Life, Death, And Dignity - Euthanasia In India And The United States
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Category: General Law
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LIFE, DEATH, AND DIGNITY: EUTHANASIA IN INDIA AND
THE UNITED STATES
Kunwar Kushagra Srivastava, Assistant Professor of Law, City Law College, Lucknow University
ABSTRACT
This paper will discuss about the legal aspects of passive euthanasia in various states of the USA and the Republic of India. Furthermore, the evolution of the legislations in different states will be discussed along with the role of judiciary in legalising or criminalising the act of “Physician Assisted Suicide”. In context of India, the active role of Supreme Court will be discussed in cases which have no parliamentary or state legislations to look up to. In the end a comparison is drawn between the two countries and the need for relevant legislations is discussed.
Introduction The objective of euthanasia is to eliminate the suffering of a fatally ill patient, and the term can refer to either the act or the practise. Anyone with a fatal or debilitating bodily disease, or anyone who intends to be executed by denying therapeutics or discontinuing support systems for life, is legally allowed to seek euthanasia. This operation can be carried out at the patient's appeal or in the event that the patient is unable to come to a decision, in which case the choice can be decided by the family, the treating physician, or the court1. Euthanasia has been the subject of fierce debate and theological, moral, and practical reasons for a long time. The India's Supreme Court held a landmark ruling on the legalisation of passive euthanasia on March 9, 2018.
Legalizing the withdrawal of continuous care for those in a persistent vegetative state, India's Supreme Court effectively legalised passive euthanasia. The ruling came up as a consequence of the case of Aruna Shanbaug, who was in a PVS (Persistent Vegetative State) until her death in 20152. Assisted suicide, or euthanasia, is a hotly debated topic in modern society. A look at the state of the art in scientific and legal knowledge reveals, however, that this topic is contentious and complex, including a number of competing theoretical frameworks and viewpoints3. The morality of assisted suicide is a pressing issue in the twenty-first century. In light of the recent, dramatic shift in public sentiment in favour of legalising assisted suicide and euthanasia, this is of paramount importance.
This is an expanded inquiry since it affects not just doctors and patients, but also politicians, philosophers, and the general populace. Withholding or withdrawing therapy or artificial life-support measures in the event of an untreatable patient or incapacitating physical disease, or in the case of a person who wishes to 1 Mani RK, “Guidelines for End-of-Life and Palliative Care in Indian Intensive Care Units' ISCCM Consensus Ethical Position Statement” (Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication Of Indian Society Of Critical Care Medicine, July 2012).
2 “Supreme Court: Passive Euthanasia: Landmark Ruling - Supreme Court Says Passive Euthanasia Is
Permissible” (The Economic Times) ;https://economictimes.indiatimes.com/news/politics-and-nation/landmarkruling-supremecourt-says-passive-euthanasia-is-permissible-withriders/articleshow/63228770.cms?from=mdr> accessed on October 10, 2024 . 3 “Euthanasia and the Dignity of Dying. Bioethics Material. Unit of Humanities and Medical Ethics - Unit of Humanities and Medical Ethics” (Humanities and Medical Ethics Unit) ;https://en.unav.edu/web/humanitiesandmedical-ethics-unit/bioethics-material/eutanasia-y-dignidad-del-morir> accessed October 11, 2024.
die, is characterised as euthanasia. In addition, the overwhelming majority of euthanasia narratives portray a scenario in which the patient actively seeks death. “There might be various forms of death (shortening life)4. They are for example”: Physician Assisted Suicide: During this type of PAS, a doctor aids a patient in committing suicide by providing them with the means to do so, such as prescription medication or access to online suicide resources5. Non-Voluntary Euthanasia: In this, the patient has not made a request to die on his own accord, but rather, an agent on his behalf has made such a request, and the carers has carried it out by either causing the patient's death or by continuing to provide life-sustaining treatment or withdrawing it.
Good Medical or Palliative Care: Treatment for the fatally sick that is both curative and palliative may include the use of drugs or procedures that shorten the patient's life expectancy. “Assertions on euthanasia centred on the individual liberty of the patient, the quality of their lives (and death), and the mitigation of unwarranted and unavoidable misery, the survival of patient's dignity during the dying process and use of the most advanced medical technologies to prolong their own lives, the need for current practise for legal safeguards, and the need to respond to shifting public and professional attitudes about euthanasia5”. Classification of Euthanasia All across the world, individuals have intense opinions about the controversial practise of euthanasia, which can be either "voluntary or involuntary, passive or aggressive".
Different forms of euthanasia are examined, as is the refusal to service the patient for that purpose. It may be broken down even further into two distinct categories: suicide and suicide with the aid of a doctor. 4 Fontalis A, Prousali E and Kulkarni K, “Euthanasia and Assisted Dying: What Is the Current Position and What Are the Key Arguments Informing the Debate? ” (Journal of the Royal Society of Medicine, November 2018). 5“Physician-Assisted Suicide” (American Medical Association); https://www. amaassn. org/deliveringcare/ethics/physician-assisted-suicide> accessed October 10, 2024. 5 Math SB and Chaturvedi SK, “Euthanasia: Right to Life vs Right to Die” (The Indian journal of Medical Research December 2012).
There is consensus in the medical and bioethical literature on whether or not the intentional or unintentional killing of a patient constitutes euthanasia. Beauchamp, Davidson, and later Wren all provided definitions of euthanasia that may have provided justification for the practise, even if they did not include patient consent as one of their conditions. Others, though, insist that getting people's permission is crucial. These are the major categories into which euthanasia can be placed: Active Euthanasia It is the deliberate administration of a fatal dose of medication or the use of other means to end the life of a person who is enduring excruciating pain. Murder at a medical facility is the premeditated slaughter of a patient. It entails actively killing individuals, either by giving them lethal injections or by some other methods6.
Unless otherwise permitted by law, active euthanasia is always illegal. According to Section
302 of the Indian Penal Code, 1860, euthanasia is a punishable offence. In the United States,
assisted suicide, including euthanasia, is against the law and the constitution. Active euthanasia is forbidden and only passive euthanasia is allowed. “A doctor provides aid in the commission of the crime under Section 306 IPC (suicide abetment). In active euthanasia, the patient is actively executed by injecting them with a lethal dose of a drug like sodium pentothal, which puts them to sleep so completely that they pass away within a few seconds”. Passive Euthanasia By withdrawing all artificial means of support for the patient's life, passive euthanasia hastens the dying process and allows for a more natural passing. By withdrawing life-sustaining interventions including ventilators, drugs, feeding tubes, and even food and drink, a patient can be allowed to die of natural causes.
Several families are requesting the doctor to relieve the patient if the patient is very ill and has little chance of recovery, and this is nothing new for the average person to hear. A patient gets
6 “Ethics - Euthanasia: Active and Passive Euthanasia” (BBC)
https://www.bbc.co.uk/ethics/euthanasia/overview/activepassive_1.shtml> accessed October 11, 2024.
released from the hospital at the behest of his or her loved ones, only to perish a short time later. Passive euthanasia in India was first brought up and examined in “Aruna Ramachandra Shanbaug v. Union of India and Ors. ” As well, it was claimed that withdrawal of life-sustaining treatments (i. e. , passive euthanasia) was legal in India. If doctors respect a terminally sick patient's wishes and do not use life-sustaining measures like the ventilator, this is not euthanasia, even if the patient lacks capacity for further decision-making. The removal of essential life support equipment is permitted by law, as shown by prior cases in our nation and those from other countries cited in the introduction. Therefore, what is commonly referred to as "passive euthanasia" is perfectly legal here in the United States.
In their decision in the Common Cause case, the justices also advanced the idea of living will and made passive euthanasia acceptable. “There are three broad categories into which both active and passive euthanasia can be placed: voluntary, non-voluntary, and involuntary”7. Voluntary Euthanasia It is a practise of administering deadly medications to a terminally ill patient in order to terminate their lives peacefully and without suffering. Volunteer euthanasia is an option for anyone dealing with an unpleasant or severe sickness or an ongoing illness. A member of the patient's family cannot coerce or otherwise influence such an application. The main case for legalising active voluntary euthanasia centres on the rights of the individual and the autonomy of the individual's will. The greatest good for the greatest number of people would be achieved if the sick died painlessly.
Human dignity is intrinsically tied to the notion of self-determination. Human dignity, according to its proponents, necessitates that individuals have autonomy over major life decisions including when and how to end their own lives, and that their wishes about these matters be honoured by their peers8.
7 Ash T, “Euthanasia: A Good Thing?” (Open Democracy, June 2011)
https://www.opendemocracy.net/en/euthanasia-good-thing/> accessed October 10, 2024. 8 “[‘Dignity’ at the End of Life: Ethical and Deontologic Reflections]” (Recent Progress in Medicine) ;https://pubmed.ncbi.nlm.nih.gov/26780067/> accessed October 11, 2024.
The proponents argue that their position is the moral one. Professor Dowry thinks people are sacred and that everyone ought to be treated with respect. Everyone has an obligation to treat others with dignity. Allowing or aiding the death of a very ill patient is ethically justifiable yet illegal. It is possible for any action to be ethically acceptable yet legally forbidden. The rising public interest in assisted suicide is another point of contention9. In voluntary active euthanasia, the patient actively consents to the doctor killing them. It should be noted that for euthanasia to be considered "voluntary," the patient must be competent in making decisions, i. e. , able to grasp the potential outcomes of their decisions. In voluntary passive euthanasia, the doctor stops or reduces life-sustaining therapy such that the patient dies of their sickness or injuries.
Retaining or discontinuing medical treatment is done at the patient's appeal and, hence, with the patient's permission. Non-Voluntary Euthanasia In this case, the doctor deliberately executes the patient, even if the person being executed can't give his or her assent or make any pleas. A patient may be in a coma or deemed incompetent, making it impossible to gain his consent. The term "non-voluntary euthanasia" refers to situations in which a patient's permission is not possible, such as in the case of a “patient in a coma or another persistent vegetative state”. Involuntary Euthanasia There is a new concept in euthanasia known as "involuntary euthanasia," in which a patient is not required to ask for assistance in dying or in ending their own excruciating suffering.
Unintentional or involuntary euthanasia refers to situations in which a patient requests their own death but has no control over the process. The alleviation of a patient's pain or suffering justifies both voluntary and involuntary euthanasia. Moreover, the plea to die and the intention to end one's life are diametrically opposed to one another. In the case of individuals in a persistent vegetative state (PVS), they lose all mental and physical faculties but continue to 9 International Journal of Legal Developments and Allied Issues, “Protection of Women's Rights and Dignity: A Social Responsibility” (The Law Brigade Publishers (India), March 2019); https://thelawbrigade. com/constitutionallaw/protection-of-womens-rights-and-dignity-a-socialresponsibility/> accessed October 10, 2024.
exhibit biological activity even while in a completely vegetative condition. There is no chance of recovery at this point10. In inadvertent passive euthanasia, the doctor intentionally allows the patient to die by stopping or withdrawing lifetime therapy. When patient permission is required but not obtained, treatment is withheld or discontinued without the patient's knowledge or approval. Statutes and Euthanasia India In India, 'righteousness of life' is held in the highest regard. The Indian Constitution guarantees each citizen the "Right to life and personal liberty under Article 21”. Article 21 of the Indian Constitution protects both the right to life and the right to freedom. This right may not be denied or infringed upon in any way11. This places a duty on the State to ensure the safety of its citizens and defend their right to live as they see fit.
However, it also states that the state may deprive an individual of life or personal liberty in accordance with the method set forth by the legal state. Maneka Gandhi v. Union of India, decided by India's highest court, emphasised that legal processes should be fair and reasonable rather than arbitrary and oppressive. Article 21 of the Constitution, which guarantees the right to life and personal liberty to all people, has assumed the role of contemplative pervasiveness in the plan for basic rights. Therefore, it was appropriately labeled the basic of fundamental rights and transformed into a haven for human ideals. But now we have a serious problem that may be understood in so many different ways that it even encompasses the right to die with grace. The High Court and the Supreme Court of India reached opposite conclusions on this issue.
The Indian Penal Code Section 309 (Attempt to Suicide) One can certainly see why suicide should not be illegal. Attempts to commit suicide, however, 10 “Euthanasia” (Euthanasia - MU School of Medicine); https://medicine. missouri. edu/centers-instituteslabs/healthethics/faq/euthanasia> accessed October 10, 2024. Bhardwaj
P,
“Article Archives”
(SCC
Blog, October 2022); https://www.scconline.com/blog/post/tag/article-/> accessed October 12, 2024.
are illegal and punished under “Section 309 of the Indian Penal Code (IPC)”. Section 309 of the IPC has been the focus of much discussion in the country. To examine the validity of this Section, the Supreme Court and the Hight Court in India have reached opposite conclusions. There was discussion on a national level about removing criminal penalties for suicide attempts. “The Indian Law Commission, in its 210th Report Humanization and Decriminalization of Attempt to Suicide, also advocated for the repeal of Section 309”12. The Supreme Court recommended Parliament look into whether or not this section of the Statute might be removed in 2011. Suicide attempts are no longer criminalised under the Mental Health Care Act of 2017, which effectively decriminalised such acts beginning in July 2018.
In light of the recent passage of the Mental Healthcare Bill, the suicide attempt is currently not considered a criminal act. “Section 115 of the Act specifies that despite anything in Section 309 of the IPC, anybody attempting suicide is presumed to be extremely stressed and not pursued and prosecuted according to that Code until otherwise proved”13. Nevertheless, this legislation would only apply to those who suffer from mental disease. The Supreme Court's Justice Chandrachud cited Section 115(2) of the Mental Health Act, which requires authorities to give only treatment, counselling, & rehabilitation to an individual who is extremely stressed and attempting suicide. This section demonstrates a sea change in how people in society think about and attempt suicide.
By seeing someone who attempts suicide as someone in need of care, therapy, and rehabilitation rather than criminal punishment, the bill aims to bring Indian law in line with new understandings of suicide. With the Bhartiya Nyaya Sanhita now in force, it has decriminalised the offence of ‘Attempt to Suicide’ except when it is done in order to compel or restrain a public servant from performing his official duties, under Section 226. Section 306 (Abetment of Suicide) / Section 108 of the Bharatiya Nyaya Sanhita (BNS) According to Section 306 of the Indian Penal Code/ Section 108 of the BNS, it is illegal to aid someone who is attempting suicide. Thus, it is quite evident that a violation of Section 306, IPC/ Sec.
108, BNS would result in criminal penalties for anybody who assists or purposefully 12 Ranjan R, “(De-) Criminalization of Attempted Suicide in India: A Review” (Industrial Psychiatry Journal, January 2014). 13 Sinha B, “Is Attempt to Suicide Punishable? Two Laws Have Opposing Views, SC Seeks Govt's Response” (The Print, September 2020), https://theprint. in/judiciary/is-attempt-to-suicide-punishable-two-laws-haveopposingviews-sc-seeks-govt-response/500905/> accessed October 10, 2024.
aids another person in committing suicide. Consequently, under our Penal Code, both attempting suicide and assisting suicide (including physician-assisted suicide) are considered criminal offences. Therefore, it must be emphasised that an attempt was made to have Section
306 declared unconstitutional in Indian courts. The judicial perspective on the issue is further
upon. Section 300 (Culpable Homicide Amounting to Murder) / Section 101 of BNS Euthanasia is against the law in India according to the IPC. Since the doctor obviously intends to murder the patient, this case falls under Section 300(1) of the Code. Murder is defined as “culpable homicide” under section 300 of the Indian Penal Code. When used as an adjective, homicide refers to an act of slashing or murder. As such, it refers to the act of one person murdering another. Homicide can be either justified or not, depending on the circumstances. “Legal murder is covered by the general defences in Chapter IV of the IPC, whereas illegal or culpable homicide is specified under Section 299 of the IPC”14. If the permission is provided with the intent to inflict death or grave damage, then the accused has no defence under Section
87 of Chapter IV, General Defenses, of IPC. As a result, the prohibition is both unconditional
and absolute with respect to death, while the intensity of the crime may be modified by the offender's permission. But in the first place, Section 92 of the IPC would make both forcible and non-voluntary euthanasia unlawful. There is currently no euthanasia law in India. Judgments handed down by the Honorable Supreme Court, beginning with Rathinam's case15 and continuing with the current case of Aruna Shaunbag16 and Common Cause, are putting the legislation into effect in the country. Under a twist of fate, both rulings found that, in exceptional circumstances, the right to life dignity encompasses the right to die. The Five Judge Constitutional Bench of the Indian Supreme Court ruled in a historic case that Article 21 of our Constitution's guarantee of life and liberty is meaningless if it does not also protect people's privacy and other personal freedoms.
In light of the Court's development throughout time, Article 21 now includes the right to a dignified existence alongside the right to life and freedom.
14 Walia IK, “Euthanasia: Right to Die” (SSRN, May 2010)
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1616264> accessed October 10, 2024.
15 P.Rathinam v. Union Of India , 1994 AIR 1844.
16 Aruna Ramchandra Shanbaug v. Union of India (2011) 4 SCC 454.
The Bench also ruled that those who are terminally sick or have little chance of recovery have the right to a more dignified dying in a persistent vegetative state. Dietary convenience and human decency may be compromised in the absence of statutory recognition of preemptive medical recommendations. Reviewing the situation in various jurisdictions reveals that Advance Directives have been granted legal legitimacy by law and judicial judgments in certain jurisdictions and specific countries. The sanctity of life must always come first, but the Advance Directive and the patient's right to self-determination must also be honoured while caring for terminally ill patients with no hope of recovery. The procedure described below will take precedence in the absence of a valid Advance Directive. In the absence of an Advance Directive, the method outlined for this group will take precedence.
If it is determined that passive euthanasia is an appropriate palliative remedy, then the best interest of the patient must supersede the interest of the State. The Bench has established the rules on how to carry out an advance directive and how to use the authority granted by Article 142 of the Constitution in the event of a passive euthanasia. United States of America "Washington, DC, and the states of California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, and Washington" permit assisted suicide. In the case of Baxter v. Montana, the state's highest court ruled that "nothing in Montana Supreme Court precedent or Montana legislation indicates that medical help in dying is against public policy," despite the fact that the legality of physician-assisted suicide remains in doubt in the state.
It wasn't until 1828 that New York passed the first American law specifically prohibiting aiding a suicide. This is the New York Laws of 1828, Chapter 20, Section 4. Following New York's lead, several of the new states and territories did the same. “Between 1857 and 1865, a commission in New York led by Dudley Field drafted a criminal code that made it illegal to assist a suicide and, more specifically, to furnish another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life”. Before the Fourteenth Amendment was established, it was illegal in most states to provide aid to someone attempting suicide17. “The wording of the Field Penal Code, which was approved
17 “Department of Health” (Chapter 4 - Decisions at Life's End: Existing Law)
in the Dakota Territory in 1877 and the State of New York in 1881, served as a model for the legislation of numerous additional western States in the late 19th and early 20th centuries”. Using language identical to those of the Field Code, the state of California enacted a law in
1874 prohibiting assisted suicide.
By the turn of the century, significant advances had been made in the field of medicine. A bill to legalise euthanasia in Ohio was voted down by a margin of 79 to 23 in the state legislature in 1905–1906. Another failed proposal to legalise euthanasia in 1906 would have extended the practise to "hideously disfigured or stupid children," in addition to terminally ill adults. Public support for euthanasia declined after 190618. In 1937, a Nebraska senator named John Comstock rekindled interest in euthanasia by proposing the "Voluntary Euthanasia Act," which would have made euthanasia legal in the United States. It was never put to a vote, but it marked a turning point in the growing attention of politicians in the issue. The Death with Dignity Act of 1994 in Oregon is the first law in the United States to legalise assisted suicide.
At the present time, assisted suicide is illegal in 36 of the 50 states in the United States, while its legality is ambiguous or undefined in the remaining 4 states due to the lack of legislation on the subject, the lack of recognition of common law, or both. Whereas, all fifty states and the District of Columbia have a prohibition on euthanasia and assisted suicide under general murder statutes but the federal government does not. Currently, physician assisted suicide is permitted in nine states and the District of Columbia by law, and in Montana through a court judgement. Oregon The Death with Dignity Act of Oregon was passed in 1994 and was ratified by voters in 1997. As in other jurisdictions with aid-in-dying legislation, Oregon law mandates that terminally ill people who choose to end their life do so by self-administering the deadly amount of medicine. https://www. health. ny.
gov/regulations/task_force/reports_publications/when_death_is_sought/chap4. htm> accessed October 10, 2024. 18 Picón-Jaimes YA, “Euthanasia and Assisted Suicide: An In-Depth Review of Relevant Historical Aspects” (Annals of Medicine and Surgery (2012)).
Capitol Hill, DC
A death with dignity statute was passed in Washington State in 2009, making it the second state
to do so. Under the new law, patients must have fewer than six months to live before they may make the request for the deadly number of drugs. Montana As a result of a court battle in 2009, the choice to terminate one's life is now lawful in Montana. In Baxter v. Montana, the state supreme court declared that a doctor is not breaking the law by giving a terminally sick patient drugs to commit suicide. There have been repeated attempts by state legislators to pass legislation prohibiting this sort of behaviour, but thus far, they have all failed. Vermont In 2013, Vermont passed the Patient Choice and Control at the End of Life Act. It was the first state to pass a legislation explicitly legalising assisted suicide without resorting to a popular vote or a judicial challenge. Colorado In 2016, Colorado voters approved the End of Life Options Act with a 65 percent margin of victory.
According to data compiled by the Colorado Department of Public Health and Environment, 125 people were legally prescribed medicine to help in dying in 2018. California The End of Life Option Act became law in California in 2016. Of the 632 patients who initiated the end-of-life option in 2017, 577 were given medication to help them die. Patients in California must make two separate spoken requests for the prescription at least 15 days apart in order to comply with the legislation. Hawaii In 2019, Hawaii became the first state to legalise medical assistance in dying.
State of New Jersey The Medical Assistance in Dying for the Terminally Ill Act in New Jersey became law on August 1, 2019. Any patient desiring to obtain life-ending drugs must have two doctors attest to the fact that they have less than six months to live. Maine Specifically, it enacts the Maine Death with Dignity Act, which allows a person who is 18 or older, meets certain requirements, and whose treating physician has determined that the patient has a terminal disease as defined by the Act to request medication prescribed for the purpose of ending the patient's life. The State of New Mexico Medical assistance in dying is not considered "suicide" in the eyes of the law, as stated in the "Elizabeth Whitefield End of Life Options Act. " Those who may be there at the end, such as doctors, nurses, and family members, are immune from punishment for "assisting suicide.
" In addition, doing what has to be done in good faith to comply with the law should not be seen as incompetence or negligence. Patients, doctors, and pharmacists all have the option of declining medical help in dying. Involvement is voluntary at everyone's discretion19. From what has been described, it is evident that India lags far behind the United States in terms of the legislative development of legislation pertaining to euthanasia or, more generally, physician-assisted suicide. Due to the federal nature of the United States, this is not yet legal in all of the states, but the spark lit in these nine will soon set the rest of the country ablaze.
The medical community in the United Jurisdictions may now operate with greater assurance because to a combination of judicial precedents and legislation in some states; in contrast, India relies only on judicial declarations to comprehend the legality of physician aided suicides20. 19 “Research Publications” (Medical Assistance in Dying: The Law in Selected Jurisdictions Outside Canada), https://lop. parl. ca/sites/PublicWebsite/default/en_CA/ResearchPublications/2015116E> accessed October 10, 2024. 20 Morton H (Medical Liability/medical malpractice laws) ;https://www. ncsl. org/research/financial-servicesandcommerce/medical-liability-medical-malpractice-laws. aspx> accessed October 10, 2024.
Euthanasia and Judicial Precedents The purpose of the law is to uphold, safeguard, and advance people's inherent worth and value as human beings. The Act is an effort by the three branches of government—legislative, executive, and judicial—to protect the rights of the people, on behalf of the people, and in the name of the people. Human decency is the foundation of the law. Respect for the law is a sign of human decency. The purpose of the law is to protect people's rights and liberties. Justice, Safety, and Stability are the Holy Trinity of Human Dignity. Therefore, protecting people's dignity requires a three-pronged approach: legislation, enforcement, and rewards21. The judicial system sees itself as a guardian of citizens' basic liberties. In addition to ensuring people's continued existence, it also helps to fortify their legal protections.
It's a process for settling legal disagreements. All parties have a right to prompt and impartial justice from the courts, and the courts must deliver both. The goal of any judicial system should be to present an empire of justice, which is the presentation of eternal truth, in service to the cause of respect and preservation of the dignity of the individual within a specific legal and political jurisdiction. The term "dignity" has a subjective legal meaning. Human dignity is seen as the fundamental principle of the law under a system of government that is ideologically committed to the concept of human dignity.
A judicial system that cowers in the face of legislative and executive powers (often referred to as "judicial restrictions") fails to uphold human dignity in good conscience and does not provide a model for the kind of judicial ideology that should be adopted to ensure the protection of human rights and the maintenance of human dignity in the administration of justice. Judge Manfred Lachs, a former president of the International Court of Justice, has said that every decision the court makes represents either a positive or negative development in the law. Therefore, the judges can't stop them from being the law's essence. India Aruna Shanbaugh v. Union of India22 King Edward Memorial Hospital Junior Nurse Aruna Ramchandra Shanbaug was attacked by ward boy Sohanlal B Valmiki on the evening of November 27, 1973. Valmiki hung a dog chain
21 “Ilo Centenary Declaration for the Future of Work”
https://www.ilo.org/wcmsp5/groups/public/@ed_norm/@relconf/documents/meetingdocument/wcms_711674. pdf& gt; accessed October 10, 2024.
22 Aruna Ramchandra Shanbaug v. Union of India (2011) 4 SCC 454.
around Shanbaug's neck and dragged her back. She was on her period when he tried to rape her, so instead he sodomised her. At one point during the deed, he wrapped the chain around her neck to render her motionless. One of the hospital's cleaners discovered her the following morning at 7:45, unconscious and covered in blood on the floor. Some say she suffered brain damage from lack of oxygen because she was strangled by the dog chain. On January 24, 2011, a journalist named Pinky Virani, who claimed to be her friend, went to the Supreme Court to ask for permission for Aruna Shanbaug to commit suicide. By this time, Aruna Shanbaug was well into her sixties and had been in a vegetative state for more than three decades. Thus, Aruna was in a P. V. S. and essentially dead, without any consciousness and with her brain essentially dead.
She is completely mute and unable to speak in any way, shape, or form. The Writ states that Aruna cannot, under any circumstances, be considered a living human being. It was also said that her condition was catastrophic and that her body had been still on the bed at Mumbai's KEM Hospital for the past 36 years, much like that of a dead animal. The Hon'ble Court appointed a committee to learn more about Aruna's condition after discovering discrepancies between the writ petition filed by Ms. Pinki Virani on behalf of Aruna Shanbaug and the counter affidavit of Dr. Pazare, the Head of KEM hospital where Aruna was being treated following the incident.
The Hon'ble court, after hearing the petition and reviewing the evidence, laid forth the specific matters that must be resolved before rendering a judgement: On March 7, 2011, the Indian Supreme Court announced landmark guidelines enabling passive euthanasia. Even yet, Pinky Virani's Appeal was denied. Aruna Shanbaug passed away on May 18th, 2015. Common Cause v Union of India23 In 2005, Common Cause petitioned the highest federal court under Article 32 to recognise the right to die with dignity as a constitutionally protected freedom guaranteed by Article 21. It
23 Common Cause v Union of India (2018) 5 SCC 1.
also asked the court to instruct the Union Government to implement "living wills" for terminally ill patients so that their wishes would be carried out if they were hospitalised. In its place, Common Cause petitioned the court for direction on the matter and for the establishment of a panel of experts consisting of scientists, physicians, and advocates to assess the future of living wills. On February 25, 2014, a Supreme Court bench consisting of Chief Justice P. Sathasiavn, Justice Ranjan Gogoi, and Justice Shiva Kirti Singh referred the case to a larger bench in light of the lopsided decisions in Aruna Ramchandra Shanbaug v. Union of India & Ors. (2011) and Gian Kaur v. State of Punjab. “Justices Ashok Bhushan, A. K. Sikri, D. Y. Chandrachud, and A. M.
Khanvilkar, sitting on a fivejudge bench presided over by Chief Justice Dipak Misra”, ruled that people have a fundamental right to die with respect and without undue suffering. It is not necessary for a State to pass a law guaranteeing an individual the right to devise advance medical directives, as doing so is an expression of the individual's right to bodily integrity and self-determination. After the Constitution Bench approved passive euthanasia in the case of Gian Kaur, a 3-judge bench ruled that the earlier ruling in Aruna Ramchandra Shanbaug v. Union of India was based on incorrect reasoning. The five-judge panel has now found unanimously that the two-judge panel in Arun Shanbaug erred in its interpretation of the Gian Kaur ruling when it ruled that passive euthanasia may be made legal “only by legislation.
” Noting that “an adult human being with the psychological ability to take a cognizant decision has right to refuse medical care compromising withdrawal from life-saving apparatus,” the article acknowledged the practise of passive euthanasia. The 538-page ruling goes on to detail the procedure for a “Living Will” or “Advance Directive,” which allows the terminally ill or those in deteriorating health to decide in advance that they do not want to be kept alive via artificial means if they subsequently enter a vegetative state in which they are unable to communicate their wishes. United States of America State legislatures should take up the subject of physician-assisted suicide for terminally ill patients head-on, as evidenced by Michigan's handling of Dr. Jack Kevorkian and similar cases.
The year 1990 marked the beginning of Dr. Kevorkian's work aiding those who wanted help killing themselves. The Michigan House of Representatives responded in November 1992 by passing a temporary assisted suicide statute intended to halt Dr. Kevorkian. In 1993, Dr. Kevorkian was arrested and faced criminal charges24. The trial court in People v. Kevorkian25 ruled that the right to end one's own life is protected by the Constitution under certain circumstances as part of the right to privacy in making important life decisions. The court agreed with Casey's analysis that the freedom interest protected by the Fourteenth Amendment "the freedom to determine one's own meaning of life" illuminating. " The state's interest in preventing suicide was found to be outweighed by the individual's interest in dying, hence the court struck down the ban on assisted suicide.
A year later, however, the Michigan Supreme Court reversed itself in People v. Kevorkian.
After looking into the past, the majority of the court concluded that suicide had never been sanctioned in the past. The court ruled that the liberty interest argument was internally inconsistent because it was based on the flawed premise that human dignity may be properly recognised via the valuation of an individual's life according to her current state of health and mental capacity. Therefore, the right to autonomy cannot exist since there is no underlying acknowledgement of human worth. Since all people, regardless of mental or physical health, have a right to personal autonomy, the court argued, this includes the right to suicide. " The majority rejected the liberty interest argument, while the dissent called for a test to weigh the public interest in avoiding suicide aid against the interest of individuals desiring a painless and quick death.
New York's prohibition on assisted suicide was challenged in the case known as Quill v. Koppell26, brought by Dr. Timothy Quill and two other doctors. The doctors' argument that "a patient's liberty interest includes the right to die" depended on Casey and Cruzan. The New York Court of Appeals disagreed, stating that the doctors had taken an excessively broad interpretation of Casey and Cruzan and that there was no liberty interest requiring the recognition of assisted suicide. 24 J; E, “Assisting Suicide in Michigan” (Bioethics) ;https://pubmed. ncbi. nlm. nih. gov/11653237/> accessed October 10, 2024.
25 People v. Kevorkian - 447 Mich. 436, 527 N.W.2d 714 (1994)
26 Quill v. Koppell, 870 F. Supp. 78 (1994).
The plaintiffs in the case Compassion in Dying v. State of Washington argued that the court should strike down a law in Washington that made assisted suicide illegal. The court ruled that the plaintiffs' liberty interest guaranteed by the Due Process Clause to choose when to terminate their own life was infringed by the absolute ban on physician assisted suicide. The court reasoned that "a competent, terminally sick adult has a right to commit physician assisted suicide under the Fourteenth Amendment. " The court compared this right to the liberty interest identified in Casey, s, and came to the same conclusion: both deal with "the most intimate and personal decisions a person, may make in a lifetime choice that are vital to human dignity and autonomy.
" The court agreed with Cruzan and its acceptance of a terminally sick patient's right to refuse unneeded medical care as a matter of liberty. The Compassion in Dying ruling was first overturned by the Ninth Circuit. An "unwarranted extension of abortion jurisprudence," as the Ninth Circuit put it, led it to conclude that privacy protections should not be extended beyond Casey, as the Michigan decisions did. A contrast was made between the denial of medical care and physician aided suicide, and the Cruzan precedent was deemed to be unconvincing by the court. " The Death with Dignity Act, or Measure 16, was subsequently enacted in Oregon in November 1994, making physicianassisted suicide lawful there. A federal district court judge blocked the state from implementing the Act despite it having been passed by voters.
On equal protection grounds, the district court ruled the Act unconstitutional. The court voiced worry over the absence of a method to determine whether a patient is competent to choose assisted suicide. A safety clause in the Act was also questioned by the court since it called for the treating physician to examine the patient and carry out all other tasks according to a reasonable standard of care applied for all patients rather than a heightened standard of care. The court concluded that people with terminal illnesses are not afforded the same safeguards against suicide as the general population under Measure 16.
The court reasoned that although there is a compassionate argument for physician assisted suicide based on the suffering of the terminally ill, these "good results" are not sanctioned under a system that does not provide safeguards against the premature death of terminally ill patients who want to live. The Ninth Circuit Court of Appeals held on March 6, 1996 that the Due Process Clause of the Fourteenth Amendment had been violated by a central element of a Washington legislation
prohibiting physician aided suicide. The court reversed a three-judge panel of the Ninth Circuit that had sustained the ban and reinstated the decision of the United States District Court for the Western District of Washington from 1994. Allowing physician-assisted suicide is legal because the Ninth Circuit found a broad constitutional right to do so. The court compared the issues surrounding physician assisted suicide to those surrounding abortion and other right-to-die cases because they "arouse similar religious and moral concerns" and "present basic questions about an individual's right of choice" regarding whether or not there is a liberty interest in the time and manner of one's death.
Since abortion, right-to-die, and physician assisted suicide all involve a person's right to decide when and how they will die, the Supreme Court has held that such a right is protected by the Fourteenth Amendment's Due Process Clause in Roe v. Wade, Casey v. Virginia, and Cruzan v. Texas "choices that have a significant impact on the person's life and are made in a very private and close setting. Conclusion The legal aspects of euthanasia in India and the United States highlights several important points that showcase the intricate balance of ethical, legal, and personal factors involved in end-of-life care. An examination of euthanasia laws in these two regions reveals a range of legislative, judicial, and societal reactions to the issue of assisted dying.
The judiciary in India has been instrumental in shaping the frameworks concerning passive euthanasia, highlighted by significant rulings in the cases of Aruna Shanbaug v. Union of India and Common Cause v. Union of India. These cases have broadened the scope of Article 21 of the Indian Constitution, which ensures the right to life, to encompass the right to a dignified death, albeit under specific limitations. Nonetheless, India's legal framework regarding euthanasia is not as thorough as that of the United States, as it does not include specific legislative measures to systematically govern euthanasia practices. Consequently, a significant portion of the policy is shaped by judicial precedent, offering some clarity while still leaving open questions regarding physician-assisted suicide and active euthanasia.
The legal situation regarding euthanasia in the United States is quite fragmented, as laws differ from one state to another due to the federal system in place. Some states, including Oregon, California, and Vermont, have implemented Death with Dignity laws permitting physician-
assisted suicide under certain circumstances, while others uphold stringent bans. This decentralised method offers useful frameworks, yet it also leads to inequalities, resulting in individuals across various states having differing levels of access to end-of-life options. Additionally, court cases like Washington v. Glucksberg and Vacco v. Quill have examined the constitutional aspects of the right to die, but have ultimately left the matter to state legislation, highlighting the importance of individual states in shaping euthanasia laws. This analysis indicates that legislative measures are crucial in both nations to establish clearer and more consistent policies. India stands to gain from implementing targeted laws on euthanasia, inspired by effective models in various U. S. states.
Such legislation would offer clear legal direction beyond court rulings, tackle ethical dilemmas, and safeguard against potential abuses. On the other hand, the United States could explore the possibility of implementing a federal standard or guidelines to guarantee equal access to physician-assisted dying options in all states, thereby addressing the existing regional disparities. In the end, euthanasia laws need to strike a thoughtful balance: honouring personal choice and dignity in life's final moments while putting measures in place to avoid misuse. Well-defined laws, backed by ethical standards and strong judicial oversight, can foster a compassionate approach that honours the rights of terminally ill patients while addressing the moral concerns of society.
This study calls for careful legal reforms in India and the United States to tackle the intricate moral and legal issues related to euthanasia, prioritising dignity, autonomy, and humanity in end-of-life care.