Euthanasia

Why in news: U.K. introduced the Terminally Ill Adults (End of Life) Bill, also known as the Assisted Dying Bill.

• Allows terminally ill adults in England and Wales with less than six months to live to choose assisted death under strict safeguards. It would require validation by two doctors, a psychiatrist, a senior lawyer, and a social worker.
• The distinction between “active” and “passive” euthanasia goes beyond the binary of “act versus omission”, said SC judge. The distinction lies in the source of the harm that leads to death, not merely the nature of the conduct.
• Active euthanasia involves causing death by introducing a new, external agency of harm such as a lethal injection. In such cases, death is not the result of the patient’s underlying illness but of an intervention. Illegal in India.
• Passive euthanasia means allowing death to occur. By withdrawing or withholding life support, the physician is not creating a new risk of death. Doctors allow the underlying fatal condition to take its natural course. This happens by not continuing medical interventions that were artificially prolonging life.

Indian Supreme Court:

• Gian Kaur v State of Punjab (1996) distinguished suicide from acceleration of natural death. Held right to live with dignity includes right to die with dignity when life is ebbing out.
• 196th Law Commission Report (2006) recommended no criminal liability for withdrawal in best interests.
• Aruna Shanbaug case (2011) led to guidelines on withholding treatment. Court relied on comparative jurisprudence.
• 241st Law Commission Report reiterated earlier suggestions.
• Medical Treatment of Terminally-Ill Patients Bill, 2016 published but no follow-up.
• Common Cause (2018) laid down procedures for withdrawal of life support. Included provision for Advance Medical Directives (AMDs). Need for judicial intervention due to absence of law. Court expressed hope for a specific Law. 2023 judgment simplified procedure for AMDs. 2024 government guidelines issued for public consultation.

Indian Government:

• Ministry of Health released draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients to operationalise the Supreme Court’s 2018 and 2023 orders on right to die with dignity for all Indians.
• Guidelines include:
  • Setting up of Primary and Secondary Medical Boards at level of hospital, which will determine when further medical treatment may not be beneficial to a terminally ill patient;
  • Nomination of doctors by district CMO or equivalent to hospital-level Secondary Medical Boards, which will confirm or reject opinion of Primary Medical Boards. Secondary Medical Board members must be different from those on the Primary Medical Board.
• There is no dedicated legislation in India on withholding/withdrawing life-sustaining treatment. But SC’s judgment and these guidelines make it clear that withholding/withdrawing life-sustaining treatment is legal.
• SC in Common Cause vs Union of India (2018) recognised right to die with dignity under Article 21.
• Withdrawal of life-sustaining treatment takes place either through informed refusal by a patient with decision-making capacity or through an advance medical directive (‘living will’). SC in its 2018 judgment also laid down framework for making advance medical directives or living wills and simplified it in 2023.
• Living wills are written documents made by a person of age 18 years or older with decision-making capacity, expressing their will on how they would wish to be treated if they lose such capacity.
• It should detail at least two surrogate decision-makers — anyone whom the person trusts, from family to neighbours, who can make decisions on behalf of the person if they lose decision-making capacity. It becomes legal when it is signed in presence of executor and 2 witnesses, and attested before a notary or gazetted officer.
• Hospital must notify decisions on withdrawing life-sustaining treatment to the local judicial magistrate.
• Government Medical College Hospital in Kerala’s Kollam district opened a ‘Living Will Information Counter’ to spread awareness & became the first hospital in the country to establish such a counter.