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The term Euthanasia comes from two Ancient Greek words: ‘Eu’ means ‘Good’, and ‘thantos’ means ‘death’, so Euthanasia means good death. It is an act or practice of ending the life of an individual suffering from a terminal illness or in an incurable condition by injection or by suspending extraordinary medical treatment in order to free him of intolerable pain or from terminal illness.
Euthanasia is defined as an intentional killing by an act or omission of person whose life is felt is not to be worth living. It is also known as ‘Mercy Killing’ which is an act where the individual who is in an irremediable condition or has no chances of survival as he is suffering from painful life, ends his life in a painless manner.
‘Right to life’ including the right to live with human dignity would mean the existence of such right up to the end of natural life. This may include the right of a dying man to die with dignity. But the ‘right to die with dignity’ is not to be confused with the ‘right to die’ an unnatural death curtailing the natural span of life. Thus the concept of right to life is central to the debate on the issue of Euthanasia.
Types of Euthanasia
Active euthanasia- it is also known as ‘Positive Euthanasia’ or ‘Aggressive Euthanasia’. It refers to causing intentional death of a human being by direct intervention. It is a direct action performed to end useless life and a meaningless existence. For example by giving lethal doses of a drug or by giving a lethal injection. Active euthanasia is usually a quicker means of causing death and all forms of active euthanasia are illegal.
Passive euthanasia- it is also known as ‘Negative Euthanasia’ or ‘Non-Aggressive Euthanasia’. It is intentionally causing death by not providing essential, necessary and ordinary care or food and water. It implies discontinuing, withdrawing or removing artificial life support systems. Passive euthanasia is usually slower and more uncomfortable than active. Most forms of voluntary, passive and some instance of non-voluntary, passive euthanasia are legal.
Voluntary euthanasia- when the person who is killed has requested to be killed.
Non-voluntary euthanasia- when the person who is killed made no request and gave no consent. In other words, it is done when the person is unable to communicate his wishes, being in a coma.
Involuntary euthanasia- when the person who is killed made an expressed wish to the contrary. In other words, it is involuntary when the person killed gives his consent not to die.
Euthanasia In Law Of Torts
Since the concept of euthanasia revolves around doctors and medical professionals it becomes imperative to view the issue in relation to the law of torts. The concept of medical negligence today can be considered to be a wing of negligence as a tort. The only assurance that a professional can render to the patient is that he possesses the required skill and competence while performing the task undertaken. A medical professional owes certain duties towards the patient –
1. A duty of care in deciding whether to undertake a particular case.
2. A duty of care in deciding what treatment to give.
3. A duty of care to be exercised while administering that treatment properly.
A breach of any of these duties can give the patient a right to sue under negligence. He would however not be liable if he acted in accordance with a practice accepted as proper by a reasonable number of skilled medical men. Under common law, a doctor cannot lawfully operate on an adult person of sound mind without their consent or he will be liable for trespass. But if the person is incapable due to some reasons to give consent the doctor can undertake the treatment if that is in the best interests of the patient or can save his life. Same is the case of an insensate person who has no chance of recovery if that patient gives his consent through a living will or otherwise for removal of the crucial life support system. A minor is generally considered as not having the required capacity to form an informed consent to crucial medical treatments. In such a case, the guardian, parent or a person in loco parentis must consent although it has been suggested that if the child is over 13 years old, his consent should also be obtained. In India however a patient still does not hold the right to decide for his treatment.
Euthanasia in torts
Imposing a tortuous liability in euthanasia cases can lead to recovery for assault, battery or intentional infliction of mental stress. Involuntary euthanasia is a battery no matter whether the person administering it is a specialist or not. In action under tort law for euthanasia, it is not always that the physician is liable
Many who debate on the issue of euthanasia being legalized raise these questions as to what if the person doesn’t want to die? What if his relatives or family members who are trusted to make a reasonable and informed decision on the patient’s behalf are impregnated with malicious and selfish motives? In order to keep these possibilities at bay, many countries have adopted advanced healthcare directives such as living will.
A living will is a document wherein a person specifies as to how would he as a patient want to be treated or what actions should be taken for their health if they become seriously ill or are no longer in a position to make decisions for themselves or communicate them because of their illness or incapacity. Living wills are also called active declarations. A living will is thus not an instrument of euthanasia, but a request to the doctors in advance to give or not to give certain medical treatments.
Living will has certain advantages –
- Respects a patient’s right to reject certain medical treatment.
- They guide family members and relatives in taking difficult yet crucial decisions.
- Knowing what the patient wants helps doctors give treatment accordingly.
Difference between Suicide and Euthanasia
There is a conceptual distinction between suicide and euthanasia. In a suicide a man voluntarily kills himself by stabbing, poisoning or by any other way. No doubt in suicide one intentionally attempts to take his life. It is an act or instance of intentionally killing oneself mostly due to depression or various reasons such as frustration in love, failure in examinations or in getting a good job etc. on the other hand, in euthanasia there is an action of some other person to bring to an end the life of a third person. In euthanasia, a third person is either actively or passively involved i.e he aids or abets the killing of another person. It is important to mention in this context that there is also a difference between ‘assisted suicide’ and ‘euthanasia’. Assisted suicide is an act which intentionally helps another to commit suicide, for example by providing him with the means to do so. When it is a doctor who helps a patient to kill himself (by providing a prescription for lethal medication) it is a ‘physician assisted suicide’. Thus, in assisted suicide the patient is in complete control of the process that leads to death because he/she is the person who performs the act of suicide. The other person simply helps (for example, providing the means for carrying out the action). On the other hand euthanasia may be active such as when a doctor gives a lethal injection to a patient or passive such as when a doctor removes life support system of the patient.
Arguments against euthanasia
Eliminating the invalid: Euthanasia opposers argue that if we embrace ‘the right to death with dignity’, people with incurable and debilitating illnesses will be disposed from our civilised society. The practice of palliative care counters this view, as palliative care would provide relief from distressing symptoms and pain, and support to the patient as well as the caregiver. Palliative care is an active, compassionate and creative care for the dying.
Constitution of India: ‘Right to life’ is a natural right embodied in Article 21 but suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of ‘right to life’. It is the duty of the State to protect life and the physician’s duty to provide care and not to harm patients. If euthanasia is legalised, then there is a grave apprehension that the State may refuse to invest in health (working towards Right to life). Legalised euthanasia has led to a severe decline in the quality of care for terminally-ill patients in Holland. Hence, in a welfare state there should not be any role of euthanasia in any form.
Symptoms Of Mental Illness- Attempts to suicide or completed suicide are commonly seen in patients suffering from depression, schizophrenia and substance users. It is also documented in patients suffering from obsessive compulsive disorder. Hence, it is essential to assess the mental status of the individual seeking for euthanasia. In classical teaching, attempt to suicide is a psychiatric emergency and it is considered a is a desperate call for help or assistance. Several guidelines have been formulated for management of suicidal patients in psychiatry. Hence, attempted suicide is considered as a sign of mental illness.
Malafide intention- In the era of declining morality and justice, there is a possibility of misusing euthanasia by family members or relatives for inheriting the property of the patient. The Supreme Court has also raised this issue in the recent judgement. ‘Mercy killing’ should not lead to ‘killing mercy’ in the hands of the noble medical professionals. Hence, to keep control over the medical professionals, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 discusses euthanasia briefly in Chapter 6, Section 6.7 and it is in accordance with the provisions of the Transplantation of Human Organ Act, 1994. There is an urgent need to protect patients and also medical practitioners caring for terminally ill patients from unnecessary lawsuits. Law commission had submitted a report (no-196) to the government on this issue.
Arguments In Favor Of Euthanasia
Caregivers burden: ‘Right-to-die’ supporters argue that people who have an incurable, degenerative, disabling or debilitating condition should be allowed to die in dignity. This argument is further defended for those, who have chronic debilitating illness even though it is not terminal such as severe mental illness. Majority of such petitions are filed by the sufferers or family members or their caretakers. The caregiver’s burden is huge and cuts across various domains such as financial, emotional, time, physical, mental and social. Hence, it is uncommon to hear requests from the family members of the person with psychiatric illness to give some poison either to the patient or else to them. Coupled with the States inefficiency, apathy and no investment on health is mockery of the ‘Right to life’.
Refusing care: Right to refuse medical treatment is well recognised in law, including medical treatment that sustains or prolongs life. For example, a patient suffering from blood cancer can refuse treatment or deny feeds through a nasogastric tube. Recognition of right to refuse treatment gives a way for passive euthanasia. Many do argue that allowing medical termination of pregnancy before 16 week is also a form of active involuntary euthanasia. This issue of mercy killing of deformed babies has already been in discussion in Holland.
Right to die: Many patients in a persistent vegetative state or else in chronic illness, do not want to be a burden on their family members. Euthanasia can be considered as a way to upheld the ‘Right to life’ by honouring ‘Right to die’ with dignity.
Encouraging the organ transplantation:
Euthanasia in terminally ill patients provides an opportunity to advocate for organ donation. This in turn will help many patients with organ failure waiting for transplantation. Not only euthanasia gives ‘Right to die’ for the terminally ill, but also ‘Right to life’ for the organ needy patients.
It is proven that euthanasia provides a way to relieve the individual from the mammoth of sufferings as though they are alive on a burning pyre of intolerable pain. It gives the right to the beings to evaluate their essence of life and live and end it in a dignified manner without any force. However, if it were to be legalized in India, there should be a requirement of stringent and well-structured laws that would guarantee the consent and will of the individual, monitoring the failure of all medical resources and methods to revive the person, intentions of the caregivers and medical officials, proper ways to ensure that no abuse of the law takes place and the review of circumstances under which the euthanasia is to be allowed.