Core Issue
- Family of a man in a persistent vegetative state (PVS) met Supreme Court of India judges seeking permission for euthanasia.
- The patient has been in a vegetative state for over 13 years.
- Judges sought views of primary and secondary medical boards on whether continuation of treatment is in the patient’s best interest.
Relevance
- GS II (Polity & Constitution)
- Article 21, judicial interpretation of dignity
- Supreme Court role in rights expansion
- GS IV (Ethics)
- Autonomy vs sanctity of life
- Medical ethics: beneficence, non-maleficence
What is Euthanasia?
- Euthanasia: Intentional act/omission to end life to relieve suffering.
- Types:
- Active Euthanasia: Direct act to cause death (e.g., lethal injection) → Illegal in India.
- Passive Euthanasia: Withdrawal/withholding of life-sustaining treatment → Legal under conditions.
- Assisted Suicide: Providing means to commit suicide → Illegal.
Article 21 – Right to Life
- Interpreted as Right to live with dignity, not mere animal existence.
- Includes:
- Right to privacy
- Bodily autonomy
- Right to refuse medical treatment
Key question: Does dignity extend to the end of life?
SC answer: Yes, in limited circumstances.
Supreme Court Jurisprudence
1. Aruna Shanbaug Case
- First legal recognition of passive euthanasia in India.
- Allowed withdrawal of life support for patients in PVS.
- Required:
- Approval of High Court.
- Medical opinion.
- Laid foundation but procedure was cumbersome.
2. Common Cause v. Union of India
- Landmark Constitution Bench judgment.
- Held:
- Passive euthanasia is legal.
- Living Will / Advance Directive recognised.
- Established:
- Right to die with dignity as part of Article 21.
- Replaced HC approval with medical boards.
Legal Framework for Passive Euthanasia
Who can decide?
- Competent patient → Through Living Will / Advance Directive.
- Incompetent patient (PVS/coma) → Family + Doctors + Medical Boards.
Safeguards:
- Opinion of:
- Primary Medical Board.
- Secondary Medical Board.
- Certification that:
- Treatment is futile.
- Continuation not in best interest of patient.
- No criminal liability if procedure followed.
Medical Boards – Role Explained
- Primary Board: Treating doctors, hospital specialists.
- Secondary Board: Independent experts, acts as safeguard.
- Purpose:
- Prevent misuse.
- Ensure decision is medical, not emotional or economic.
Ethical Dimension
Competing Ethical Principles
- Autonomy: Respecting patient’s will/dignity.
- Beneficence: Acting in patient’s best interest.
- Non-maleficence: Avoiding prolonged suffering.
- Sanctity of life vs Quality of life debate.
Indian approach: Middle path – no active killing, but dignity-preserving withdrawal.
Social & Governance Concerns
- Fear of misuse against:
- Elderly
- Disabled
- Economically dependent patients
- Indian society:
- Strong family involvement.
- Limited palliative care infrastructure.
- Hence emphasis on procedural safeguards.
Relevance of Current Case
- Tests implementation of SC guidelines in real-life scenarios.
- Shows shift from judicial approval to medical ethics-based governance.
- Reinforces:
- Family’s role.
- Medical board centrality.
- Highlights growing acceptance of end-of-life dignity.
International Context
- Many countries allow:
- Passive euthanasia (UK, India).
- Some allow active euthanasia (Netherlands, Belgium).
- India follows conservative, dignity-based model.
Challenges
- Low awareness of Living Wills.
- Hospital-level hesitation due to fear of litigation.
- Uneven capacity of medical boards across States.
- Emotional burden on families.
Way Forward
- Standardise hospital protocols for end-of-life care.
- Public awareness on Advance Directives.
- Strengthen palliative care services.
- Periodic training of doctors on legal safeguards.
- Ethical committees at hospital level.
