Passive Euthanasia updates: Mumbai couple who wanted assisted suicide from President 'not satisfied' with SC verdict

‘Living Will’, or passive euthanasia could be misused, may lead to abuse of elderly

The Centre, had earlier raised objections to legalising the concept of ‘Living Will’. It pointed out that this may lead to the abuse and neglect of the elderly, especially if they were financially well-off,  The Hindu reported. The government had pointed out that the living will was a concept which contradicts a person’s instinctive urge to survive, the newspaper said.

Euthanasia may be useful in rarest of rare cases, says medico-legal expert

Hailing the Supreme Court’s decision on passive euthanasia, Ashish Tiwari, physician and medico-legal expert said, it would be useful in rarest of rare cases. However, he said, “it must be decided by a team of domain experts and verified by central team. Otherwise in a country like our’s, there are chances of it being misused much more than it being used,” he said.

Here’s how the world stands on euthanasia

Mumbai couple who sought legalisation of active euthanasia ’not satisfied’ with SC order

The elderly couple from Mumbai, who sought legalistaion of active euthanasia, said they are not satisfied with the Supreme Court order. Narayan (88) and Iravati (78) do not suffer from any terminal ailment but are motivated by the will to die after having lived a satisfactory life. They also fear having to live without the other. 

The couple told ANI that the government should give the right to active euthanasia and assisted suicide to people above 75.

Ruling will stop a lot of pain and also lessen expenses: Dr Naresh Trehan, Medanta Hospital

#BREAKING - This will help many families. It will stop a lot of pain and also lessen expenses: Dr. Naresh Trehan, Medanta Hospital. #RightToDie #DieWithDignity pic.twitter.com/WwdeSp1iVH

— News18 (@CNNnews18) March 9, 2018

Welcome the decision on moral grounds: Senior lawyer Mahesh Jethmalani

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Senior advocate Mahesh Jethmalani welcomed the Supreme Court decision on passive euthanasia stating that he believes any individual who is very ill and unable to take care of himself should be allowed to make a decision on his life. “Anyone who is reduced to a life that is unlike that of a sentient being should be given the choice of deciding on his/her life. Any liberty that is given is liable to be misused. Care must be taken to ensure this does not happen by putting strict guidelines,” he said.

Bill to permit passive euthanasia still under consideration, MoS said during Winter Session of Parliament

In response to an unstarred question submitted to the Lok Sabha during the Winter Session of Parliament last year, Ashwini Kumar Choubey, MoS, health and family welfare, said that the government is yet to finalise the bill allowing passive euthanasia and that such formulation of legislation is under consideration in the health ministry.

The reply also mentioned that the government is not against letting people make ‘living wills’ to stop medical treatment in future, if he/she becomes terminally ill.

Aruna Shanbaug’s death in 2015 sparked national debate over legalising euthanasia again

The death of 66-year-old nurse Aruna Shanbaug in 2015, who was sexually assaulted and left in a vegetative state for more than 40 years, had sparked a national debate over the legalisation of euthanasia.

Living will makes sense when coupled with medical power of attorney, independent third-party monitoring

The right to live with dignity includes the right to die with dignity. The individual must at all times be in charge of their medical treatment. Indian law has always recognised this principle of medical autonomy. The problem arises when this medical autonomy conflicts with the prohibition against a person ending their own life, argues Ajay Kumar in this _Firstpost_ article. A living will in some cases can permit an individual to effectively end their own life by refusing medical treatment that would keep them alive longer. Further, it is evident that the state has an interest in the life of a person.

While the decision to passively euthanise oneself can be left to the patient, the conditions on when this right may be invoked can be left to a medical board. A living will makes sense if coupled with a medical power of attorney and independent third party monitoring. This will allow for a middle way between all the interests that are at play here. The Right of the patient, the State’s interest in human life and the interest of the family of the patient.

Supreme Court lays down certain conditions regarding passive euthanasia

According to senior lawyer Prashant Bhushan, the apex court said any individual has full right to decide that he should not take any kind of medical treatment should not be kept alive on life support system. And if that person so decides, his decision is binding on the doctors and his family members have to respect and give effect to his decision.

If a person leaves a living will that if he becomes unconscious and his life can only be prolong by artificial life support systems, then that living will should be effected by the doctors and his family. 

If a person fell unconscious and has not expressed his will and he can only be kept alive on life support system then the treating doctors and family members together can decide to withdraw life support system if they feel that the person is in an incurable state.

Precedents prove that Indians need the right to die with dignity

Historically, India is no stranger to the right to die, argues this _Firstpost_ article. Unlike the west, where giving up one’s life is a sin, a criminal act, in India, as in most Oriental cultures, opting to die is often an act of honour, of salvation.

Cultural practices like santhara among the Jain community allows a person to conclude that his work in this world is done and over with, and that he must now prepare for the soul’s onward journey, namely death. Such a person stops consuming food and water, and allows his body to waste away.

Even Hinduism permits this. Hindu saints are known to take sanyas and even opt for samadhi. This convention and belief involves a saint holding his very breath, and through meditation allows the body and the soul to get separated. In many ways, even the vanaprastha stage advocated by Hinduism allows for a person to leave the material world and wander into the forest, where he is no longer distracted by the world of attachments. How the person eventually dies, remains unknown. It is another practice that is both voluntary and immensely venerated.

‘Supreme Court has delivered historic decision’ says senior lawyer Prashant Bhushan

“Today the Supreme Court has delivered a historic decision. The constitution bench has cleared all the air on passive euthanasia,” said Supreme Court advocate Prashant Bhushan.

Supreme Court judgment also includes guidelines on ’living will’

Chief Justice Dipak Misra, in his judgment, laid down specific guidelines to test the validity of a “living will”, reported  The Hindu. He also details who should certify the living will, when and how it comes into effect etc. The guidelines also mention what is to be done if there is no living will and how to make a plea for passive euthanasia, the report added.

Aruna Shanbaug couldn’t exercise ’living will’, says KEM Hospital dean, hails SC verdict

“Aruna Shanbaug could not have exercised Living Will, but it is a good decision by the Supreme Court,” says Dr Avinash Supe, Dean, KEM Hospital.

Supe said it was a much-needed decision. “The concept of Do Not Resuscitate (DNR) is an established concept in the West. Many patients ask doctors to not prolong their lives with interventions and medicines. Elderly who suffer can now discuss with family members and take a decision on Living Will. The ailing may be relieved of their pain while their family members can avoid the stress of seeing their loved ones suffer through medical interventions, ICU, etc and also medical expenses.”

“However, having said that, there must be strict guidelines which should be followed. In Aruna Shanbaug’s case, the Supreme Court had recognised passive euthanasia by which it had permitted withdrawal of life-sustaining treatment from patients not in a position to make an informed decision. Today’s decision goes further. It is welcome,” Dr Supe said.

Religion, morality, philosophy share conflicting opinions, but agree person should die with dignity: Justice AK Sikri

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Stating in the Supreme Court judgment, Justice AK Sikri justified his opinion and said that even though religion, law, philosophy, morality and society share conflicting opinions on the right to life and if it includes the right to death as well, they all concur that a person should be able to die with dignity, reported  The Hindu. 

He also said that a having a “living will” from the patient to stop medical treatment at a certain stage — such as when he/she is brain dead or clinically dead — helps remove regret or guilt for relatives and “criminal action against doctors”.

‘Monumental verdict’, says Laxmi Yadav, who wrote to president, prime minister for euthanasia

This is a monumental verdict. It is good that people can die in peace with some self-respect: Laxmi Yadav, who wrote to Prime Minister & President for #Euthanasia pic.twitter.com/K0WvKFcYxn

— ANI (@ANI) March 9, 2018

Contention by petitioners: ‘Right to life includes right to die with dignity’

The primary basis of the petition is, “How can a person be told that he/she does not have right to prevent torture on his body? Right to life includes right to die with dignity. A person cannot be forced to live on support of ventilator. Keeping a patient alive by artificial means against his/her wishes is an assault on his/her body.”

Senior lawyer Prashant Bhushan, who was the amicus curiae, in the case had stated that after Aruna Shanbaug case it was only the legal guardian or a medical board who could decide whether life support could be withdrawn to a terminally ill patient, but the person suffering from such terminal illness cannot decide, according to News18. 

Bhushan pleaded for active euthanasia to be allowed by saying that a person facing the only option of leading a life with suffering and pain, should have the sole right decide whether he should put an end to life with dignity.

Former KEM Hospital dean Sanjay Oak continues to oppose passive euthanasia

Sanjay Oak, former dean of KEM Hospital in Mumbai, has been a strong opponent of passive euthanasia. Today, he reiterated his stand and said he stands by his decision.

Mumbai couple who wrote to Centre asking euthanasia be allowed for them ’not fully satisfied’ with Supreme Court’s decision 

We're not fully satisfied with SC's judgement. People above the age of 75 should be given this right. They can verify the details of these people from the police & doctors. Govt should come up with a policy: Mr & Mrs Lavate, who had asked for #Euthanasia pic.twitter.com/MtmBgVCa23

— ANI (@ANI) March 9, 2018

Criminal lawyer Dinesh Tiwari hails Supreme Court’s ruling on euthanasia

Advocate Dinesh Tiwari, criminal lawyer, says that the decision on euthanasia was long overdue. “It is a very good judgment. It provides a huge relief for those who are in pain and find the pain unbearable to continue living. The Supreme Court ruling is a good development. However, there are chances of the ruling being misused. To avoid this, state governments can lay more procedures in keeping with the apex court ruling to avoid it being misused.”

Why is physician-assisted suicide complex?

The issue of physician-assisted suicide is complex because sentiment about the practice ranges greatly from strong support for personal freedoms to religious backlash that insists it is murder and against the teachings of God. At this juncture, it seems that the debate will need to be settled before progress towards an agreeable solution will take place.

Example of a case where euthanasia was not allowed: ‘Should not allow medicine to become inhumane’

The following excerpt is sourced from: Voluntary Euthanasia, Edited by AJS. Downing and Barbara Smoker; Published   by  Peter Owen, London and Humanities International; Atlantic Highlands, New Jersey, 1986, 303 pp, $29.95

Let us begin with Barnard’s story about a patient named Eli Kahn. Aged 78, he was suffering from carcinoma of the prostate, obstruction of the bowel, and very severe emphysema. Mr. Kahn said to his doctor: “You mustn’t try to save my life. I am ready to die. The machine is worn out, and the mechanic must now give up.” “No,” was the reply, “this is not a hospital which just allows patients to die like that. We treat you here, we don’t just let you die.”

Unfortunately what happened to Mr. Kahn is all too familiar. After pointless surgery he developed problems with his lungs, and was intubatcd. During the night he somehow managed to disconnect the respirator. And in bed there was a note, written in a shaky hand. The message read: “Doctor, the real enemy is not death—the real enemy is inhumanity?’

According to Barnard that also should be our message. We should not allow medicine to become inhumane. And to become unconcerned about the quality of life is to become inhumane. Thus he writes:

ll is not true that we become doctors in order to prolong life, We become doctors in order to improve the quality of life, to give (he patient a more enjoyable life . . . And the same is true when we are dealing with terminally ill patients: what we should ask ourselves is whether there is still any quality of life left. The doctor who is unconcerned about the quality of life is inhumane; and the real   enemy  is  not  death   but  inhumanily. (pl77)

Fundamental right to ‘meaningful existence’ includes right to die without suffering, says SC

In its landmark judgment on ’living will’ for passive euthanasia, the apex court upheld that the fundamental right to a meaningful existence included a person’s choice to die without suffering, reported  The Hindu. 

CJI Dipak Misra also detailed how pressure from society and fear of criminal liability led to prolonging a patient’s suffering, resulting in his/her “undignified death”. The court also added that it was time to let go of such shared suffering and face reality.

Senior advocate Prashant Bhushan lauds Supreme Court’s verdict

Kudos to SC for clearing air on passive euthanasia&living will.Ct holds that every person has right to refuse treatment.Doctors&kin must respect it.If he has left 'living will' that he mustn't be kept on life support,it must be followed. Doctors&kin can decide for unconscious ppl

— Prashant Bhushan (@pbhushan1) March 9, 2018

Chronology of events leading to Supreme Court recognising ’living will’ 

Following is the chronology of events related to Friday’s landmark verdict by a five-judge Constitution bench, recognising ’living will’ to be made by terminally-ill patients for passive euthanasia:

11 May, 2005: Supreme Court takes note of PIL of NGO ‘Common Cause’ seeking nod to allow terminally-ill persons to execute a living will for passive euthanasia. It seeks the Centre’s response on the plea which seeks declaration of ‘right to die with dignity’ as a Fundamental Right under Article 21 (right to life) of the Constitution.

16 January, 2006: Supreme Court allows Delhi Medical Council (DMC) to intervene and asks it to file documents on passive euthanasia.

28 April, 2006: Law Commission suggests a draft bill on passive euthanasia and says such pleas be made to high courts which should decide after taking experts’ views.

31 January, 2007: Supreme Court asks parties to file documents.

7 March, 2011: Supreme Court, on a separate plea on behalf of Aruna Shanbaug, allows passive euthanasia for the nurse lying in vegetative state at a hospital in Mumbai.

23 January, 2014: A three-judge bench led by then-CJI P Sathasivam starts final hearing in the case.

11 February: DMC files copy of proceedings of International Workshop for Policy Statement on Euthanasia in India and SC reserves verdict.

25 February: Supreme Court cites inconsistencies in earlier verdicts on passive euthanasia including the one given in the Shanbaug case and refers the PIL to a Constitution bench.

15 July: A five-judge bench commences hearing on the plea, issues notices to all states and UTs, and appoints senior advocate TR Andhyarujina as an amicus curiae. He dies during the pendency of the case.

15 February, 2016: Centre says that it is deliberating the issue.

11 October, 2017: Five-judge Constitution bench led by CJI Dipak Misra hears arguments and reserves the verdict.

9 March, 2018: Supreme Court recognises ’living will’ made by terminally-ill patients for passive euthanasia and lays down guidelines on procedures to be adopted for it.

Legalising passive euthanasia is not just about patient’s rights, it is an emotional and legal relief to the family

The Supreme Court judgment on passive euthanasia is a big relief to family members of terminally-ill patients, emotionally, financially and legally. To decide to pull the plug on a family member who is on artificial life support system with rising medical costs and very little or no hope of survival is in itself a tortuous decision to make. 

But that is nothing compared to the insensitivity the family goes through with the legal system. Passive euthanasia won’t begin from today, now that the Supreme Court has legalised it. It is the worst kept secret of our medicare system. 

This is how passive euthanasia used to work on the ground: The hospital or treating doctors would advise family members about the futility of keeping the patient on life support any longer. They would not take any responsibility beyond that because passive euthanasia was illegal. It would now be up to the family  to decide whether and when to switch off. What should be a joint decision would be pinned solely on the family. 

But it wouldn’t stop there because most hospitals don’t like to show the death on their statistics, they would then force the family to shift the patient home. Worse, to legally secure the hospital, the release certificate would term it “discharge against medical advise” after actually advising the family, unofficially, to the contrary. Legally, the hospital would want no responsibility. Following the discharge, if the patient died on the way home — a real possibility in the circumstances — then the family would run into problems procuring the death certificate because the hospital would now be out of the picture and there would be nobody to certify the death. The family would then have to run around for a doctor who would be willing to certify the death. That is why the SC judgement is so welcome. 

Now, all this can happen legally and in a hospital. The judgement does not recognise just the right to dignity of death, but it relieves the family of enormous emotional and legal hassles by legalising what was anyway happening in every hospital.

I respect Supreme Court decision, but as a Christian don’t advocate killing: Archdiocese of Mumbai 

Speaking to Firstpost, Father Sebastian Michael, secretary, inter-religious commission, Archdiocese of Mumbai said that as a citizen of India he respects the Supreme Court decision. “However, as a Christian, I believe life is precious and cannot be taken away by anyone. Eeven by oneself. We have no right to take anyone’s life or even our’s. We have to live out life. I understand that sometimes certain circumstances in life may be very difficult. However, these teach lessons for the individuals and  society. No one should take away another’s life or his/her own.”

Supreme Court lays down guidelines

The court also laid down guidelines governing execution and enforcement of living wills, as well as procedure to be followed for passive Euthanasia in case there is no living will/advance directive.

Full text of the judgment is still awaited.

The Court also laid down guidelines governing execution and enforcement of living wills, as well as procedure to be followed for passive Euthanasia in case there is no living will/advance directive.

— Bar and Bench (@barandbench) March 9, 2018

All judges were unanimous that living will should be permitted: CJI Misra

CJI Dipak Misra, while reading out the judgment, said that though there were four separate opinions of the bench but all the judges were unanimous that the ’living will’ should be permitted since a person cannot be allowed to continue suffering in a comatose state when he or she doesn’t wish to live.

What did the Supreme Court observe?

– Terminally ill patients can make living will. 

– Close friends and family can go to high court

– High courts should constitute medical board which will decide if passive euthanasia is needed

Why was there a verdict on passive euthanasia after Aruna Shanbaug case?

Friday’s Supreme Court verdict is not primarily on passive euthanasia or its legality. Last year, on 11 October, the Centre had categorically informed the Supreme Court that “passive euthanasia” was the law of the land and that the government was in conformity with it.

The top court in its verdict on 7 March, 2014 in Aruna Shanbaug case had permitted passive euthanasia or passive mercy killing under certain circumstances, provided it was backed by the permission of the high court concerned.

What is a Living Will?

Living will is a written document that allows a patient to give explicit instructions in advance about the medical treatment to be administered when he or she is terminally-ill or no longer able to express informed consent.

What is Passive Euthanasia?

Passive euthanasia is a condition where there is withdrawal of medical treatment with the deliberate intention to hasten the death of a terminally-ill patient.

What is the difference between active and passive euthanasia

While the Supreme Court has legalised passive euthanasia, it has not passed any judgment on active euthanasia. Passive euthanasia entails a withdrawal of medical treatment to deliberately hasten the death of a terminally-ill patient. While active euthanasia entails the use of lethal substances to end a life.

Passive euthanasia has been made legal as doctors are not condemned for failing to save a life. They are not directly killing someone to save them from a worse death but are just denying saving them.

Rahul Eeswar tweets, says ‘sad and pained’ by Supreme Court judgment

While majority of the country is hailing the Supreme Court ruling on passive euthanasia as landmark, activist Rahul Eeswar tweeted and said that the judgment was sad and painful. “Sad and pained by Hon’ble Supreme Court Verdict ; The very idea of “living will” can be misused and more importantly not taking into account future growth of Science and medicine.”

Sad and pained by Hon'ble Supreme Court Verdict ; The very idea of "living will" can be misused and more importantly not taking into account future growth of Science and medicine.

Irreversible & Terminally ill today may be reversible Tomorrow due to growth of Science. https://t.co/P7TyctYwaR

— Rahul Easwar (@RahulEaswar) March 9, 2018

Living will by terminally-ill individual demanding euthanasia will also be recognised, rules SC

Passive euthanasia is a person’s right, Supreme Court has ruled. The top court also held that a living will by an individual demanding euthanasia, if in case the said individual is terminally ill, will also be recognised.

#RightToDie - SC has said that passive #euthanasia has a person's right. SC has also held that a living will by an individual demanding euthanasia if in case the said individual is terminally ill, will also be recognised: @pbhushan1, Petitioner #DieWithDignity pic.twitter.com/xyk7ApYHOK

— News18 (@CNNnews18) March 9, 2018

All thanks to Aruna Shanbaug, says Pinki Virani

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Writer and one of the biggest supporters of passive euthanasia Pinki Virani said that Aruna Shanbaug gave the gift of passive euthanasia to the country and brought patients’ rights into focus, even though the system failed her. 

Virani filed a euthanasia petition before the Supreme Court in 2009.

#DieWithDignity - This is all thanks to Aruna Shanbaug who lived in sad circumstances for 40 years: Pinki Virani, Activist. #RightToDie pic.twitter.com/lF12gqEu5G

— News18 (@CNNnews18) March 9, 2018

SC lays down guidelines governing execution and enforcement of living wills

The judgment was delivered by a five-judge Constitution Bench of Chief Justice Dipak Misra and Justices AK Sikri, AM Khanwilkar, DY Chandrachud and Ashok Bhushan. The apex court also laid down guidelines governing execution and enforcement of living wills, as well as the procedure to be followed for passive Euthanasia in case there is no living will/advance directive.

Passive euthanasia legal, rules Supreme Court

Supreme Court of India has held that right to die with dignity is a fundamental right. The five-judge Bench also held that passive euthanasia and a living will also legally valid.  The Court has issued detailed guidelines in this regard.