Syllabus
GS Paper 4 – Ethics and Human Interface: Essence, determinants and consequences of Ethics in-human actions; dimensions of ethics; ethics – in private and public relationships.
Applications where to apply?
When asked about
– Ethics of assisted death
– Implementation of court judgements
– Euthanasia debates
Context
Challenges and shortcomings in the implementation of living wills exists in India, despite their legalization in 2018 by the Supreme Court.
Source
The Hindu | Editorial dated 4th April 2024
Living wills implementation lags in India
Euthanasia is the practice of intentionally ending a life to relieve pain and suffering. The word ‘Euthanasia’ is derived from Greek words, ‘Eu’ meaning ‘good’ and ‘thanatos’ meaning ‘death’, put together it means ‘good death’.
Types of Euthanasia
- Active euthanasia involves a doctor or other medical professional directly causing the death of a patient, typically through lethal injection.
- There are three types of active euthanasia, in relation to giving consent for euthanasia:
- Voluntary euthanasia – at patient request,
- Non-voluntary – without patient consent,
- Involuntary euthanasia – patient is not in a position to give consent.
- Passive euthanasia involves withholding or withdrawing life-sustaining treatment, such as a ventilator, allowing the patient to die naturally.
Debate Surrounding Euthanasia
| Argument | Con-Euthanasia | Pro- Euthanasia |
| Autonomy | Euthanasia can be seen as taking away a person’s right to fight for life. Many view it as suicide and murder. | Patients have the right to control their bodies and choose how they die. |
| Suffering | Euthanasia can be seen as giving up on life and there may be advances in treatment in the future | Euthanasia offers a way to relieve unbearable suffering for terminally ill patients. |
| Scope for misuse | Legalizing euthanasia could lead to a situation where vulnerable people are pressured to end their lives. | Safeguards can be put in place to prevent abuse. |
| Sanctity of Life | Life is sacred and should be preserved at all costs. Against moral and religious aspects, where life is considered as a gift of god. | Some believe that suffering can be part of a meaningful life. Eg. Jainism sallekhana practice. |
| Disability Rights | Concerns that euthanasia could be used to target people with disabilities. | Proper safeguards can ensure euthanasia is only used for terminally ill patients. |
| Medical Ethics | Doctors’ primary role is to save lives, not end them. | Doctors can be allowed to withdraw life support based on patient wishes. |
In India, active euthanasia is a crime.
Section 309 of the Indian Penal Code (IPC) deals with the attempt to commit suicide
Section 306 of the IPC deals with abetment of suicide – both actions are punishable.
Living wills
The “living will” is a person’s right to issue advance directive on the course of his/her treatment, including withdrawal of life support, should such a situation arise.
Legalization and Initial Challenges
- Living wills or passive euthanasia were legalized in India in 2018 by the Supreme Court to allow terminally-ill patients to withhold or withdraw treatment and die with dignity.
- Initially, the Court’s process was complex and hindered by bureaucratic procedures,
- Including the requirement for judicial magistrate countersigning, which discouraged execution of living wills.
Streamlining of Procedures
- In January 2023, recognizing the flaws in the process, the Supreme Court streamlined the procedure for living wills.
- Under the streamlined process, living wills require signature in the presence of two witnesses, attestation by a notary or gazetted officer, and custody by a designated government officer.
- If the patient becomes terminally ill and does not have decision-making capacity, the treating doctor is to authenticate the living will against the copy held with the custodian or against digital health records.
- Decisions on withholding or withdrawing treatment are certified first by a primary medical board and then confirmed by a secondary medical board.
- If a patient doesn’t have a living will, the Supreme Court says the primary medical board must get permission from the patient’s closest family member, ‘next of kin’ before stopping treatment.
Challenges in Implementation
- Lack of Designated Custodians:
- Despite the streamlined process, local governments have been slow to designate custodians for living wills.
- Maharashtra’s recent appointment of custodians after a public interest litigation exemplifies the challenges in this aspect.
- Absence of Digital Protocols:
- Furthermore, there is a lack of protocols by National Health Authority for authentication through digital health records, hindering the implementation of living wills.
- Medical Board Certification:
- Living wills require certification by primary and secondary medical boards, posing challenges for hospitals.
- Without a nominated doctor by the chief medical officer, hospitals may struggle to form secondary medical boards.
- Ambiguity in Legal Definitions:
- Indian law lacks clear definitions for crucial terms like ‘next of kin,‘ leading to disputes among family members regarding treatment decisions.
- This ambiguity discourages officials from issuing orders without detailed guidance from superiors and state governments.
- Reluctance of State Governments:
- State governments exhibit reluctance due to the complexity of the issue and the need for expertise from medical and legal professionals.
- Lack of essential guidance for implementation.
- Haryana issued directions to civil surgeons across the State to follow the judgment but did not offer essential guidance or protocols on how to implement it.
Call for Action
- Urgent action is needed from both Central and State governments to bridge the gap in expertise and provide effective guidance for the implementation of living wills.
- In Odisha, the State government has formed a committee of experts to consider detailed draft orders for implementing the judgment.
- Until the judgment is effectively implemented, doctors will continue to hesitate in honouring patients’ wishes, contributing to legal uncertainties and barriers in end-of-life care decision-making
Conclusion
Despite the Supreme Court’s landmark judgment allowing Indians to die with dignity through living wills, government inaction and reluctance have hindered effective implementation, emphasizing the need for immediate and comprehensive action to provide clarity and guidance at all levels of governance.
Related Topics
Sallekhana
It is a Jain religious practice involving voluntarily giving up food and water to achieve spiritual liberation through death.
- Seen by Jains as a path to shedding karma and attaining enlightenment, not suicide.
Court Order
- In 2015, the Rajasthan High Court in India banned sallekhana, considering it akin to suicide (illegal).
- Jains argued it’s a core religious practice protected by the Indian Constitution’s freedom of religion.
- Supreme Court of India intervened in 2015, staying the ban and allowing sallekhana to continue.
References
Related PYQ
Ethics is knowing the difference between what you have the right to do and what is right to do. [UPSC Civil Services Exam – Mains 2022]
Practice Question
Examine the ethical, legal, and societal implications of euthanasia in India. [150 words]
How to approach this question?
Introduction (about 30 words):
- Start by briefly defining euthanasia and its relevance in the Indian context.
- Mention the ongoing debate around its ethical, legal, and societal implications.
Body (about 90 words):
- Ethical Implications: Discuss the moral dilemmas associated with euthanasia. For instance, the conflict between the sanctity of life and the relief from suffering.
- Legal Implications: Discuss the current legal status of euthanasia in India, referencing the Aruna Shanbaug case and the 2018 Supreme Court verdict.
- Societal Implications: Discuss the potential societal consequences, such as the impact on family dynamics or the potential for misuse.
Conclusion (about 30 words):
- Summarize the main points discussed and provide a balanced view.
- You could also suggest measures for addressing the concerns associated with euthanasia.
Remember to provide a balanced answer, incorporating relevant facts and figures, and propose feasible solutions. Structure your answer well, with a clear introduction, body, and conclusion. Also, ensure that your answer is within the word limit specified for the exam. Good luck!