India took another nervous step forward towards the practice of euthanasia with the Supreme Court on Wednesday (March 11) authorising the withdrawal of life support for a 32-year-old man who has been in a persistent vegetative state (PVS) for 13 years following a head injury. When implemented, this will be the first time that passive euthanasia, greenlighted as a principle eight years ago, will be put into practice.
A constitution bench of the Supreme Court had in 2018 upheld passive euthanasia, ruling that the right to die with dignity derived from the fundamental right to life and dignity under Article 21 of the Constitution. That laid down the conceptual basis for death with dignity, but the practical, legal and administrative aspects of the issue remained to be sorted out. This judgment provides just a little more clarity on that thicket of issues.
The latest ruling came in the case of a Panjab University student, Harish Rana, who fell from the fourth floor of a building and sustained severe head injuries and 100% quadriplegic disability in 2013. He has remained in a vegetative state since then, and doctors ruled out recovery. The man’s family approached the Delhi High Court to allow withdrawal of life support, but were denied because the patient was in a vegetative state, not terminally ill.
Their appeal in the apex court led to the judges considering several intricate questions and finally ruling that Rana had a right to die with dignity and that withdrawal of clinically assisted nutrition and hydration would not amount to abandonment and denial of basic care.
The judges reiterated the distinction between active euthanasia, which is interventionist (say a lethal injection) and illegal, and passive euthanasia, which is to let the inexorable process of death play out on a patient in a vegetative state while easing his or her pain and discomfort. They further directed that withholding of life-sustaining intervention should not be one summary act, nor an act of abandonment; it must adhere to a well-structured, administered and monitored palliative care plan.
The judgment is but a step in the evolution of the euthanasia scenario in India. There is a long haul ahead to iron out all the ethical, legal, medical and procedural issues. To start with, there is a need to arrive at a cast-iron and mischief-proof definition of terms used in the discipline, such as ‘vegetative state’, ‘terminal illness’, ‘life-support’ as opposed to ‘palliative care’, ‘withdrawal of intervention’, etc.
Then there is the humongous task of creating an administrative structure to govern euthanasia. The current system of medical boards to certify fit cases is simply inadequate and certainly needs closer monitoring. Only a few states have active frameworks that are capable of the rigour demanded by the top court. Do we have enough doctors trained in the deep ethics of euthanasia to manage or certify potentially thousands of cases? We also need to address the apprehensions of the medical fraternity over managing euthanasia procedures. Doctors fear litigation and criminal liability if a case is contested or thought to have been mismanaged.
Most importantly, there must be an overarching central legislation laying down the norms for euthanasia. Currently, the entire framework rests on sporadic judicial guidelines, which can lead to inconsistent application across hospitals and High Courts. The Centre, therefore, needs to speed up its process of formulating euthanasia guidelines for universal application.