The meaning of the word “euthanasia”, as per a standard dictionary, is “gentle and easy death: bringing about of this, especially in case of incurable and painful disease”.
The Supreme Court of India has, pending legislation, laid down the socio-legal parameters to permit euthanasia. Such a situation connotes a willful act in the name of mercy with intent to kill when the person is still in control of vital functions but fears a bleak future due to an irreversible disease process. In the judgment on euthanasia, the Supreme Court does not deal with cases of what can be classified as “active euthanasia”. The judgment deals with “passive” euthanasia and not “active” euthanasia. Passive euthanasia concerns those who have been kept alive with artificial means or those who fear such a future.
The law that has evolved itself through this judgment indicates that a permissible case is to be preceded by the conditionality of an unambiguous statement of the person concerned while in full consciousness that he or she would like his or her life terminated, if ever in a vegetative condition. Opinions about freedom to exercise the option of taking their own life have been in an arena of uncertainties.
In a case of terminal illness or where a person has become a burden on the family or is irreversibly fed up with living, the Supreme Court does not endorse any of the above.
The recent judgment does not cover or endorse “active” euthanasia. The Supreme Court relies upon the right to life. The expression ‘life’ has to be supplemented with the expression right to life with dignity that must ensure a reasonable level of quality of life. In order to implement such a measure, we must debate out the kind of death we would want so that when the time comes and we are not capable of taking decisions, our family members would do so on our behalf keeping our wishes in mind.
We have also the option of authoring a living will expressly recording the wish of invoking the cautions and conditionalities of “passive” euthanasia. From experience, it is known that only a small section of the community opts for making out a will for euthanasia.
From the viewpoint of professional doctors, we will now have a vital role in the decision relating to futile treatments and also taking people off life-support systems in keeping with the Hippocratic oath.
The Supreme Court construed this as a part and parcel of the professional ethics and oath. It is enjoined on the doctors that they must ensure that their actions benefits patients and cause no harm.
letting a patient continue in a persistently vegetative state or indulging in treatments that will compromise personal dignity at the end of life have been held to be violation of the Hippocratic oath. For the legal mechanism to function properly, doctors have to have a critical minimum of communication skills. In our present professional curriculum for doctors, communication skills are not included in the training programme.
This communication skill is of a special type and has to be inculcated without any avoidable delay. Professionals working in the arena of palliative care in critical medicine and in neurology have welcomed this judgment. The professionals have to assist patients and their families to navigate the tricky terrain without a guiding route map.
Safety valves have further been provided for in certain cases. The High Court has to oversee and supervise the final decision-making process in certain cases. There are committees or boards which would deal in a collective manner with the decision-making process. The attempt is to make the decision as objective as feasible. There is also an attempt at balancing the precautions while opening up the passage for decision-making. There are always objectors and critics per se rejecting any idea of leading life to come to an end. The Supreme Court relies on the principle of dignity of life, including death. It is in the pursuit of dignity that the apex court has laid down the guidelines to be followed pending legislation in the matter. It is possible that there will be a small beginning and experience shall dictate the further course of action. From out of the databank relating to these, further fine-tuning should be taken care of in course of drafting and formulating the concerned legislation.
The experience should base itself on a reality check and ought to be pragmatic in keeping with evolving norms of the society. One should anticipate controversies arising out of the implementation of the concept. Precaution and prevention of unwarranted wrong decisions should keep us alert so as to ensures remedies without avoidable delay.
The final determinant is the personal and collective value patterns. This further provides the foundation of individual and collective sensitivity, rationality and integrity. It has been argued that the poverty shall pollute the decision-making process when passive euthanasia is permitted. Such a challenge is bound to continue and linger for some time, evolving a growth of rationality, logical positivism and integrity to the process and the cause. This cloud will over and above the horizons of passive euthanasia and is an inevitable factor that the society must take care of.
The SC judgment has redefined the principles of good medical practice that the treating team should be sensitive to the needs of the patients and should ensure that quality of life at all times, specially at the end of life.
The judgment requires wide publicity with translated copies in regional languages. A new branch of socio-legal activity will commence and the youth power ought to take the lead as their future is at stake. Socially-active elements should create widespread awareness in their local communities regarding the modalities and details of “passive” euthanasia. Moral questions will continue to emerge in every case.
Do you have a moral right to extinguish lifeIJ Inevitably, there will be an element of facilitating death. The euthanasia, suggested by the Supreme Court, is subject to elaborate regulatory process. But every single case will pose its own peculiarities. The law, as laid down, has a lot of responsibility in the hands of professionals. The quality of life and the element of dignity in death have to be harmonised through delicate fine-tuning by human ingenuity.
The sociological shift would harbinger inevitable structural changes in the value-pattern of all concerned being as truthful as death. The collective decision-making is an inevitable requirement. Faithful implementation of the new socio-legal framework is a matter of grave concern. The value system may also undergo a change. Change we must, but change does not spare anyone of us. Surely, this concerns us all!
(The writer, a Senior Advocate, is a former All India Service officer, a former diplomat, a former editor, a former President of Orissa High Court Bar Association and a former Advocate General of Odisha. jayantdas@hotmail.com)