[Answered] Examine the ethical dilemmas involved in the practice of passive euthanasia, with reference to recent judicial pronouncements in India. Discuss the implications of these ethical considerations on the rights of terminally ill patients to die with dignity.

The ethical dilemmas surrounding passive euthanasia in India are complex, as highlighted by recent judicial pronouncements, particularly in the case involving Harish Rana. The case reveals not only the legal ambiguities but also the profound ethical challenges in balancing the right to die with dignity against cultural and medical norms.

Ethical Dilemmas

• Autonomy: The ethical principle of autonomy supports the right of individuals, or their surrogates, to make decisions regarding their medical care, including the refusal of life-sustaining treatment. However, the denial of permission to remove the Ryles tube in Harish’s case effectively overrides this autonomy, ignoring the expressed wishes of his parents, who have endured immense suffering and financial strain.
• Beneficence: Beneficence, or acting in the patient’s best interest, is compromised when prolonging life results in more harm than good. Forcing a patient to endure a low quality of life, particularly when they are in a vegetative state with no hope of recovery, violates this principle.
• Non-Maleficence The ethical principle of non-maleficence (not harm) is called into question when medical interventions that offer no hope of recovery are continued, causing prolonged suffering to both the patient and their caregivers. In Harish’s case, maintaining the Ryles tube may have prolonged life, but it did not contribute to a dignified existence.
• Justice: The decision to deny the removal of the Ryles tube may reflect a societal and judicial bias against acknowledging the right to die with dignity, thus denying justice to the patient and their family.

Implications for Terminally Ill Patients

• Right to Die with Dignity: The denial of the right to withdraw clinically assisted nutrition in cases like Harish Rana’s represents a significant infringement on the right to die with dignity. It suggests that legal and cultural biases continue to prioritize the mere prolongation of biological life over the quality of life and the dignity of death.
• The Role of Medical Experts: The case highlights the necessity for judicial decisions on euthanasia to involve medical and ethical experts, particularly those trained in palliative care. The absence of such expertise in the decision-making process can lead to rulings that are medically unsound and ethically questionable.
• Cultural and Social Considerations: The reluctance to permit the withdrawal of feeding tubes may be influenced by cultural taboos surrounding death and dying, where the act of feeding is imbued with deep social and existential significance. However, this cultural perspective must be balanced with the ethical imperative to alleviate suffering and respect patient autonomy.

Conclusion

The Harish Rana case underscores the urgent need for greater legal clarity and ethical consistency in the application of passive euthanasia in India. Addressing these issues requires not only judicial clarity but also the involvement of medical experts in end-of-life care decisions, ensuring that the rights and well-being of patients and their families are upheld.