Assisted Dying

Syllabus: GS4/ Ethics; GS2/ Governance

Context

• Pope Leo XIV has termed assisted dying “false compassion”, reinforcing the Catholic Church’s view that life is sacred from conception to natural death.

Key Concepts

• Passive euthanasia: Withholding or withdrawing life support.
• Active euthanasia: Deliberate administration of a lethal agent by a doctor.
• Assisted suicide: The patient self administers a lethal substance provided by a doctor.

Arguments Against 

• Sanctity of life: Life is a gift and not a personal possession. Ending it undermines human dignity.
• Compassion redefined: True compassion means accompanying the sick through palliative care, not eliminating the sufferer.
• Vulnerability: Elderly, disabled and poor patients may feel like a burden on family or the health system.
• Medical ethics: It conflicts with the Hippocratic principle of “do no harm” and erodes trust in doctors.

Arguments For

• Autonomy: Individuals should decide the manner of their death, especially in irreversible suffering.
• Dignity: Article 21 covers dignity in living and, by extension, in dying. For ex: the Supreme Court in Common Cause (2018) recognised the right to die with dignity.
• Relief from suffering: Terminal illness often brings pain that palliation cannot fully control.
• Resource use: Prolonged futile treatment burdens families and scarce ICU capacity.

India’s Position

• Aruna Shanbaug (2011): The Supreme Court permitted passive euthanasia with High Court oversight.
• Common Cause v Union of India (2018): Passive euthanasia and advance medical directives (living wills) were legalised.
• 2023 modification: Procedures were simplified. Medical boards now decide within set timelines, and living wills need only notary or gazetted officer attestation.
• Active euthanasia: It remains illegal and can attract culpable homicide provisions under the Bharatiya Nyaya Sanhita.
• Mental Healthcare Act 2017: It presumes severe stress in suicide attempts and decriminalises them in practice.
• Palliative care: The National Programme for Palliative Care (2012) exists, but access remains very limited. Kerala’s community model is the notable exception.

Challenges and Concerns

• Weak palliative infrastructure: Choosing death is not a free choice when good care is unavailable.
• Implementation gaps: Few living wills are executed, and hospitals lack clarity on medical board procedures.
• Risk of misuse: Property disputes and family pressure can distort consent, especially with low health literacy and high out of pocket health spending.
• Determining capacity: Depression can mimic a wish to die, so mental health screening is essential.
• Ethical pluralism: Religious diversity in India makes a uniform position on end of life care contentious.
• Doctor’s dilemma: Fear of legal liability leads to defensive medicine and either overtreatment or undertreatment.

Way Forward

• Strengthen palliative care first: Integrate it into Ayushman Bharat Health and Wellness Centres and train doctors and nurses.
• Clear legislation: A dedicated law on end of life decisions, as recommended by the Law Commission’s 241st Report (2012) and 196th Report (2006), would end reliance on judicial guidelines alone.
• Safeguards: These should include multiple independent medical opinions, psychiatric evaluation, cooling off periods and judicial or board oversight.
• Awareness: Promote living wills through digital registries, such as linking them to health records under the Ayushman Bharat Digital Mission.
• Ethics committees: Hospitals should set up standing bioethics committees for transparent decisions.
• International learning: Study Belgian and Dutch experience with expansion of eligibility, and Swiss and Oregon models of tight regulation.

Source: HT