This article has been written by Oishika Banerji of Amity Law School, Kolkata. This article provides a detailed analysis of whether euthanasia has received legal enforcement and backing in the democratic land of India or not. The article also witnesses a comparison of India with other nations on this subject matter. 

It has been published by Rachit Garg.

Introduction 

Palliative care and quality of life difficulties in patients with terminal illnesses such as advanced cancer and AIDS have become a major source of worry for clinicians in our culture. Another contentious issue has evolved in response to this concern: euthanasia or “mercy killing” of terminally sick patients. Physician-assisted suicide (PAS) proponents believe that a person’s right to autonomy inherently rights him to a painless death. Opponents argue that a physician’s role in a patient’s death goes against the medical profession’s basic precept. Furthermore, untreated depression and the risk of social ‘coercion’ in persons seeking euthanasia cast doubt on the ethical foundations driving such a decision. As a result of these problems, specific criteria for adopting PAS have been established. Assessment of the mental health of the individual agreeing to PAS becomes required, and the psychiatrist’s role becomes critical in this regard. Despite the fact that PAS is illegal in our nation, it has a number of supporters in the form of non-profit organisations such as the “Death with Dignity” foundation. The recent judgement delivered by the Supreme Court of India, in the Aruna Shaunbag case (2011) has given this a boost. What remains to be seen is how long this sensitive matter will be debated in the Indian legislature.

What does euthanasia mean

Euthanasia, sometimes known as mercy killing, is the act or practice of putting to death people who are suffering from a terrible and incurable sickness or a physically incapacitating disorder without pain, or permitting them to die without treatment or artificial life-support measures. Because most legal systems do not have a specific provision for it, it is commonly seen as either suicide (if carried out by the patient themselves) or murder (if performed by another). Several European countries had unique provisions in their criminal laws in the late twentieth century for lenient sentencing and the consideration of extenuating circumstances in euthanasia proceedings.

The Netherlands and Belgium were the first countries to legalise euthanasia in 2001 and 2002, respectively. In 1997, Oregon became the first state in the United States to decriminalise physician-assisted suicide. Opponents, however, pushed to have the contentious law repealed. The Supreme Court of South Korea acknowledged the “right to die with dignity” in 2009 when it granted the family of a brain-dead woman’s request to have her life-support systems removed.

The ability of the modern medical practice to extend life through technological methods has raised the question of what courses of action should be accessible to the physician and family in times of acute physical or emotional pain, particularly if the patient is unable to make their own decisions. Criminal charges have been brought against physicians for passively doing nothing to prolong life or withdrawing life-support measures; on the other hand, the families of comatose and apparently terminal patients have taken legal action against the medical establishment to force them to stop using extraordinary life support.

Relevant terms with respect to euthanasia

1. Physician Assisted Suicide (PAS): PAS, sometimes called as aid-in-dying, is a semi-passive method of euthanasia in which a medical practitioner prescribes or introduces the appropriate amount of lethal dose to end life at the patient’s request. The dose may be self-injected or made available to the patient, who then injects or inhales the lethal dose.
2. Permanent Vegetative State (PVS): It is a state in which a patient is in a vegetative state, in which he or she is unable to sustain himself or herself and requires the assistance of one or more life support systems or even other people (including family, relatives, doctors, medical staff, and so on) to perform basic human functions.
3. Terminal disease: It refers to a medically confirmed incurable and irreversible sickness or condition that will, within reasonable medical judgement, result in death.
4. Advanced medical directive: It is also known as a ‘living will,’ and it is a direction issued by a person who wishes to avoid receiving extraordinary medical care if he or she is diagnosed with a fatal illness. To be legal, such a direction must be voluntary, competent, and given in advance.

Euthanasia in clinical practice

The Indian Penal Code, 1860, which deals with both active and passive euthanasia, as well as PAS, determines the legal position of the same in India. Active euthanasia is a crime under Section 302 (punishment for murder) of the 1860 Code or at the very least Section 304 of the Indian Penal Code 1860 which deals with punishment for culpable homicide not amounting to murder. The distinction between euthanasia and physician-assisted death lies in who administers the lethal dose. While in euthanasia, a doctor or a third party does so, but in physician-assisted death, the patient himself/herself carries out the same. 

In India, PAS’ legal standing would be abetment of suicide under Section 306 of the Indian Penal Code, 1860 which discusses abetment of suicide. Speaking technically, anyone considering euthanasia or PAS must go through Indian Courts, and the courts have never issued a clear ruling permitting a PAS to proceed. India is not alone in this regard. Most countries have been attempting to obtain rulings on this subject. In contrast to the general public in the United Kingdom, research of 3733 UK doctors on the legality of medically assisted death (euthanasia and PAS) indicated that the majority of doctors opposed PAS legislation and that a strong religious belief was independently related to resistance to assisted dying.

India is a healthy example of a diverse range of cultures, customs, and faiths that have all maintained their distinct identities while also blending with traditional Indian ideas and rituals. In the Indian setting, untangling religion and culture, customs and rituals, and beliefs and attitudes is a Herculean undertaking. A professional and public discussion of PAS will encounter a variety of problems, such as people’s moral standards, how religion and culture will interact in people’s brains, whether the intensity of religiosity will trump any kind of religion, and so on. According to a recent survey in Egypt, doctors assess whether PAS should be considered based on religiosity rather than a specific religion.

More religious doctors, whether Christians or Muslims, believed that PAS should not be considered since it would be against their faith. Only a small amount of information about Indian doctors’ attitudes toward euthanasia and PAS has been published. Although the study stated previously provides some insights, generalisations are impossible due to the small sample size. The attitudes of Indian doctors, particularly psychiatrists, oncologists, palliative care physicians, and geriatricians, concerning the notions of euthanasia and PAS, need to be studied further.

The majority of palliative medicine specialists oppose changing the law on assisted dying, according to a study undertaken by the Association for Palliative Medicine in the United Kingdom. They suggest that people who work with dying patients should be included since they have a plethora of knowledge about the subject. According to a qualitative observational study conducted in the Netherlands, one of the nations where assisted suicide is permitted, euthanasia practice entails lengthy considerations, the majority of which do not result in death. Discussions about euthanasia have two outcomes:

1. Patients are encouraged to continue discussions about death resulting from euthanasia as a consequence of the talk.
2. A socio-therapeutic component is present, which tends to reinforce social relationships and social life.

Another study in the Netherlands found that physical symptoms (62 percent), function loss (33 percent), reliance (28 percent), or deterioration (15 percent) were frequently cited as reasons for considering euthanasia. As many as 35% of physicians reported that there had been alternatives to relieve patients’ suffering which the majority refused. According to a Swedish study of physicians who had worked with adult dying patients, about half of them had addressed palliative care with all of their dying patients, and more than half had heard their patients express a desire to die. About a third of the doctors had administered analgesics or other medications in such high quantities that some of their patients died sooner. One-third had been requested to participate in active euthanasia, while 10% had been asked to aid in suicide.

There have always been a debate existing between those who support and oppose euthanasia and PAS. People claim that hospitals do not listen to patients’ requests, especially when they are terminally sick, crippled, or unable to respond to medical treatment. This medical culture will undoubtedly change as a result of the new legislation that may be enacted if the PAS is allowed. Psychiatrists must deal with mental capacity difficulties on a regular basis, therefore this topic is becoming increasingly significant with them. There is a need for empirical research in India on perceptions and attitudes toward euthanasia and PAS among a large number of professionals and the general public in order to develop meaningful conclusions on whether or not euthanasia and PAS should be legalised. Let us check out some of these arguments below. 

Arguments supporting legalisation of euthanasia

1. Patrick Stuart, Patron of Dignity in Dying, once said, “We have no control over how we arrive in the world but at the end of life we should have control over how we leave it.” The three kinds of arguments supporting legalisation of euthanasia are provided hereunder: 

1. The compassion argument (We need it): Supporters of assisted suicide argue that allowing people to ‘die with dignity’ is preferable to forcing them to live in pain. 
2. The autonomy argument (We want it): Some people believe that each patient has the right to decide when they want to die. 
3. The public policy argument (We can control it): Proponents argue that government law can safely regulate assisted suicide.
4. Those who support euthanasia or assisted dying argue that in a civilised society, people should be able to choose when they want to die and should be assisted if they are unable to do it themselves.

Arguments opposing the legalisation of euthanasia

However, according to the BBC, some detractors take a moral stance opposing euthanasia and assisted suicide, claiming that life is given by God and only God has the power to take it away. Others believe that laws legalising euthanasia could be exploited, resulting in the death of persons who did not want to die.

India and euthanasia : the story so far

Suicide, in general, is defined as a reaction to situations that cannot be resolved at any cost at any given time. It is considered to be one of the last reactions a person might have when confronted with inner emotional suffering. The successful act of committing suicide is punishable under Section 309 of the Indian Penal Code, 1860. For a long time, the effectiveness of this clause has been at the focus of all disputes and is also vulnerable to judicial scrutiny. Furthermore, the Supreme Court of India and different High Courts have examined the constitutional validity of Section 309 of the Indian Penal Code in multiple cases since then. 

The timeline of events surrounding the right to die 

1. 1994 (P. Rathinam v. Union of India): P. Rathinam and Nagbhushan Patnaik had filed petitions contesting Section 309 of the Indian Penal Code’s, 1860 constitutional validity. Anyone who tries to commit suicide is subject to a one-year sentence of simple imprisonment under Section 309. The Supreme Court made a connection between the other fundamental rights. As a result, Section 309 was declared unconstitutional.
2. 1996 (Gian Kaur v. The State of Punjab): A Trial Court had found Gian Kaur and her husband Harbans Singh guilty of violating Section 306 of the Indian Penal Code, 1860. They were sentenced to six years in prison and a fine of Rs. 2,000/- for assisting Ms. Kulwant Kaur in her suicide. Anyone who aids in the act of suicide is punished under Section 306, whereas anyone who tries to commit suicide is punished under Section 309 of the Code. In this case, it was held that the right to life under Article 21 includes the freedom to die as well. Assisting in the implementation of Article 21 is thus the same as abetting suicide. P. Rathinam was overruled by a five-judge bench of the Apex Court of India.
3. 2006 (Law Commission Report on Euthanasia): In its 196th Report, the Law Commission of India suggested that a law be enacted to safeguard terminally ill individuals who refuse medical care, artificial feeding, or hydration from being prosecuted under Section 309 of the Indian Penal Code, 1860. Furthermore, clinicians who obey such a patient’s decision, or who make such a decision for incompetent patients in their best interests, shall be shielded from prosecution under Section 306 or Section 299 of the Code. According to the report, the ‘patient’ must be suffering from a terminal illness, which is defined as an illness, injury, or degeneration of a physical or mental condition that causes extreme pain and suffering and, in the opinion of a reasonable medical expert, will inevitably result in the patient’s untimely death.
4. 2008 (Law Commission Report on Decriminalisation of Attempt to Suicide): In its 210th Report, the Indian Law Commission determined Section 309 of the 1860 Code to be inhumane. Suicide attempts are described as a symptom of a ‘diseased mental condition,’ according to the report. It deserved to be treated with respect and not punished. It is unjust and unfair to impose more punishment on someone who is already in pain. It does not aid in the prevention of suicide attempts or the improvement of access to medical care for individuals who have attempted suicide.
5. 2011 (Aruna Ramachandra Shanbaug v. Union of India): Ms. Aruna Shanbaug’s ‘next friend’ had petitioned before the Supreme Court, requesting that it order the hospital to cease feeding her and let her die peacefully. Since being sexually assaulted in 1973, Ms. Shanbaug has been in a Persistent Vegetative State (PVS). Ms. Shanbaug was examined by a team of three doctors, who submitted a report on her physical and mental state. Although the Court did not allow Ms. Shanbaug’s medical treatment to be withdrawn, it did go into great detail on euthanasia and permitted passive euthanasia. It decided that the Court is the ultimate decider of what is best for the patient, invoking the Parens Patriae principle (Latin for “parent of the nation,” where the Court can step in and function as a guardian). Under Article 226 of the Constitution, it expanded this power to the High Courts.

Landmark euthanasia cases in India

A list of ten landmark decisions surrounding the subject matter of euthanasia and the right to die has been elaborated hereunder. 

Maruti Shripati Dubal v. State Of Maharashtra (1986)

In the matter of Maruti Shripati Dubal v. State of Maharashtra (1986), the petitioner was a police officer who became mentally sick after being involved in a car accident. He was diagnosed with schizophrenia and had a history of mental illness, including mental depression and instability. Before being apprehended by the police, he poured kerosene on his body, attempted to light a match, and set himself on fire. He was charged with attempting to commit suicide under Section 309 of the Indian Penal Code, 1860. The legality of the clause was challenged before the Bombay High Court.

Issues raised before the Court of law

1. Whether Section 309 of IPC criminalising attempts to suicide is constitutionally valid or not?
2. Whether the petitioner liable under the section for an attempt to suicide?

The reasons given by the Bombay High Court

The Court ruled that Section 309 of the Indian Penal Code, 1860 is ultra-vires of the Constitution because it violates Articles 14, 19, and 21 of the same. Taking the same into account, the Court reached the following conclusion:

1. Article 19 is violated by Section 309 because the right to life has a negative connotation, as in Maneka Gandhi v. Union of India (1978), Kharak Singh v. State of Uttar Pradesh (1962) and Sunil Batra v. Delhi Administration (1980), it guarantees the right to personal liberty and protection of life. Articles 19 and 21 must be construed in tandem and read in connection with one another. 
2. Further, Section 309 violates Article 14 since the term “suicide” is not defined anywhere in the statute. There is a lot of ambiguity in the concept because suicide has varied meanings in different groups. Also, while some suicides are eulogised in religions, others are reviled.
3. Terminating one’s life is not the same as ending one’s life in an unnatural manner, because the person may have exhausted their desire to live, which is not unnatural. To end one’s life is an act of living that must be regarded in the context of the individual’s circumstances that compel him to do so, which must be considered natural.

The Court finally decided that Section 309 was unconstitutional because it violated Articles 19, 21, and 14 of the Indian Constitution. As a result, the petitioner’s prosecution was dismissed, and he was found not guilty under Section 309 of the Code of 1806.

The leftovers of the case

The present case’s decision was overturned by the judgement delivered in the case of Gian Kaur v. State of Punjab (1996), where the Supreme Court had declared that Section 309 is constitutional and does not violate Articles 21 and 14. The Apex Court had also held that the right to life cannot be compared to the rights to freedom, business, movement, and so on because the latter rights are positive rights that include negative aspects, whereas the right to life enshrined in Article 21 is a negative right that protects against any intrusion and thus cannot be compared to include positive aspects. 

Following this, the case of State of Maharashtra v. Maruti Shripati Dubal (1996) was revisited. The criminal prosecution against the constable was quashed in 1996 by the Court due to the unusual circumstances of the case and the constable’s mental instability. It was decided that the respondent did not merit a trial 11 years after the incident occurred, and that even if the prosecution’s case was proven beyond a reasonable doubt, he deserved the moderate sentence of a nominal fine.

P. Rathinam v. Union of India (1994)

P. Rathinam and Nagbhushan Patnaik had filed petitions contesting the constitutional validity of Section 309 of the Indian Penal Code, 1860. The Supreme Court considered a variety of judicial and legal perspectives on the issue, some of which are briefly covered hereunder.

A person is freed of torment, pain, and suffering if he or she decides to end his or her life and dies as a result of that decision. If the person is unlucky enough to survive, they are charged with ‘attempted suicide’ and dragged before the court of law. To say the least, it is unjust that a person who is already suffering is penalised simply because a clause like Section 309 still exists in our supreme criminal code. The provision has been in place since the Code was created in 1860 during the British Raj, despite the fact that the Britishers have since long altered their laws to make attempting suicide illegal. 

The petitioners argued that Section 309 was unconstitutional because it violated Articles 14 and 21 of the Constitution, and they asked for the Section to be declared void. The petitioner (Nagbhushan) was also seeking to have the proceedings against him quashed under Section 309 of the Indian Penal Code, 1860.

Issues raised before the Court of law

The fundamental question before the Court was whether Section 309 of the Indian Penal Code, 1860 violated Articles 21 and 14 of the Constitution, and if Article 21 of the Constitution includes the “right to die” or not. The following are some of the other key issues that the Court discussed:

1. Is it moral to commit suicide?
2. Is suicide associated with negative societal consequences?
3. Is it against the law to commit suicide?
4. Is committing suicide a threat to the State’s monopolistic authority to take a life?

The reasoning of the Supreme Court of India

The Supreme Court took into consideration some of the observations of eminent personalities on the subject matter. Some of which are:

1. After retiring as Chief Justice of the Delhi High Court, Shri V.S. Deshpande wrote an article titled ‘To Be or Not to Be’ in which he shared his thoughts on the subject of euthanasia. He pointed out that if Section 309 is limited to cowardly and unworthy attempts at suicide, then only this Section would be in accordance with Article 21 because if a person has no obligations to himself or others when he is terminally ill and decides to end his life to relieve himself of the pain of living and the burden of caring for him, prosecution of such a person would be adding insult to injury.
2. The Court also cited an article published in the Illustrated Weekly of India (September 29, 1985) by Justice R.A. Jahagirdar of the Bombay High Court, in which the learned Judge stated that Section 309 was unconstitutional for four reasons: 

1. Neither academicians nor jurists agree on what constitutes suicide, much less attempted suicide;
2. Mens rea, without which no offence can be sustained, is not discernible in such acts; 
3. Temporary insanity is the ultimate reason of such acts which is a valid defence even in homicides;
4. Individuals driven to suicide require psychiatric care.
5. In his famous track ‘On Liberty,’ J.S. Mill stated in this regard that the only reason for exercising power over any member of a civilised community against his will is to avoid harm to others. His goodness, whether physical or moral, is insufficient. The only aspect of a person’s behaviour that is acceptable to society is that which affects others. His freedom is absolute in the part of his life that is only concerned with himself. The individual is sovereign over himself, his own body and mind.

The Supreme Court’s observations

1. The Supreme Court ruled that Section 309 of the Indian Penal Code, 1860 is violative of Article 21 of the Indian Constitution. The Court stated that Section 309 of the Penal Code should be repealed in order to make our penal rules more humane. It’s a cruel and unreasonable rule that could lead to a person being punished twice (doubly) for suffering misery and facing ignominy for failing to commit suicide.
2. The Court further stated that the term “life” in Article 21 refers to the right to live in human dignity rather than simply existing as an animal. As a result, the right to live is followed by the right not to live a forced life. A person’s right to life cannot be taken away from him or made to be something he dislikes.
3. The Court went on to say that Section 309 does not violate Article 14 since the notion that the Section regards diverse attempts to commit suicide with the same penalty is incorrect. As the Section only allows for a maximum punishment of one year or a fine, the sentence can be adjusted to the type, extent, and intensity of the attempt.
4. The Court stated that in euthanasia, a third party is involved, either actively or passively, and it is possible to say that he assists or abets the killing of another person. Suicide, on the other hand, is the act of taking one’s own life. In this context, the Court examined the case of Mckay v. Bergstedt (1990), in which the Nevada Supreme Court held that the patient’s intention to remove his respirator did not constitute suicide, but rather an exercise of his rights.
5. The Court stated that they do not agree with the Andhra Pradesh High Court’s conclusion that if Section 309 is declared unconstitutional, it is highly unlikely that Section 306 will survive because self-death is conceptually distinct from assisting others in killing themselves. They are on opposing sides because in one, a person takes his own life, while in the other, a third person is aided in taking his own life.
6. The Court also used examples to demonstrate how harsh the clause is. It was stated that a student who jumps into a well after failing his exams, or a boy or girl who despises arranged marriage and would rather die, do not deserve to be tried as a criminal. The Court went on to say that a woman who tries to kill herself after being raped is not a criminal, but rather someone who deserves our pity. If they are forced to go through trials, it will just add insult to injury and make their lives even more unbearable.
7. Finally, the Court clarified that the judgement does not imply that the fundamental rights contained or given by Article 21 can be waived, as a Constitution Bench held in Olga Tellis v. Bombay Municipal Corporation (1985) that such a right cannot be waived.

Gian Kaur v. The State of Punjab (1996)

Gian Kaur and her husband Harbans Singh were found guilty of aiding and abetting their daughter in suicide. The trial court found them guilty under Section 306 of the Indian Penal Code, 1860, and sentenced them to six years in prison and punishment of Rs. 2,000, with an additional nine months’ incarceration if the appellant cannot pay the fine. In the High Court, the appellant filed an appeal. It reaffirmed the trial court’s decision and lowered the sentence from six to three years in prison.

Issues raised before the Court of law

1. Whether Section 306 of the Indian Penal Code, 1860 constitutionally valid?
2. Whether Section 309 of the Indian Penal Code, 1860 violates Article 14 and 21 of the Indian Constitution?

Observations by the Supreme Court of India

1. A five-judge Constitution Bench ruled in Gian Kaur v. The State of Punjab (1996), that the ‘right to life’ included in Article 21 of the Indian Constitution does not encompass the ‘right to die.’ The Supreme Court stressed that a person’s ‘right to life’ also includes the ‘right to a decent life’ until death. This must correspond to a dignified and natural death process. 
2. The Court was implying that the ‘right to die’ with dignity at the end of a person’s life should not be confused with the ‘right to die’ in an unnatural manner. It was claimed that any act that hastens an individual’s natural death is illegal under Article 21. 
3. The Apex Court also decided the question of whether Section 306 of the Indian Penal Code, 1860 is constitutional. For apparent considerations in the wider interest of society, the Court determined that “aided attempt to commit suicide” and “assisted suicide” are punishable. 
4. The purpose of such a provision is to reduce the inherent hazard that exists in its absence. P. Rathinam v. the Union of India (1994) was thus overturned, rendering Sections 306 and 309 of the Indian Penal Code, 1860 constitutionally legitimate and declaring the accused liable for abetment of suicide.

Judgement delivered by the Apex Court

1. Article 21, which deals with the ‘right to life,’ was deemed to exclude the ‘right to die.’
2. The constitutionality of Sections 306 and 309 of the 1860 Code was confirmed.
3. Arguments based on Article 14 of the Indian Constitution were found to be incompatible with the case’s main issues.

Ms. Taposhi Chakervarti v. State (2000)

The present case was a revision petition that appeared before the Delhi High Court concerning charges under Sections 306/498-A read with Section 34 of the Indian Penal Code, 1860, by the Additional Sessions Judge against the petitioner.  The petitioner was a relative of a deceased woman who had committed suicide out of angusih developed from her in-laws joint family with whom she was residing after her marriage. The only material available on record for the petitioner to show to the Court were two letters written by the deceased giving reasons as to why she had chosen to take the drastic step of ending her life.

Issues raised before the Court of law 

1. Whether the act of suicide fall under the subject-matter of ‘right to die’? 
2. Whether the charges framed against the petitioner stand valid owing to the circumstances of the case and the ingredients of Section 107 and 108 of the 1860 Code are made out to justify an offence under Section 306?

Reasoning opined by the Delhi High Court

1. So long as the right to die is effectively exercised, the law recognises it. A failed effort to take one’s own life is punishable, yet, a successful attempt at self-destruction is not. However, where suicide is not a voluntary act but is carried out under duress, the law punishes those who may be held responsible for causing it, either directly or indirectly, through active suggestion or the creation of objective conditions that drive the victim to it, but only if these are intended to achieve the desired result. 
2. Everyone has a different tolerance level. The coping strategy differs from person to person. Some people can handle certain types of pressures, while others can’t.  When someone commits suicide, it raises challenging issues about the reason for it, the compulsions for it, the circumstances that led to it, and those who were, wittingly or inadvertently, purposefully or unintentionally, responsible for it. The answers to these questions will determine whether a person is guilty of abetment or not, and these questions can be effectively answered not only with reference to the victim’s last words, which may or may not be unbiased, but also with material pertaining to the victim’s background, the state of the environments in which the act was committed, and the conduct of the suspect at the time of the act.
3. The abettor must be demonstrated to have aided the commission of the crime on purpose, and mere proof that the act accused could not have been accomplished without the suspected abettor’s intervention is insufficient to meet Section 107’s standards. The same does not meet the requirements for the accused to be charged under Sections 306 and 498-A of the Penal Code. 
4. The deceased in the present case was a “sensitive, pious, and devoted person who was finding the usual wear and tear of life to be difficult to cope with,” according to the remarks recorded at the most. This mentality is also reflected in the letters she left behind. As a result, reading more into the content than is necessary would be prohibited. In the absence of any other material, the trial of the accused on the charge stated above would appear to be an exercise in futility and hence should not be continued.

Judgement of the Delhi High Court

1. The Court observed that if the accused must be acquitted on the evidence, subjecting her to the misery of trial would be a misuse of the court’s process, especially since the accused must have already suffered mental anguish and shame as a result of the sad occurrence. 
2. The action or inaction of those who had the moral and legal obligation to keep the deceased happy and satisfied could not be described as anything other than impelled by judicial malice, however socially condemnable they were.
3. As a result, the petition was granted. The accusation under Sections 306 and 498-A of the Indian Penal Code, 1860 were quashed, and the challenged order was set aside.

People for elimination of stray dogs v. The State of Goa by its Chief Secretary (2008)

The facts of the present case unfold that in a judgement and order dated October 5, 1998, a Division Bench of the Bombay High Court established certain rules for dealing with the problem of stray dogs. All parties, including the Municipal Corporation of Greater Bombay and the intervenors, agreed to the foregoing order. Comprehensive Guidelines for Dog Control and Management were therefore framed. The aforementioned Guidelines state that stray dogs should not be killed unless they are critically ill, violent, fatally injured, or rabid. It further states that aggressive, diseased, incurably ill, and mortally wounded dogs, as well as those capable of transmitting diseases as recognised and diagnosed by a certified veterinarian, must be euthanized in a humane way.

Meanwhile, under the Prevention of Cruelty to Animals Act, 1960, the Central Government had enacted the Animal Birth Control (Dogs) Rules 2001. Learned Counsel, Mrs.Norma Alvares had argued that Section 11(3)(b) of the Act should not be interpreted in isolation from the Act’s other sections dealing with animal cruelty prevention. By mentioning the same, she wanted to point out that it’s crucial to remember Article 51A(g) of the Indian Constitution, which states that every Indian citizen has a constitutional obligation to exhibit compassion to all living species. Homeless/abandoned stray dogs are especially deserving of societal compassion, therefore killing stray dogs only because they are ownerless would constitute a lack of compassion, and thus would be a violation of Article 51A (g). Similarly, outlawing euthanasia completely would be a breach of Article 21 of the Indian Constitution, as it would be a threat to everyone’s right to life.

Issues raised before the Court of law

1. Whether the provisions of Sub-section (3) of Section 11 of the Prevention of Cruelty to Animals Act, 1960, and the relevant provisions of the Bombay Municipalities Act, Mumbai Municipal Corporation Act (MMC Act) and the Goa Municipalities Act and other enactments can be used in the circumstances and seriousness of the problem, the danger posed and the threat posed by stray dogs?
2. Is it necessary to prohibit the killing of stray dogs in spite of the aforementioned requirements of sub-section (3) of Section 11 of the Prevention of Cruelty to Animals Act, 1960 and other Acts referred to above?

Judgement of the Court of law

1. The Court of Law had observed that Section 11(3) of the Act of 1960 does not allow for the execution of “all” stray dogs in deadly chambers or by other means.
2. The Bombay High Court further stated that if a veterinarian comes across dogs who are incurably ill, gravely injured, or rabid while implementing the dogs control scheme, he should not waste his time and energy treating them and is permitted to put them to sleep. Other than these types of dogs, this does not preclude them from being put to sleep under the provisions of Section 11(3) of the Act of 1960 and Section 191-BA of the Mumbai Municipal Corporation Act. Dogs that are detected or reported to be a source of public nuisance, and if the nuisance exists, the Commissioner has the authority to destroy the dog(s) in accordance with Section 191BA of the MMC Act.

Aruna Ramchandra Shanbaug v. Union of India (2011)

The petitioner, Aruna Ramachandra Shanbaug, was described as a staff nurse at King Edward Memorial Hospital in Parel, Mumbai. She was attacked by a hospital sweeper on the evening of November 27, 1973, who placed a dog chain around her neck and yanked her back with it. He attempted to rape her, but when he discovered she was menstruating, he sodomised her instead. He twisted the chain around her neck to immobilise her throughout the act. The next day, a cleaner discovered her lying on the floor with blood all over her. The supply of oxygen to the brain was said to have been cut off as a result of the dog chain strangulation, causing the brain to be injured. It had been 36 years after the aforementioned incident, she couldn’t move her hands or legs and was surviving on mashed food. It was claimed that there was no chance of her health improving and that she was completely reliant on KEM Hospital in Mumbai. It was prayed to direct that the respondents stop feeding Aruna and allow her to die in peace.

A counter-petition was filed by the respondents, KEM Hospital and the Bombay Municipal Corporation. Because there were discrepancies between the petitioner’s and respondents’ petitions, the Court decided to establish a team of three distinguished doctors to investigate and report on Aruna Shanbaug’s exact medical and mental conditions. 

They thoroughly examined Aruna Shanbaug’s medical history and concluded that she is not brain dead. She has her own style of reacting to particular events. For example, she likes mild religious music and fish dishes. She becomes agitated when there are a large number of people in the room. When there are fewer people around her, she is at ease. KEM Hospital’s personnel were providing her with adequate treatment. She was kept spotless at all times. They also didn’t notice anything in Aruna’s body language that suggested she was willing to end her life. Furthermore, the nurses at KEM Hospital were more than happy to assist her. Thus, the doctors opined that euthanasia in the instant matter is not necessary.

Issues raised before the Court of law 

1. Should withholding or withdrawing life-sustaining therapies be permissible or ‘not unlawful’ when a person is in a permanent vegetative state (PVS)?
2. Should the patient’s wishes be honoured if he or she has previously stated a desire to avoid life-sustaining treatments in the event of futile care or a PVS?
3. Should a person’s family or next of kin make a request to withhold or discontinue ineffective life-sustaining therapies if he or she has not previously indicated such a wish?

Concept of medical ethics in Aruna Shanbaug’s case

As Aruna’s consent could not be acquired in this case, the subject of who should make decisions on her behalf became more apparent. This was decided by beneficence. Beneficence means behaving in the best interests of the patient. Following a course of action that is best for the patient and is not influenced by personal convictions, intentions, or other considerations is referred to as acting in the patient’s best interest. The public interest and the state’s interests were also taken into account. The Court looked at diverse jurisprudence to evolve with the protections because simply legalising euthanasia could lead to widespread misuse of the law.

Classification of euthanasia

1. To be able to rule on the aforementioned issues, the Court first clarified what euthanasia is. There are two types of euthanasia, or mercy killing, namely, active and passive. Active euthanasia refers to the employment of lethal drugs or forces to kill a person, such as a lethal injection given to a terminally sick individual in excruciating pain. Passive euthanasia comprises withholding medical treatment in order to prolong life, such as withholding antibiotics when a patient is likely to die if they are not given, or disconnecting the heart-lung machine from a coma patient.
2. Another distinction made in euthanasia is between voluntary and non-voluntary euthanasia. Voluntary euthanasia occurs when the patient’s consent is obtained, but non-voluntary euthanasia occurs when the patient’s consent is unavailable, such as when the patient is in a coma or otherwise incapable of giving consent. While the former has no legal ramifications, the latter has a number of issues. The current case involved non-voluntary passive euthanasia.

Judgement delivered by the Supreme Court of India

1. On March 7, 2011, the Supreme Court of India’s Hon’ble Division Bench, consisting of Justice Markandey Katju and Justice Gyan Sudha Mishra, handed down this landmark decision. Aruna was not brain dead, according to the doctors’ findings and the definition of brain death under the Transplantation of Human Organs Act, 1994. She was able to breathe without the use of a machine, she had feelings, and she was able to provide the essential stimuli. Despite the fact that she was in a PVS, her condition has remained constant. As a result, putting an end to her life was unwarranted.
2. Furthermore, KEM Hospital’s administration and employees, not Pinki Virani (the petitioner), have the authority to make decisions on her (Auna’s) behalf. The mashed meal was her life-saving strategy, and she was able to survive because of it. In this scenario, removing the life-saving treatment would have meant not feeding her. The Indian law made no provision for refusing to feed a person. The removal of ventilators and the removal of food, could not be compared. Allowing Aruna to die via euthanasia would entail undoing the years of work put in by the staff at KEM Hospital.
3. Furthermore, in order to protect the parens patriae concept, the Court had lodged the right to determine the termination of a person’s life in the High Court. As a result, the Supreme Court approved passive euthanasia in specified conditions, subject to the High Court’s consent following the proper procedure. When a request for passive euthanasia is made, the Chief Justice of the High Court should convene a Bench of at least two judges to decide whether to approve it or not. Before doing so, the Bench should seek the advice of a committee of three reputable doctors, which it will appoint after consulting with any medical authorities or practitioners it deems appropriate.
4. In addition to appointing the doctor’s committee, the High Court Bench must also issue notice to the State and the patient’s close relatives, such as parents, spouses, brothers/sisters, and in their absence, his/her next friend, and provide a copy of the doctor’s committee report as soon as it is available. The High Court should issue its decision after hearing them. Until Parliament passes laws on the matter, the approach outlined above should be followed throughout India.
5. Aruna Shanbaug, on the other hand, was denied euthanasia because the Court ruled that the situation did not warrant it. If the personnel or management of KEM hospital ever felt the need for anything similar, they might go to the High Court using the procedure outlined. 
6. This case highlighted the concerns surrounding euthanasia and also established standards for mass euthanasia. In addition, the Court recommended that Section 309 of the Indian Penal Code, 1860 be repealed. This case is significant because it established the procedure to be followed in an area where no legislation exists.

H. B. Karibasamma v. the Union Of India (2012)

The petitioner in the present case was a retired school teacher who is around 70 years old. She is currently residing at a nursing home for the elderly. The petitioner had been suffering from a serious health ailment known as ‘Intervertebral Disc Prolapse,’ or ‘Slip Disc.’ The condition in question was a disorder in which the outer fibrous ring of the spine tears, causing the soft, middle section of the spine to pop out. The disc ring rip may cause the release of inflammatory chemical mediators, which can cause significant discomfort. This ailment had plagued the petitioner for the past ten to eleven years. The petitioner was diabetic as well.

The petitioner appears to have sought the advice of several doctors, both neurologists and orthopaedic surgeons, in order to find a cure for her condition. However, due to the petitioner’s age and health condition, all of the doctors have recommended non-surgical, conservative treatments, whereas any possible improvement in her condition can only be achieved through invasive surgery.

The petitioner was not only in extreme bodily pain, but also suffers from mental anguish and is monetarily disadvantaged. The petitioner appears to have undertaken all of the necessary steps to alleviate the discomfort, but had failed, and was unwilling to endure a life of excruciating agony and sorrow. As a result, the petitioner has made the decision to end her life because it had been nothing but a continual drudgery of excruciating pain and mental anguish.

Issue raised before the Court of law 

Whether the petitioner in the present case can be termed as a person who is terminally ill or is in a permanent vegetative state, inasmuch as she requires the administration of euthanasia?

Judgement delivered by the Court

The Karnataka High Court delivered the following judgement: 

1. The guidelines laid down in the Aruna Shanbaug were followed.
2. The Court declared that the petitioner cannot be termed as a person who is terminally ill or is in a permanent vegetative state, inasmuch as she does not require the administration of euthanasia.

Common Cause v. the Union of India (2014)

The topic of the right to die with dignity was submitted to the Ministry of Law & Justice, Family Health & Welfare, and Company Affairs, by Common Cause, a recognised association. Common Cause petitioned before the Supreme Court under Article 32, requesting that the right to die with dignity be declared a fundamental right under Article 21. Appeals/prayers for terminally ill patients to be able to sign ‘living wills’ that direct what should be done if they are admitted to hospitals, were made. The Court then convened an expert committee of lawyers, doctors and scientists to investigate the issue of living will execution. 

A three-judge bench, consisting of then-Chairman of the Supreme Court P. Sathasiavn, Justice Ranjan Gogoi, and Justice Shiva Kirti Singh, had referred the case to a larger Bench to resolve the issue, citing inconsistent opinions in Aruna Shanbaug v. Union of India (2011) and Gian Kaur v. the State of Punjab (1996). The right to die with dignity was declared to be a fundamental right, according to a five-judge panel led by Chief Justice Dipak Misra and Justices A.K. Sikri, A.M. Khanwilkar, D.Y. Chandrachud, and Ashok Bhushan. The right to make prior medical directives is a statement of a person’s right to bodily integrity and self-determination, and it is independent of any state acknowledgment or regulation.

Issues raised before the Apex Court 

1. Is it true that Article 21, which provides the right to life, also includes the right to die?
2. Is it possible to make euthanasia legal just through legislation?
3. What is the distinction between passive and active euthanasia?
4. Can people offer ‘Advanced Directives,’ i.e., medical treatment directives, if they become incompetent or unable to speak in the future?

Passive euthanasia vis a vis active euthanasia

Passive euthanasia varies from active euthanasia as while the latter involves doing something to end the patient’s life, the former involves not doing anything that, if done, would have saved the patient’s life. Living wills, on the other hand, are written papers that allow patients to offer explicit instructions about medical care when they are unable to give informed permission. Passive euthanasia is a contentious notion that poses a slew of complex moral, ethical, social, philosophical, legal, and religious issues.

When it comes to passive euthanasia, there are two distinct factions. 

1. The first is a regional sect that believes life is a divine gift and does not believe there is a right to die. 
2. The second one has to do with the consent requirement. It is frequently questioned whether terminally ill patients are capable of giving informed consent for their own death. 

As a result, there have been numerous euthanasia campaigns in the past, some in support of the practice and others in opposition. However, legislation supporting euthanasia have been enacted, taking into account the interests of people. Though this philosophy is in opposition to religious beliefs, it is thought to be beneficial to society. There is a conflict between law and religion in this regard. In circumstances of irrational and unjustified behaviour, the law takes precedence over religion.

As a result, the decision made in this present case is an appropriate decision. Chronic disease patients are frequently subjected to excruciating pain and suffering, as well as therapies in which there is no cure and only medication and treatment that extends life. Denying them the right to a dignified death prolongs their agony. As a result, the Court is correct in proclaiming the right to die with dignity as a fundamental right, as it will alleviate the suffering of individuals who are undergoing chronic treatments and allow them to die in a dignified manner.

Judgement delivered by the Supreme Court of India 

In this case, the Supreme Court ruled that under Article 21 of the Indian Constitution, an individual has the right to die with dignity as part of his or her right to life and personal liberty. As a result of this judgement, life-support systems for the terminally ill or those in incurable comas can be removed. The Court also recognised the importance of writing a living will and allowed people to opt out of artificial life support. In this decision, the Court also established certain propositions regarding the procedure for executing advance directives and issued guidance for doing so in order to give effect to passive euthanasia. The judgement delivered by the Bench comprising of former Chief Justice Dipak Misra, Justices A.K. Sikri, A.M. Khanwilkar, D Y Chandrachud and Ashok Bhushan, can be categorised under the following heads:

1. Death with dignity: A life without dignity is an unbearable defeat, whereas a life that faces death with dignity is a virtue to be aspired to and a reason to rejoice. Sanctioning under Article 21, the right to a dignified life in the face of adversity right to a dignified death.
2. Sanctity of life vs. Quality of life: The right to life is the most important right, and the right to die with dignity is justified by “quality of life.” According to the Indian Constitution, human dignity is vital to safeguarding the sanctity of life, and dignity is harmed by pain, suffering, and the progressive loss of physiological functions, as stated by Justice Chandrachud in this case.
3. Legal implications for doctors: In this opinion, J. Chandrachud found that a doctor’s decision to withhold or discontinue medical intervention for a terminally ill patient should not be intended to cause death. However, in order to alleviate the suffering, the conduct should not be classified as culpable homicide or murder.
4. Hypocratic oath: “I will not offer a medication that is fatal,” says the Hypocratic Oath. This is frequently misinterpreted as a ban on euthanasia. So, in the name of oath, should a person be allowed to remain in such an incurable state of inactivity, suffering from pain and anguish? In contrast, the terminally ill patient should have the full right to close the doors of life and enter the dark tunnel of death painlessly and with dignity. Individual dignity should be preserved by smoothing the process of dying only permitted for passive euthanasia if medical technology exists and s/he is unaware of what is happening.
5. Advanced directives: Advanced directives comprise two components, namely, living will (passive euthanasia) and durable power of attorney for health care (active euthanasia). Living willI, a person’s thoughts and preferences regarding medical care, assures the ‘Consent & Authenticity’ for termination of the treatment and smoothens its death process. Whereas durable power of attorney for healthcare, allows another individual to make medical decisions for a patient who is unable to do so themselves (unconscious, mentally unstable). The final outcome will be rendered by the high court after consultation with three panellists of the Medical Board, under the impression of close relatives.

Nikhil Soni v. Union of India and Others (2015)

India has long been famed for its religious tolerance. In India, Jainism has a lengthy history, and Jains are devout adherents of their faith. Jains are noted for practicing ‘Santhara’ or ‘Sallekhana,’ a delicate kind of passive euthanasia. The Jain Shwetambar Sangha, Tonk Road, Jaipur, has come to their aid and has arranged for a group of Jains to be provided with facilities. They have also scheduled a Mahotsav for the Jains, and they have begun their fasts.  The Right Foundation, an NGO, filed a writ petition in the public interest against the Sangha and the Union of India before the High Court of Rajasthan, claiming that Santhara should be declared illegal because it violated several provisions of the Constitution, and that the Court should investigate the practice and prosecute it appropriately. Furthermore, it was alleged that facilitating the activity is also considered a criminal conduct.

Issues raised before the Court of law

1. Whether the petitioner’s special leave petition is maintainable  before the Honourable Court?
2. Whether the Santhara’s tradition stands up to the test of Article 21 of the Indian Constitution?
3. Whether Santhara is a necessary religious practice and is covered by Article 25 of the Indian Constitution?
4. Whether Santhara is punishable under Section 309 of the Indian Penal Code, 1860, and facilitating its execution is punishable under Section 306 of the Indian Penal Code, 1860?

Decision given by the Rajasthan High Court

The Nikhil Soni decision has ramifications not just for the liberties provided by the Constitution to non-sectarian groups, but also for the ongoing argument over the right to die with dignity. The key takeaways from the judgement are provided hereunder: 

1. The argument that Santhara or Sallekhana is an essential religious practice of the Jain religion has not been established in order to save the practice of Santhara or Sallekhana in the Jain religion from the vice of criminal offence under Section 309 IPC, 1806 which provides for the punishment of suicide, and Section 306 IPC, 1806 which provides for the punishment of abetment of suicide.
2. Santhara or Sallekhana is not suicide because it is a voluntary act of giving up one’s body for salvation that is not violent in any way, but it is legal religious practice guaranteed by Articles 25 and 26 of the Indian Constitution. The right to freedom of conscience and the right to freely profess, practice, and promote religion are constrained by the overarching and controlling principles of public order, morality, and health. Article 25’s right is subject to Article 21 of the Indian Constitution.
3. The writ petition is granted with instructions to the State authorities to put an end to the practice of ‘Santhara’ or ‘Sallekhana,’ and to treat it as suicide punishable under Section 309 of the Indian Penal Code, 1860 and abetment under Section 306 of the 1860 Code. In any form, the State shall prohibit and outlaw the practice of ‘Santhara’ and ‘Sallekhana’ in the Jain religion. Any complaint filed in this regard will be treated as a criminal matter and investigated by the police in accordance with the law, based on the recognition of law in the Indian Constitution and in accordance with Section 309 or Section 306 of the Indian Penal Code, 1860.

Chandrakant Narayanrao Tandale v. the State of Maharashtra (2020)

In the present case of Chandrakant Narayanrao Tandale v. the State of Maharashtra (2020), the petitioner made extraordinary prayer seeking permission for active euthanasia through a registered medical practitioner by invoking Article 226 of the Constitution of India, before the Bombay High Court. The petitioner, aged about 81 years old, decided to donate his body to the respondent, Government Medical College and Hospital, Aurangabad for the purpose of research. The petitioner was also not mentally and physically able to face severe pain because of back disc problems and was bed-ridden. 

Issues raised before the Court of law 

1. Whose consent is required in the situation of patients who are unable to articulate their desires because of their mental state, or because they are in a lifelong persistent vegetative state, or because of some other reason?
2. How should the decision be made in cases of mentally incompetent patients about the withdrawal of life-saving measures?
3. Whether active euthanasia should be granted to the petitioner or not?

Judgement delivered by the Bombay High Court

1. When an adult with mental ability can exercise his right to refuse treatment or withdraw from treatment, the aforementioned right cannot be taken away from a person who is unable to make an informed decision owing to terminal illness or being in a persistent vegetative condition (PVS). There are three stakeholders in the event of a person suffering from an illness and receiving medical treatment, namely, the patient, his family members, and the doctor treating the patient. No one can make decisions about another person’s life unless he/she has the authority to do so under the law.
2. True, the petitioner is 81 years old and suffers from a variety of ailments. He is in excruciating pain and misery on a daily basis, and it is becoming increasingly difficult for him to deal with such medical issues. His desire is to experience a “happy death” through active euthanasia with the assistance of a qualified medical practitioner. But active euthanasia is not permitted in India, and the same was made clear in the landmark judgement in the case of Common Cause. The right to life is guaranteed under Article 21 of the Constitution, but it does not include the right to die. The Hon’ble Supreme Court has prescribed the method for passive euthanasia in extreme circumstances as well.
3. Active euthanasia is a form of euthanasia that is illegal. The distinction between “active” and “passive” euthanasia is that active euthanasia involves doing something to end the patient’s life, whereas passive euthanasia involves not doing anything that would have saved the patient’s life. Although the Court expressed sympathy towards the petitioner in this case, his prayer was not allowed. 

Global euthanasia and assisted suicide laws

An overview of the status of euthanasia in different countries has been outlined hereunder:

1. Canada: Sue Rodriguez, dubbed “Victoria Woman,” was diagnosed with Lou Gehrig’s disease in 1991 and petitioned politicians to modify the statute prohibiting assisted suicide in 1992. Despite the fact that Rodriguez was found guilty by the Supreme Court of Canada, she had committed suicide in 1994 with the help of an unknown doctor.
2. The Netherlands: In 2002, the county passed legislation to make assisted suicide and active euthanasia legal. Since 1984, however, the courts have allowed them. Doctors were given strict guidelines by the Dutch government. Patients who are in excruciating pain and have little possibility of recovery may request to die. He or she must have a thorough understanding of the patient’s condition and prognosis, and a second doctor must concur with the choice to assist the patient in dying.
3. Belgium: In 2002, Belgium made euthanasia lawful. If the patient’s competency is in dispute, two doctors must be involved, as well as a psychologist. The doctor and the patient can agree on a fatal injection or a prescription overdose as a method of death.
4. Switzerland: Since 1941, assisted suicide by a physician and a non-physician has been legal, but euthanasia has been prohibited. Three right-to-die organisations in the country provide counselling and lethal medications to terminally ill persons. Injection-based death is prohibited.
5. Britain: In May 2006, a Bill that would have legalised assisted suicide for terminally sick people was defeated in the House of Lords.
6. United States: Passive euthanasia is authorised in only three US states, namely, Oregon, Washington, and Montana.

Countries where euthanasia is legal 

1. Till date, euthanasia has been legalised in the Netherlands, Belgium, and Luxembourg. PAS is also legal in the Netherlands and Luxembourg. The states of Oregon and Washington authorised PAS in 1997 and 1999, respectively, but euthanasia remains illegal in the United States. The status in Montana is currently unclear. In 2010, the state legislature passed a law legalising PAS, but it was recently defeated by the State’s Senate Judiciary Committee.
2. After over 30 years of public debate, euthanasia and assisted suicide were fully allowed in the Netherlands in 2001. The Royal Dutch Medical Association has collaborated with the country’s court system to develop and adapt standards and procedures for administering and controlling euthanasia since the 1980s. Despite strong resistance, especially from the Belgian Medical Association, Belgium legalised euthanasia in 2002, following a three-year public debate that included government commissions.
3. The law was influenced by the experiences of the Netherlands and Oregon, and the public was assured that any flaws in Dutch law would be corrected in Belgian law. In 2009, Luxembourg approved euthanasia and assisted suicide. Switzerland is an outlier, in that aided suicide is allowed despite the fact that it is not technically legalised. This is due to a loophole in a statute that decriminalises suicide and dates back to the early 1900s. Euthanasia, on the other hand, is prohibited. A person who is committing suicide with the help of another person is allowed to do so as long as the other person has no selfish intentions and stands to benefit personally from the death. Unlike other jurisdictions, Switzerland enables non-physicians to help people die via euthanasia or assisted suicide.
4. Safeguards, criteria, and procedures were implemented in all of these nations to regulate the practices, ensure social oversight, and prevent euthanasia and assisted suicide from being abused or misused. Some criteria and methods are consistent across jurisdictions, while others differ by country. A closer examination of the extent to which these rules and protections have been able to control practices and prevent abuse is warranted, particularly by states considering legalising euthanasia and PAS. 

Switzerland 

1. Switzerland is probably the first country that springs to mind when it comes to physician-assisted suicide because it enables it without a minimum age requirement, diagnosis, or symptom state.
2. Assisted suicide, on the other hand, is banned if the intentions are “selfish,” such as if the person assisting the death stands to inherit sooner or doesn’t want the responsibility of caring for a sick person. In this country, euthanasia is not permitted.
3. In 2018, 221 people visited the Dignitas clinic in Switzerland for assisted suicide, 87 among them were from Germany, 31 from France, and 24 from the United Kingdom. According to the Campaign for Dignity in Dying, a British person used to travel to Dignitas for help to die every eight days.
4. About 1.5% of Swiss deaths are the result of assisted suicide.

Netherlands

1. In the Netherlands, euthanasia and assisted suicide are authorised in circumstances where someone is suffering unbearably and there is no hope of relief. There is no condition that you be terminally ill or that you wait for a certain amount of time.
2. The Dutch government authorised proposals in October 2020 to allow euthanasia for terminally ill children aged one to twelve. According to the BBC, the health ministry stated that the rule modification would save some youngsters from “suffering endlessly and unbearably.”
3. For those under the age of 16, parental permission is required. Before assisted dying can be allowed, a variety of checks must be completed. Doctors who are considering legalising assisted dying must speak with at least one other doctor to ensure that the patient fits the requirements.

Spain

1. In March 2021, Spain made it lawful in certain situations for people to take their own lives.
2. According to the BBC, the rule permits adults with “serious and incurable” conditions that inflict “unbearable suffering” to opt to end their lives. When making the request, the adult must be a Spanish national or legal resident who is “completely aware and conscious” of the situation. The request must be filed twice in writing.
3. In Spain, aiding someone to die was punished with up to ten years in prison prior to the law’s passage.

Belgium 

1. Belgium permits euthanasia and assisted suicide for people who are in excruciating pain with no hope of improvement. There is a one-month waiting time before euthanasia can be conducted if the patient is not terminally sick.
2. Belgium does not have an age limit for children, but they must have a fatal illness to be approved.

Canada 

1. Canada’s statute on assisted dying was expanded in March 2021. Adults with a chronic and incurable “disease, illness, or disability” who are in an advanced condition of dying and suffering can now request a medically assisted death, according to the New York Times.
2. Previously, euthanasia and assisted suicide were only approved for persons suffering from “grievous and irreversible disorders” whose death was “reasonably foreseeable.”
3. According to the BBC, medically assisted deaths accounted for 1.89 percent of all deaths in Canada in 2019.
4. Only euthanasia is legal in Quebec.

Luxembourg

In Luxembourg, assisted suicide and euthanasia are both allowed for adults. Patients must be suffering from an incurable illness that causes them constant, terrible mental or physical pain with no hope of recovery.

Colombia 

1. In 1997, Colombia became the first Latin American country to decriminalize euthanasia, with the first death occurring in 2015.
2. According to the Rio Times, the Colombian Constitutional Court expanded the law on euthanasia or assisted death to include cases of non-terminal illnesses in July 2021, “provided that the patient is in intense physical or psychological suffering, resulting from bodily injury or serious and incurable illness.”

Australia

1. After 20 years and 50 failed efforts, the Australian state of Victoria became the first in the country to enact voluntary euthanasia legislation in November 2017. In 1997, the Australian Senate abolished the law after a popular outcry against the 1995 Bill that enabled it.
2. You must be an adult with decision-making ability, a resident of Victoria, and suffering from intolerable pain owing to a disease with a life expectancy of less than six months, or 12 months if suffering from a neurological illness, to qualify for legal approval for euthanasia.
3. The idea of assisted dying cannot be brought up by a doctor; it must be brought up by the patient first. You must submit three requests to the scheme, one of which must be in writing. According to the Guardian, you must next be evaluated by two competent doctors, one of whom is a specialist, to determine your eligibility.
4. If you qualify, you will be given medications that you must store in a “locked box” until a time that you specify. A doctor can provide a deadly injection if you are unable to administer the fatal medications yourself.
5. Since then, Victoria has been joined by Western Australia, South Australia, and Tasmania in legalising voluntary assisted death. And, despite being one of the most conservative states in Australia, Queensland became the sixth to allow voluntary euthanasia in September 2021, with an overwhelming majority of MPs voting in favour.
6. According to the Guardian, voluntary assisted dying will be limited to persons who have an advanced and progressive disease that causes intolerable suffering and is predicted to kill them within a year.

France 

1. In France, palliative sedation, in which a person can want to be heavily drugged until death, is legal, but assisted dying is not.
2. In April 2021, a proposal in the French parliament to legalise assisted dying for persons with terminal conditions was defeated.
3. Neither President Emmanuel Macron nor his government has commented on the subject, though Macron was cited as saying in 2017 that “I myself wish to pick the end of my life,” according to France 24.

USA

1. Assisted death is currently legal in some states. Doctor-assisted suicide for terminally ill patients is legal in Oregon, Washington, Vermont, California, Colorado, Washington, DC, Hawaii, New Jersey, Maine, Montana, and New Mexico, according to state statutes or court judgements.
2. Doctors can issue people prescriptions for the lethal medications, but they must be administered by a healthcare practitioner.
3. A 15-day waiting period is required between two spoken requests, and a two-day waiting period is required between a final written request and the fulfilment of the prescription in all states. 

New Zealand

1. The BBC reported that New Zealanders decided to legalise euthanasia in October 2020, calling it a “win for compassion and generosity” by activists.
2. If approved by two doctors, terminally ill persons with less than six months to live will be able to choose assisted death. It was scheduled to take effect in November of 2021.

Countries where euthanasia is not legal

Although it is clear from the aforementioned list of countries that the remaining countries not included in the list contribute to declare euthanasia illegal within their jurisdiction, a general, non-exhaustive list of such countries have been provided hereunder.

Chile

In Chile, active euthanasia and assisted suicide are illegal. However, passive euthanasia is legal. The right to informed consent has been in place since 2012, and it empowers people to accept or refuse any medical treatment. When a patient’s life is on the verge of ending, they have the option of refusing treatment. The Congress is currently debating a bill that would legalise active euthanasia and assisted suicide. On December 12, 2020, the Chamber of Deputies passed the bill in its entirety.

Czech Republic

Euthanasia and assisted suicide are prohibited in the Czech Republic. Both are deemed homicides in that jurisdiction. Articles 143 and 144 of the Czech Republic’s Criminal Code make it illegal.

Finland

Active euthanasia is not legal in Finland. Passive euthanasia, however, is legal.

United Kingdom

In the United Kingdom, active euthanasia is prohibited. Anyone caught assisting suicide or attempting suicide is breaking the law, and they can be charged with assisting suicide or attempted suicide. Lord Joffe attempted four times between 2003 and 2006 to introduce measures that would have legalised voluntary euthanasia, all of which were rejected by the UK Parliament. By way of advance decisions allowing patients the right to decline life-saving treatment, passive euthanasia is legal.

Turkey

In Turkey, euthanasia is severely prohibited. Under the provisions of Article 84 of the Turkish Criminal Law, an aide who assisted or encouraged a person to commit suicide or other means of self-destruction will be penalised for assisting and encouraging suicide. In the case of active euthanasia, Article 81 of the same legislation states that anyone who commits this act shall be tried and sentenced to life in prison, exactly as anyone who commits a simple murder.

India

In India, passive euthanasia is legal. The Supreme Court of India legalised passive euthanasia by withdrawing life support from people in a permanent vegetative condition on March 7, 2018. Active euthanasia, such as the delivery of fatal chemicals, is prohibited.

Ireland

A doctor (or anyone else) cannot actively contribute to someone’s death in Ireland. If a person (or their next of kin) requests it, it is not illegal to stop life support and other treatments (the “right to die”). According to a poll conducted by the Irish Times in September 2010, the majority of respondents (57%) felt that doctor-assisted suicide should be permitted for terminally ill patients who desire it. After being sedated, doctors can stop giving a patient life-sustaining therapies like ventilators and feeding tubes, enabling the patient to die peacefully in their sleep. This only happens in particular situations. The Dying with Dignity Bill passed its second reading on October 7, 2020, and a delaying amendment was defeated, bringing Ireland closer to legalising assisted dying.

Israel

The Israeli Penal Code prohibits causing another’s death, as well as causing another’s life to be cut short. In some situations, active euthanasia has been legalised in Israel. Passive euthanasia could be administered using a switch mechanism similar to Sabbath clocks, according to ideas made in 2005.

Italy

Active euthanasia is prohibited by Article 579 of the Italian Criminal Code. Following a petition signed by over a million individuals, the Constitutional Court dismissed a request to hold a referendum on the legalising of euthanasia in February 2022.

Latvia

Euthanasia is not legal in Latvia. However a doctor may refuse further treatment of a patient if they believe it is the best course of action.

Lithuania

Euthanasia is not legal in Lithuania. However, as of 2016 a draft of a law about the right to die has been produced

Moldova

All forms of euthanasia are banned in Moldova. They are prohibited by Articles 150 and 162 of the Criminal Code.

Mexico

Active euthanasia is illegal in Mexico, but since 7 January 2008, the law has allowed terminally ill people or their closest relatives if they are unconscious in Mexico City, the central state of Aguascalientes (since 6 April 2009), and the western state of Michoacán to refuse medication or further medical treatment in order to prolong their lives (also known as passive euthanasia).

Norway

Active voluntary euthanasia remains illegal, though a caregiver may receive a reduced punishment for taking the life of someone who consents to it.

Peru

Although there have been some attempts to alter Peruvian legislation, euthanasia is still considered a crime. The Reviser Special Commission of the Penal Code of the Parliament voiced its support for a proposal to change Article 112 of the Penal Code in October 2009, but the proposal failed. However, in early 2015, the situation of young Valentina Maureira, a Chilean woman suffering from cystic fibrosis, an incurable disease, and who requested that euthanasia be legalised in her country, drew the attention of Chilean and international media.

Philippines

In the Philippines, euthanasia is prohibited. The Philippine Senate debated whether or not to enact a measure authorising passive euthanasia in 1997. The Catholic Church in the country was outspoken in its opposition to the law. The Philippines would have become the first country to legalise euthanasia if it had been approved. Doctors who help a patient in dying might be imprisoned and punished with malpractice under present legislation.

Russia

Article 45 of Russian Federal Law No 323 prohibits euthanasia as of November 2011. However, there is no law that particularly punishes illegal euthanasia procedures. In Soviet Russia, active euthanasia was temporarily legalised in 1922.

Conclusion

Suicide prevention is not just a social and public health goal in India, but also a traditional mental health practice. As a result, the time has come for mental health practitioners to take a more proactive approach to suicide prevention. In addition, the government should initiate a national discourse on suicide prevention. Human life, however, is the most valuable gift of nature by its very nature. As a result, it should not be taken away by means that are not natural, such as suicide. However, one or two judgements by the judiciary will not be enough to fix this complex socio economic problem. To totally fix this challenge, consistent and concerted efforts will be required. In light of the growing problem of suicide, the three branches of government, namely, the judiciary, legislature, and executive branch, as well as citizens, must work together. Only then will the problem of suicide be addressed.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440914/#:~:text=In%20India%2C%20euthanasia%20is%20a,the%20help%20of%20family%20members.
2. https://thewire.in/health/passive-euthanasia-now-a-legal-reality-in-india.
3. https://www.scconline.com/blog/post/2020/11/28/euthanasia-indian-view/.

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