Indian J Med Res 136, December 2012, pp 899-902

Editorial
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Euthanasia: Right to life vs right to die

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The word euthanasia, originated in Greece means 21. This made the Supreme Court to rethink and to
a good death1. Euthanasia encompasses various reconsider the decision of right to die. Immediately
dimensions, from active (introducing something the matter was referred to a Constitution Bench of the
to cause death) to passive (withholding treatment Indian Supreme Court. The Court held that the right
or supportive measures); voluntary (consent) to to life under Article 21 of the Constitution does not
involuntary (consent from guardian) and physician include the right to die5.
assisted (where physician’s prescribe the medicine and
Regarding suicide, the Supreme Court reconsidered
patient or the third party administers the medication to
its decision on suicide. Abetment of suicide (IPC
cause death)2,3. Request for premature ending of life has
Sec 306) and attempt to suicide (IPC Sec 309) are
contributed to the debate about the role of such practices
two distinct offences, hence Section 306 can survive
in contemporary health care. This debate cuts across independent of Section 309. It has also clearly stated
complex and dynamic aspects such as, legal, ethical, that a person attempts suicide in a depression, and
human rights, health, religious, economic, spiritual, hence he needs help, rather than punishment. Therefore,
social and cultural aspects of the civilised society. Here the Supreme Court has recommended to Parliament to
we argue this complex issue from both the supporters consider the feasibility of deleting Section 309 from
and opponents’ perspectives, and also attempts to the Indian Penal Code3.
present the plight of the sufferers and their caregivers.
The objective is to discuss the subject of euthanasia Arguments against euthanasia
from the medical and human rights perspective given Eliminating the invalid: Euthanasia opposers argue
the background of the recent Supreme Court judgement3 that if we embrace ‘the right to death with dignity’,
in this context. people with incurable and debilitating illnesses will
In India abetment of suicide and attempt to suicide be disposed from our civilised society. The practice
are both criminal offences. In 1994, constitutional of palliative care counters this view, as palliative care
validity of Indian Penal Code Section (IPC Sec) 309 would provide relief from distressing symptoms and
was challenged in the Supreme Court4. The Supreme pain, and support to the patient as well as the care giver.
Court declared that IPC Sec 309 is unconstitutional, Palliative care is an active, compassionate and creative
under Article 21 (Right to Life) of the constitution in care for the dying6.
a landmark judgement4. In 1996, an interesting case Constitution of India: ‘Right to life’ is a natural right
of abetment of commission of suicide (IPC Sec 306) embodied in Article 21 but suicide is an unnatural
came to Supreme Court5. The accused were convicted termination or extinction of life and, therefore,
in the trial court and later the conviction was upheld by incompatible and inconsistent with the concept of
the High Court. They appealed to the Supreme Court ‘right to life’. It is the duty of the State to protect life
and contended that ‘right to die’ be included in Article and the physician’s duty to provide care and not to
21 of the Constitution and any person abetting the harm patients. If euthanasia is legalised, then there is a
commission of suicide by anyone is merely assisting in grave apprehension that the State may refuse to invest
the enforcement of the fundamental right under Article in health (working towards Right to life). Legalised
21; hence their punishment is violation of Article euthanasia has led to a severe decline in the quality of
899
 900 INDIAN J MED RES, december 2012

care for terminally-ill patients in Holland7. Hence, in a and the fellow citizen take extreme measures such as
welfare state there should not be any role of euthanasia suicide, euthanasia or substance use. In such situations,
in any form. palliative and rehabilitative care comes to the rescue of
the patient and the family. At times, doctors do suggest
Symptom of mental illness: Attempts to suicide or
to the family members to have the patient discharged
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completed suicide are commonly seen in patients

from the hospital wait for death to come, if the family
suffering from depression8, schizophrenia9 and
or patient so desires. Various reasons are quoted for
substance users10. It is also documented in patients such decisions, such as poverty, non-availability of
suffering from obsessive compulsive disorder11. Hence,
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bed, futile intervention, resources can be utilised for

it is essential to assess the mental status of the individual other patients where cure is possible and unfortunately
seeking for euthanasia. In classical teaching, attempt to majority of our patient’s family do accordingly. Many
suicide is a psychiatric emergency and it is considered of the terminally ill patients prefer to die at home, with
as a desperate call for help or assistance. Several or without any proper terminal health care. The societal
guidelines have been formulated for management of perception needs to be altered and also the medical
suicidal patients in psychiatry12. Hence, attempted professionals need to focus on care rather in addition
suicide is considered as a sign of mental illness13. to just cure. The motive for many euthanasia requests
Malafide intention: In the era of declining morality and is unawareness of alternatives. Patients hear from their
justice, there is a possibility of misusing euthanasia by doctors that ‘nothing can be done anymore’. However,
family members or relatives for inheriting the property when patients hear that a lot can be done through
of the patient. The Supreme Court has also raised palliative care, that the symptoms can be controlled,
this issue in the recent judgement3. ‘Mercy killing’ now and in the future, many do not want euthanasia
should not lead to ‘killing mercy’ in the hands of the anymore16.
noble medical professionals. Hence, to keep control Commercialisation of health care: Passive euthanasia
over the medical professionals, the Indian Medical occurs in majority of the hospitals across the county,
Council (Professional Conduct, Etiquette and Ethics) where poor patients and their family members refuse or
Regulations, 2002 discusses euthanasia briefly in withdraw treatment because of the huge cost involved
Chapter 6, Section 6.7 and it is in accordance with in keeping them alive. If euthanasia is legalised, then
the provisions of the Transplantation of Human Organ commercial health sector will serve death sentence to
Act, 199414. There is an urgent need to protect patients many disabled and elderly citizens of India for meagre
and also medical practitioners caring the terminally ill amount of money. This has been highlighted in the
patients from unnecessary lawsuit. Law commission Supreme Court Judgement3,17.
had submitted a report (no-196) to the government on
this issue15. Research has revealed that many terminally ill
patients requesting euthanasia, have major depression,
Emphasis on care: Earlier majority of them died and that the desire for death in terminal patients is
before they reached the hospital but now it is converse. correlated with the depression18. In Indian setting
Now sciences had advanced to the extent, life can be also, strong desire for death was reported by 3 of the
prolonged but not to that extent of bringing back the 191 advanced cancer patients, and these had severe
dead one. This phenomenon has raised a complex depression19. They need palliative and rehabilitative
situation. Earlier diseases outcome was discussed in care. They want to be looked after by enthusiastic,
terms of ‘CURE’ but in the contemporary world of compassionate and humanistic team of health
diseases such as cancer, Aids, diabetes, hypertension professionals and the complete expenses need to
and mental illness are debated in terms best ‘CARE’, be borne by the State so that ‘Right to life’ becomes
since cure is distant. The principle is to add life to years a reality and succeeds before ‘Right to death with
rather than years to life with a good quality palliative dignity’. Palliative care actually provides death with
care. The intention is to provide care when cure is dignity and a death considered good by the patient and
not possible by low cost methods. The expectation the care givers.
of society is, ‘cure’ from the health professionals, but
Counterargument of euthanasia supporters
the role of medical professionals is to provide ‘care’.
Hence, euthanasia for no cure illness does not have Caregivers burden: ‘Right-to-die’ supporters argue that
a logical argument. Whenever, there is no cure, the people who have an incurable, degenerative, disabling
society and medical professionals become frustrated or debilitating condition should be allowed to die in
 MATH & CHATURVEDI: EUTHANASIA, MERCY KILLING, SUICIDE 901

dignity. This argument is further defended for those, argument. We do endorse the Supreme Court Judgement
who have chronic debilitating illness even though it that our contemporary society and public health system
is not terminal such as severe mental illness. Majority is not matured enough to handle this sensitive issue,
of such petitions are filed by the sufferers or family hence it needs to be withheld. However, this issue needs
members or their caretakers. The caregiver’s burden is
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to be re-examined again after few years depending upon

huge and cuts across various domains such as financial, the evolution of the society with regard to providing
emotional, time, physical, mental and social. Hence, health care to the disabled and public health sector with
it is uncommon to hear requests from the family regard to providing health care to poor people.
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members of the person with psychiatric illness to give

some poison either to patient or else to them. Coupled The Supreme Court judgement to withhold
with the States inefficiency, apathy and no investment decision on this sensitive issue is a first step towards
on health is mockery of the ‘Right to life’. a new era of health care in terminally ill patients. The
Judgment laid down is to preserve harmony within a
Refusing care: Right to refuse medical treatment is society, when faced with a complex medical, social and
well recognised in law, including medical treatment legal dilemma. There is a need to enact a legislation
that sustains or prolongs life. For example, a patient to protect terminally ill patients and also medical
suffering from blood cancer can refuse treatment or practitioners caring for them as per the recommendation
deny feeds through nasogastric tube. Recognition
of Law Commission Report-19615. There is also an
of right to refuse treatment gives a way for passive
urgent need to invest in our health care system, so that
euthanasia. Many do argue that allowing medical
poor people suffering from ill health can access free
termination of pregnancy before 16 wk is also a
health care. Investment in health care is not a charity;
form of active involuntary euthanasia. This issue of
mercy killing of deformed babies has already been in ‘Right to Health’ is bestowed under ‘Right to Life’ of
discussion in Holland20. our constitution.

Right to die: Many patients in a persistent vegetative Suresh Bada Math* &
state or else in chronic illness, do not want to be a Santosh K. Chaturvedi
burden on their family members. Euthanasia can be Department of Psychiatry
considered as a way to upheld the ‘Right to life’ by National Institute of Mental Health
honouring ‘Right to die’ with dignity. & Neuro Sciences (Deemed University)
Encouraging the organ transplantation: Euthanasia Bangalore 560 029, India
in terminally ill patients provides an opportunity
*
For correspondence:
to advocate for organ donation. This in turn will [email protected]
help many patients with organ failure waiting for [email protected]
transplantation. Not only euthanasia gives ‘Right to
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