing. A dignified death should follow a meaningful existence, the five-judge
Bench agreed in a unanimous voice.

Justice Chandrachud stated that "Free will includes the right of a person to refuse
medical treatment”.

Write some para here to connect to next point

Following is the procedure fixed by the Supreme Court which is to be adopted for
making and executing of an Advance Directive or "Living Will" by a person for
withdrawal of medical treatment if he is suffering from an incurable disease with no
chance of recovery to prevent pain and suffering:

Who can execute the Advance Directive and how?

It can be executed only by an adult of a sound and healthy state of mind. It must be
voluntarily executed and without any coercion or compulsion. It shall be in writing
clearly stating as to when medical treatment may be withdrawn or no specific medical
treatment shall be given which will have the effect of delaying the process of death
that may otherwise cause pain and suffering.

What should it contain?

It should clearly indicate the decision relating to the circumstances in which

withdrawal of medical treatment can be resorted to. It should mention that the
executor may revoke the authority at any time. It should specify the name of a
guardian or close relative who, in the event of the executor becoming incapable of
taking a decision, will be authorised to give consent for withdrawal of treatment.

How should it be recorded and preserved?

The document should be signed by the executor in the presence of two attesting
witnesses and countersigned by the jurisdictional Judicial Magistrate of First Class
(JMFC). The witnesses and JMFC shall record their satisfaction that the document has
been executed voluntarily and without any coercion. The JMFC shall preserve one
copy of the document in his office and shall forward one copy to the registry of the
jurisdictional district court for being preserved. The JMFC shall inform the immediate
family members of the executor, if not present at the time of execution. A copy shall
be handed over to the competent officer of the local Government.

When and by whom can it be given effect to?

In the event, the executor becomes terminally ill with no hope of recovery and cure of
the ailment, the treating physician shall ascertain its authenticity from the
jurisdictional JMFC.
If the physician is satisfied that the instructions need to be acted upon, he shall inform
the executor or his guardian /close relative about the nature of the illness, the
availability of medical care and consequences of alternative forms of treatment and
the consequences of remaining untreated.
The hospital shall then constitute a Medical Board consisting of the head of the
treating department and at least three expert doctors with at least twenty years
experience who, in turn, shall visit the patient in the presence of his relative and form
an opinion whether medical treatment should be withdrawn or not.
If Medical Board certifies that the instructions be carried out, the hospital shall inform
the collector about the proposal. The collector shall then immediately constitute
another Medical Board comprising the Chief District Medical Officer and three expert
doctors. The board shall examine the patient and may allow withdrawing treatment
after ascertaining the wishes of the executor or his family members if the patient is
not in a position to communicate.
The board shall convey the decision to JMFC before allowing to withdraw the
treatment. The JMFC shall visit the patient and, after examining all aspects, may
permit to implement the directive.

What if permission is refused by the Medical Board?

If permission is refused by the Medical Board, it would be open to the executor or his
family members or even the treating doctor or the hospital staff to approach the High
Court. The court shall take a call on the plea at the earliest.

Revocation or inapplicability of Advance Directive

A person may withdraw the Advance Directive at any time. Withdrawal or revocation
of Directive must be in writing. If the Directive is not clear and ambiguous, the
Medical Boards shall not give effect to the same and when the Hospital Medical
Board declines the plea then an application shall be made before the Medical Board
constituted by the Collector for appropriate direction.

In case where there is no Advance Directive

When a patient is terminally ill which is incurable, the hospital shall constitute a
Medical Board which shall discuss with the family members and record the minutes
of the discussion in writing. The family shall be apprised of the pros and cons of
withdrawal of further medical treatment to the patient and if they give consent in
writing, then it may certify the course of action to be taken.
The hospital shall immediately inform the jurisdictional collector who shall then
constitute a Medical Board which shall examine the patient. The board then shall
inform its decision to the JMFC and the family members. JMFC shall visit the patient
and examine the condition of the patient and may endorse the decision of the Board to
withdraw the treatment.
In case of difference of opinions between two medical boards, the nominee of the
patient or the family member can seek permission from the high court to withdraw
life support.

NEW PARA
India does not have a comprehensive law on ‘End of Life’ decision-making. The
Supreme Court judgement is one step forward in handing control over to the
individual. As a society we need to normalise death and to remove the taboo around
discussing it. All doctors need to be aware of the basic principles of palliative care so
that we can offer care when cure is no longer possible.

Compare w other countries + active euthanasia should legalise in india

India joins countries like Netherlands, Belgium,
Colombia and Luxembourg in legalising passive
euthanasia. The Supreme Court made a reference to the
Swiss Criminal Code before passing their judgement
where in active euthanasia is illegal.

USA
While euthanasia is still illegal in most parts of the United
States, the doctors are allowed to prescribe lethal doses of
medicine to terminally ill patients in five state -- Washington
DC, California, Colorado, Oregon and Vermont. Oregon was
the first US state to legalise “assisted suicide”.
Belgium:

Belgium became the second country in the world to pass a law

to legalise euthanasia with the enactment of the Belgium Act on
Euthanasia on May 28th, 2002. The law mentions doctors can
help patients to end their lives when they freely express a wish
to die after suffering unbearable pain. Patients can also receive
euthanasia if they have clearly stated it before entering a coma
or similar vegetative state. Interestingly, Belgium became the
first country to legalise euthanasia for children in 2014. There is
no age limit for minors seeking a lethal injection but there are
strict norms for it.

Germany:

The term ‘euthanasia’ is generally not used in Germany because

of its association with the eugenicist policies of the Nazi era.
Hence, the law between assisted suicide and active assisted
suicide. Assisted suicide is legal as long as the lethal drug is
taken without any help, such as someone guiding or supporting
the patient's hand.

Netherlands

Netherlands became the first country to legalise euthanasia and

assisted suicide by passing a law in 2002. The country imposed
a strict set of conditions -- the patient must be suffering
unbearable pain, their illness must be incurable, and the patient
must make the demand in “full consciousness”. In 2010, 3,136
people were given a lethal cocktail under medical supervision.

UK

An important distinction in UK law exists between active

euthanasia and passive euthanasia. Since the Bland ruling of
1993, 'assisted suicides', which involve 'omissions' that are
principally the removal of life-saving care, are legal. However,
actively taking action to end another's life is illegal, even with
consent (active euthanasia)

LIVING WILL LEST IT BE MISUSED

Hon’ble SC has issued an important Judgement of Living Will. Of course court has,
as is normally done, has taken a long time to pronounce judgement even after it was
reserved 2017.All will agree to me that it is sensitive issue which will still remain
under the consideration of Social activist’s Human Rights Family members and of
course the sufferers who may opt to die respectfully to get rid of life what they are
living.
What encouraged me to write this article is the pain which I got from few statements
of doctors who were over elated after the judgment .Doctors are no doubt like a God
to save us and it is the quality of profession that they never give up so welcoming the
judgement by doctors is not welcome at all. I hope these doctors of a Govt institution
are not going as low as saving few beds or getting rid of patients and not the sickness.
I hope they will realize their folly.
The question is haunting me that will it be implemented in the spirit it was deemed or
it will deteriorate the lives of elders suffering from terminal illness or those who have
turned vegetables. Keeping in view the suffering of Senior Citizens, which I am
experiencing in many cases, will it not be possible that many will opt for dyeing
respectfully out of fear or being demoralized or being hopeless etc etc. Will not the
children who do not acre for their parents or grandparents will not make them sign a
will to die or make them suffer for want of medicines and other comforts. Who will
ensure the healthy implementation?

WE trace the ways to by-pass the rules as soon as a law is made or announced.
Helpage India and other NGOs should read the crux in between the lines and not
make this judgement a way to get rid of their super citizens.

HURDLES
With religious beliefs against premature death held strong in India, right to life may
weigh over the right to die with dignity that has just been granted legal sanction by
the apex court.
Requests from patients suffering from terminal medical conditions across India, have
led to government and courts professing for palliative care policies. Yet the debate
has been around issues that are legal, ethical, human rights-related, health-related,
religious, economic, spiritual, social and cultural.
Even though the Supreme Court has recognised the right to die with dignity as a
fundamental right, major hurdles might be posed by religious communities, who
mostly oppose euthanasia in India.

Euthanasia would be for people who are 'terminally ill' but how is it possible to decide
the expectancy of life, I wonder, said Ashish Tiwari, physician and medico-legal
expert. "Euthanasia can become a means of containing healthcare costs. However, it
can be misused by healthcare providers. Euthanasia can become non-voluntary
because emotional and psychological pressures on such patients will increase and they
will be inclined to opt for passive euthanasia. Legalising euthanasia and assisted
suicide is contagious. Is suicide a legitimate answer to life's problems?"
Tiwari said that euthanasia is a rejection of the importance and value of human life.
With euthanasia, no one's life is being saved instead life is only taken away, he added.
"The right to live with dignity is more important than right to die with dignity."