In a historic judgment, the Supreme Court on Friday held that the right to die with dignity is a fundamental right, saying that an individual could make an advance "living will" that would authorise passive euthanasia under certain circumstances. The apex court's Bench held that passive euthanasia and living will were legally valid.
While the decision has received a thumbs up from the medical fraternity and top Jain monk Tarun Sagar, the Catholic Church has criticised the verdict, saying that right to life is in God's hands and the decision should not be "acceptable to anyone who believes in humanity to kill a person suffering from old age or sickness due to sympathy".
The apex court said on its verdict that a person could prepare a "living will", under which the withdrawal of life-support system could be authorised if he reached an irreversible stage of terminal illness in the medical view.
However, while a five-judge Constitution Bench, headed by Chief Justice Dipak Misra, allowed an individual to prepare the advance directive, or living will, it attached strict conditions for executing the "will", which would be made by a person in his or her normal state of health and mind.
The apex court was delivering its verdict on a public interest litigation filed in 2005 by an NGO called Common Cause and argued by lawyer Prashant Bhushan.
On May 11, 2005, the Supreme Court had taken note of Common Cause's PIL seeking approval for terminally ill individuals to be allowed to execute a living will for passive euthanasia. The apex court had sought the Centre's response on the plea that sought the declaration of 'right to die with dignity' as a Fundamental Right under Article 21 (right to life) of the Constitution.
The court pronounced four separate but concurring judgments.
Here is what a living will means and the top 10 developments around SC's passive euthanasia judgment:
1) Narayan Lavate says 'SC ruling disheartening': Narayan Lavate, an octogenarian man who has sought the President's permission for active euthanasia, also called "assisted suicide", said that the Supreme Court ruling was "disheartening" as it was only concerned with passive euthanasia.
Lavate, 87, said that the time had come for the government to look at elderly people with a different perspective. He said that the apex court's ruling was "disheartening" as it did not deal with active euthanasia. Lavate has been campaigning for active euthanasia.
Reacting to the landmark verdict, Lavate said: "What the Supreme Court has ruled today is for those who are in a persistent vegetative state or dependent on medical support system. It's about passive euthanasia. I have been fighting for active euthanasia. I would have been more than happy if the Supreme Court had given the same stand on active euthanasia too."
In a letter to President Ram Nath Kovind in December, Lavate and his wife Iravati, 78, sought his permission to end their lives through a physician-assisted death. They made this request as they felt that they were of no use to society or themselves anymore. "Even now, the court or the government or even president can consider our case individually and allow us to end our lives peacefully and with dignity," he said.
The government should give special rights to those who are above 75 years of age to donate their organs and decide on ending their lives with dignity, Lavate said. "We have already written a letter to the President. We are still hopeful of getting a positive response from his office. If his (president) office does not respond by March 31, we will decide our next course of action," he added.2) Jain monk welcomes decision: Jain Monk Tarun Sagar on Friday welcomed the Supreme Court's decision saying it coincided with the tenets of Jainism.
"The whole world takes birth crying, but Mahavira taught us to die laughing. Today, the Supreme Court has given a historical ruling, which has been a law in Jainism for ages. I thank the Supreme Court (for the verdict)," the monk told ANI.3) SC verdict on euthanasia could be misused, says KCBC: Senior Kerala priests said the Supreme Court judgment, allowing terminally-ill patients passive euthanasia with conditions, could be misused.
Terming it "unfortunate and condemnable", Kerala Catholic Bishop Conference president Archbishop Soosa Paikam said the verdict was "painful" and would have disastrous consequences.
"The right of life is in the hands of God.
It was not acceptable for anyone who believes in humanity to kill a person suffering from old age or sickness due to sympathy," he said.
4) Medical fraternity hail judgment: Health experts welcomed the verdict as "long overdue", saying that the decision was in the right path to ensure "right to die with dignity" for everyone.
"It is a landmark decision in a resource-constrained country and would save a lot of salvageable patients by giving them an opportunity to avail of ventilatory support," AIIMS' assistant professor Dr Prasoon Chatterjee said.
Dr R N Tandon, Secretary General of the Indian Medical Association(IMA), said, "Just as every person has the right to life, they also have the right to die with dignity."
However, some experts called for strict guidelines to ensure that there is no abuse of the 'living will' by relatives of the terminally ill patients.
5) Now, we have the 'right to die with dignity': The apex court held that an individual had the "right to die with dignity" and could make an advance living will to authorise the withdrawal of life-support system. The advance will would allow this if, in the medical view, the person concerned reached an irreversible stage of terminal illness.
In his or her living will, an individual could state in advance that his or her life should not be prolonged through the means of a ventilator or artificial support system. Recognising the "right to die with dignity", the court permitted a person to draft in advance a living will in case she/he slips into an incurable condition.
6) SC lays down strict conditions: While it allowed any person to prepare a living will, the five-judge Constitution Bench, headed by Chief Justice Dipak Misra, attached strict conditions for the execution of the will. The will would be made by a person in his normal state of health and mind.
The Bench, which also included justices A K Sikri, A M Khanwilkar, D Y Chandrachud, and Ashok Bhushan, laid down guidelines on who would execute the will and how the approval for passive euthanasia would be granted by the medical board.
The life support system could be turned off only after the statutory medical board declared the patient in question to be incurable, the apex court said. Further, the Bench said that its guidelines and directives would remain in force until a legislation was brought regarding the issue. In such a case where there is no living will that has been framed, for passive euthanasia, the family members of a terminally ill person could approach the high court under Article 226, Bar & Bench reported. According to the site, detailed guidelines on how to deal with such pleas have also been laid down.
ALSO READ: SC allows Passive Euthanasia with guidelines
7) Living will explained: However, what exactly is a living will? According to Livelaw.in, it is a written document allowing a patient to provide explicit instructions in advance regarding the medical treatment that is to be administered when he or she is terminally ill or no longer capable of expressing informed consent.
The living will, according to the site, includes authorising a patient's family to switch off the life-support system if a medical board declares that the person is beyond medical help.
8) Passive euthanasia explained: The next question in people's mind would be what exactly is passive euthanasia. The Oxford Dictionary provides a simple explanation: Passive euthanasia is the withdrawal and/or withholding of life-sustaining medical treatment with the knowledge that doing so will lead to the patient's death.
This differs from active euthanasia, which, according to the dictionary, is the ending of a terminally ill patient's life through direct intervention, including a lethal dose of painkilling drugs.
9) Govt opposed to living will: The government, for its part, had expressed its opposition to the idea of a living will during the hearing, Livelaw.in reported. According to the site, the government had argued that a living will could be misused, adding that it might not be viable as a part of public policy.
However, it also said that it was in-principle in agreement with permitting passive euthanasia.
10) Judgment on a 2005 plea: The apex court's judgment came on a plea filed in 2005 by NGO Common Cause. The NGO was seeking the right to make a living will that would authorise the withdrawal of life-support system in the event of the will-maker reaching an irreversible vegetative state.
Appearing for the NGO Common Cause, advocate Prashant Bhushan had said that since a patient in a coma could not express his or her wish to end his or her life, the law should allow them to put it down in writing in advance so that they should not be tortured. (Watch Prashant Bhushan reacting to the verdict)
In the absence of a law authorising doctors to do so, they keep incurable patients on life support, he had said. ALSO READ: All you need to know about Aruna Shanbaug
On March 7, 2011, in a separate plea on behalf of Aruna Shanbaug, a nurse lying in a vegetative state at a hospital in Mumbai, the apex court had allowed passive euthanasia.
I had requested for mercy killing in 2014 & PM Modi took cognizance of the same & had told local officers to look into the matter. SC has taken a good decision, we've hope now: Anamika Mishra, patient of Muscular Dystrophy on SC's verdict on #Euthanasia pic.twitter.com/L59jXAbCNM— ANI (@ANI) March 9, 2018
We're not fully satisfied with SC's judgement. People above the age of 75 should be given this right. They can verify the details of these people from the police & doctors. Govt should come up with a policy: Mr & Mrs Lavate, who had asked for #Euthanasia pic.twitter.com/MtmBgVCa23— ANI (@ANI) March 9, 2018
With agency inputs