Reforming passive euthanasia in India

UPSC Syllabus Topic: GS Paper 2 –Issues relating to development and management of Social Sector/Services relating to Health. Reforming passive euthanasia in India.

Introduction

The U.K. House of Commons passed the Terminally Ill Adults (End of Life) Bill. It allows physician-assisted dying for mentally competent adults expected to live fewer than six months, with medical certification and oversight by a national panel. The Bill now awaits approval from the House of Lords. India, by contrast, recognises only passive euthanasia through Supreme Court judgments and has consciously drawn a line against active euthanasia. Yet practical inaccessibility persists: cumbersome procedures, weak implementation, and a fragmented health system hollow out patients’ basic dignity while dying. India should refine passive euthanasia rather than mirror the U.K.’s path.

Active and passive euthanasia

1. Euthanasia is the intentional act of ending another person’s life, typically to relieve suffering from a serious, incurable, or debilitating condition. It is most often performed by a physician through the administration of a lethal drug or other means, with the purpose of ensuring a painless death.
2. There are different types of euthanasia practised across the world. Active euthanasia where a patient is killed a patient by active means, for example, injecting a lethal dose of a drug.
3. There’s also Passive euthanasia, which is described as letting a patient die by withholding artificial life support such as a ventilator or a feeding tube.

Status of euthanasia in India

1. The abetment to suicide remains a criminal offence under the Bhartiya Nyaya Sanhita (Section 108 BNS). Which is corresponds to Section 306 of the Indian Penal Code (IPC). (Section 309 has been restricted by the Mental Healthcare Act, 2017).
2. Regulation 6.7 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 explicitly prohibit the practice of euthanasia.
3. In March 2018, the Supreme Court passed an order that allowed passive euthanasia (Common Cause Judgment). The Court declared that right to die with dignity is a fundamental right under Article 21.

Latest guidelines of the Ministry of Health and Family Welfare for the Withdrawal of Life Support

Issues with the present Euthanasia rules in India

1. Procedural delays and bedside harm: The combined requirements of advance directives, two medical boards, and occasional court oversight create delays that defeat the purpose of timely end-of-life care, and patients and families face long, painful waits in practice.
2. Informal decisions due to weak implementation: Because the legal pathway is slow and unclear and hospitals lack a clear, speedy process, families act outside the framework, which exposes doctors to legal uncertainty.
3. Fragmented health system: Wide gaps in capacity and funding across India’s health services make it hard to follow the passive-euthanasia rules consistently everywhere.
4. State-level ombudsman limitations: The proposed ombudsman model mirrors past schemes with delays, weak enforcement powers, and low public familiarity, which risks adding another slow layer instead of clearing bottlenecks.
5. Complexity in Medical Board Setup: Establishment of Primary and Secondary Medical Boards for every hospital can be resource-intensive, particularly for smaller hospital facilities.
6. Lack of Dedicated Legislation: The absence of a specific law on the issue of Right to die could lead to inconsistent application and legal uncertainty. This might discourage hospitals from implementing the guidelines fully.
7. Misunderstanding of Treatment Withdrawal: The term “passive euthanasia” is still commonly used, leading to confusion and social discomfort with the right to die with dignity. This cultural and terminological barrier may hinder acceptance of life-support withdrawal.
8. Challenging Process for creation of living will: Creation of a living is a complex process involving documentation and verification by witnesses, executors, and a notary.

Way forward

1. Digitise advance directives: India should create a national digital portal for advance directives, link it with Aadhaar for secure verification, and allow patients to create, update, or revoke directives easily, with the treating physician recording capacity and intent online.
2. Empower hospital ethics committees: Each hospital should authorise a committee of senior clinicians, a palliative-care specialist, and a neutral member to decide within 48 hours. Only cases that raise disputes, doubts about validity or capacity, or other legal/ethical concerns should be escalated for additional review..
3. Shift to decentralised oversight: Oversight should move from a slow, centralised ombudsman to transparent digital dashboards across hospital networks, supported by independent medical auditors or health commissioners with statutory backing.
4. Cooling-off period: A seven-day cooling-off period, psychological counselling, and a mandatory palliative-care review should remain in place to prevent misuse and ensure fully informed choices.
5. Legislative Clarity and Support: Lawmakers should consider enacting legislation that defines and governs life-support withdrawal in terminal cases. This would further affirm the Right to die with dignity.
6. Educating and Training Medical Professionals: Medical professionals should be provided robust training on the ethical, legal, and procedural aspects of withdrawing life-sustaining treatment.
7. Streamlining the Living Will Process: The process for creating and validating a living will should be simplified, and made accessible to people from diverse backgrounds.
8. Raising Public Awareness: Increased awareness will enable families to make informed choices aligned with their loved ones’ wishes and alleviate unnecessary suffering.

Question for practice:

Discuss the key problems in India’s current passive-euthanasia rules and the reforms needed to overcome them.

Source: The Hindu