Context: More than four years after its landmark order on passive euthanasia, the Supreme Court said it is for the legislature to enact a law for terminally ill patients choosing to stop treatment but agreed to modify its 2018 guidelines on “Living Will”, an advance medical directive on end-of-life treatment.
What is Passive euthanasia?
Passive euthanasia occurs when the patient dies because the medical professionals either don’t do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive.
- switch off life-support machines
- disconnect a feeding tube
- don’t carry out a life-extending operation
- don’t give life-extending drugs
What is Active euthanasia
- Active euthanasia occurs when the medical professionals, or another person, deliberately do something that causes the patient to die.
What is Living will?
- A living will—also known as an advance directive—is a legal document that specifies the type of medical care that an individual does or does not want in the event they are unable to communicate their wishes.
- In the case of an unconscious person who suffers from a terminal illness, or a life-threatening injury, doctors, and hospitals consult the living will to determine whether or not the patient wants life-sustaining treatment, such as assisted breathing or tube feeding.
- In the absence of a living will, decisions about medical care become the responsibility of the spouse, family members, or other third parties.
- These individuals may be unaware of the patient’s desires, or they may not wish to follow the patient’s unwritten, verbal directives.
Passive Euthanasia in India
- The Supreme Court delivered a landmark judgment in 2018 allowing “living will” where, an adult in his conscious mind, is permitted to refuse medical treatment or voluntarily decide not to take medical treatment to embrace death in a natural way.
- In the 538-page judgment, the court laid down a set of guidelines for “living will” and defined passive euthanasia and euthanasia as well.
- The court stated the rights of a patient would not fall out of the purview of Article 21 (right to life and liberty) of the Indian Constitution.
Key disputes in the controversy over euthanasia
- Killing vs. letting die: There is dispute over whether killing a patient is really any worse than letting the patient die if both result in the same outcome.
- The distinction between killing and letting die is controversial in healthcare because critics charge there is no proper moral basis for the distinction. They say that killing the above patient brings about the same end as letting the patient die. Others object to this and claim that the nature of the act of killing is different than letting die in ways that make it morally wrong.
- Ordinary vs. extraordinary treatment: Ordinary medical treatment includes stopping bleeding, administering pain killers and antibiotics, and setting fractures. But using a mechanical ventilator to keep a patient breathing is sometimes considered extraordinary treatment or care. Some ethicists believe letting a patient die by withholding or withdrawing artificial treatment or care is acceptable but withholding or withdrawing ordinary treatment or care is not. This view is controversial. Some claim the distinction between ordinary and extraordinary treatment is artificial, contrived, vague, or constantly changing as technology progresses
- Death intended vs. anticipated: Some ethicists believe that if a suffering, terminally ill patient dies because of intentionally receiving pain-relieving medications, it makes a difference whether the death itself was intended or merely anticipated. If the death was intended, it is wrong but if the death was anticipated it might be morally acceptable. This reasoning relies on the moral principle called the principle of double effect.
Current Issue
- The Constitution bench was considering a plea seeking modification of the guidelines for living will/advance medical directive issued by it in 2018.
- SC agreed to modify its 2018 guidelines on “living will”, an advance medical directive on end-of-life treatment.
- A five-judge Constitution bench of Justices KM Joseph, Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy and Justice CT Ravikumar observed that the legislature is much more endowed with “skills and sources of knowledge” to enact a relevant law for terminally ill patients choosing to stop treatment.
- The apex court was informed that the procedure under the Supreme Court guidelines had become unworkable due to the involvement of multiple stakeholders in the process.