Right to Die with Dignity: A Human Right or A Legal Dilemma?

Authored by Mansi Pathak & Riya Pimputkar, 3rd-year law students at ILS Law College, Pune.

Representational Image/AI-Generated

Introduction

The famous quote “I don’t fear death, I fear dying” is the outcry of millions of individuals who battle the severe agony of incurable, fatal diseases on an everyday basis. Choosing the manner and the moment of their own death will probably be the greatest form of human dignity relished by them. This argument lies at the heart of one of the most polarising debates of the 21st century- the right to die with dignity. Today, technology in the healthcare sector has advanced to such an extent that humans can now extend life far beyond its natural course. However, the other side of the same coin is that such scientific development inadvertently prolongs the pain and suffering of the patient, and leads to slow and persistent erosion of his personal autonomy.

Should the law make an individual suffer the unbearable agony just because of its rigid nature, or should it give an individual complete freedom to choose not only how to live, but also when and how to die? This question challenges the traditional legal systems and moral doctrines across the globe by posing the concern of whether the law is truly successful in safeguarding the human rights of dying patients. This article tries to examine whether the right to die with dignity is a rightful claim of autonomy or a complex legal dilemma that continues to challenge the modern human rights discourse.

Evolution of “Right to Die With Dignity” in India

In India, a few landmark cases have shaped the development and recognition of this right. It not only revolves around the concept of euthanasia, but also around the act of suicide. The premise for this right was laid through a discussion on the “right to die” in the case of P. Rathinam v Union of India in the year 1994. In this case, the petitioners, P. Rathinam and Nagbhushan Patnaik, challenged the constitutional validity of Section 309 of the Indian Penal Code (IPC), which punishes anyone who attempts to commit suicide with simple imprisonment for up to one year. To address the issue, the Supreme Court drew a parallel between the fundamental rights under Article 19 and Article 21 of the Constitution. Article 19 grants the freedom of speech, which encompasses both the right to speak and the right not to speak. Similarly, Article 21, which guarantees the right to life, can also be interpreted to include the right not to live (right to die). Hence, Section 309 of the IPC was held to be unconstitutional.

Thereafter, in 1996, a similar issue erupted in the case of Gian Kaur v. State of Punjab. A Trial Court convicted Gian Kaur and her husband, Harbans Singh, under Section 306 of the Indian Penal Code for abetting the suicide of Ms Kulwant Kaur. Section 306 punishes anyone who abets the commission of suicide. It was argued that, based on the judgment in P. Rathinam v. Union of India, the right to life under Article 21 also encompasses the right to die. Therefore, someone who abets a suicide is simply facilitating the exercise of Article 21. Following this argument, a five-judge bench of the Supreme Court overruled P. Rathinam.

In 2011, a watershed moment occurred in the course of legalising the right to die with dignity, as the judgment of Aruna Ramachandra Shanbaug v. Union of India (2011) was passed. Ms. Shanbaug was in a Persistent Vegetative State (PVS) since she had been sexually assaulted in 1973. Although the Court rejected the request to withdraw her treatment, it engaged in an extensive examination of the legality and ethics of euthanasia, ultimately permitting passive euthanasia. The court cited the Parens Patriae doctrine, meaning "parent of the nation," under which the Court can act as a guardian, and declared that the judiciary holds the final authority in determining what serves the best interest of the patient.

Pursuant to Aruna Shanbaug, The Medical Treatment of Terminally Ill Patients (Protection of Patients & Medical Practitioners) Bill, 2016 was introduced in the Rajya Sabha as a private member’s bill. It distinguished between competent and incompetent patients and gave every competent patient the right to refuse medical treatment. It provided that such a patient refusing treatment would not be guilty of any offence, and medical practitioners withholding the treatment shall be excused from any kind of liability. Additionally, it recognises the validity of living wills and medical power of attorney. Additionally, it outlines the role of the High Court when a decision regarding an incompetent patient must be made. But unfortunately, this bill was never passed.

Had this Bill been enacted, it could have provided much-needed legislative clarity to an area otherwise governed only by judicial pronouncements. The bill could have been implemented effectively through a framework requiring prior medical board approval and judicial oversight, similar to the safeguards later prescribed in Common Cause v. Union of India (2018). Additionally, awareness campaigns and standardised living will formats could ensure that only informed and voluntary decisions are respected. All in all, such a statutory framework would have provided legal certainty both for patients and medical practitioners.

However, in the absence of such a legislative framework, the Supreme Court in 2018, in the landmark judgement of Common Cause v. Union of India, recognised the right to die with dignity as a fundamental right under Article 21. It stated that a terminally ill person can opt for passive euthanasia and provided guidelines for doing the same. These guidelines were modified by the Supreme Court in 2023 to make the right to die with dignity more accessible.

International Human Rights Framework

The United Declaration of Human Rights (UDHR) and the International Covenant on Civil and Political Rights (ICCPR) are two of the most regarded frameworks that aim to safeguard basic human rights of every single individual across the globe. UDHR, though legally non-binding, serves as a foundational statement of aspirations and guidance to further create legally binding treaties. ICCPR, on the other hand, is legally binding on the countries that ratify it. Article 3 of UDHR and Article 6 of ICCPR both guarantee “right to life”. However, the “right to die” is not explicitly provided under these frameworks, leading to ambiguity in the international discourse on euthanasia. Consequently, India had to develop its own jurisprudence on the matter, despite being a signatory to both frameworks. Additionally, the absence of an international treaty addressing the legalisation of euthanasia has further contributed to the uncertainty in the ongoing debate within the Indian context.

Dilemmas Pertaining to The Right to Die With Dignity: Legal, Moral and Social

1. Palliative Care v. The Caregivers’ Burden

Palliative care is the care given to improve the quality of life and help reduce pain in people who have a serious or life-threatening disease, by treating the symptoms of the disease and the side effects caused by it. Those against euthanasia argue that legalising the “right to die with dignity” would lead to the fall of the practice of palliative care, and as a result, people suffering from debilitating diseases would be eliminated from our society. Such kind of behaviour is harmful because, in recent times, the role of medical professionals is changing from providing ‘cure’ to providing ‘care’. Today, the principle is to add life to years rather than years to life with good quality palliative care. In such a situation, any decision which may lead to a decline in palliative care would turn out to be harmful for the years to come.

On the contrary, caregivers, including the hospital staff and the families of the patients, have to invest a lot of time and effort in supporting people suffering from degenerative diseases who may never be cured. The financial burden on the family members, especially when a patient comes from an economically weaker section, can be huge, supplemented by emotional and mental fatigue as well. Additionally, supporters of euthanasia argue that these patients can act as a burden on the medical sector, consuming disproportionate resources that would otherwise be utilised for the patients who have the potential to recover. They further contend that giving patients the right to die with dignity would not only relieve them from their pain but would also enable caregivers to redirect their time and expertise towards assisting other patients in need.

2. Right To Life v. Right To Die

As pointed out by the European Court of Human Rights in the case of Pretty v. UK, both of these rights are “diametrically opposite” to each other. There is an inherent contradiction between life and death. The state, on one hand, is obliged to protect the life of each and every individual, and on the other hand, it is also obliged to protect the liberty of individuals who choose to end their own lives. Both rights can be viewed as positive rights, which means the state has an obligation to take steps towards safeguarding these rights. With regard to the right to life, the Indian judiciary has, over time, expanded the scope of Article 21 of the Constitution, and with respect to the right to die, the state is supposed to assist the procedure of dying if an individual wants to end his life. In this situation, the legal dilemma arises- while assisting in the death of an individual, is the state violating its duty to protect life? But, Common Cause v. Union of India has taken a step closer towards solving this dilemma when it recognised that the right to die with dignity is a fundamental human right, and it is thus included in the right to life. Therefore, if the state recognises the right to live with dignity, it logically follows that a person should also have the right to end life when it ceases to embody that dignity, since life without dignity is of little value. This reiterates the principle that the right to life and the right to die are not mutually exclusive, but are rather compatible with each other.

3. Medical Ethics v. Patient Autonomy

Medical ethics govern a doctor’s duty towards his patients. Patient autonomy and beneficence are the two cardinal principles of medical ethics. Autonomy embodies the principle of self-determination, where an informed patient has the freedom to decide the course of their medical treatment.

While exercising the autonomy to choose his medical treatment, the patient must be competent to make such a decision, and if he is not competent enough, then his living will should be referred to. If no living will is made, then the doctor should act in the best interests of the patient. Initially, the principles of beneficence and non-maleficence, described in the Hippocratic Oath, require a doctor to provide all the necessary care and life support system to the patient to keep him alive. But if the patient neither recovers nor dies, it poses a question- whether it is in the best interests of the patient to keep him alive using artificial means. Lord Goff in the Airedale case answered the question by stating that- “But if the question is asked, as in my opinion it should be, whether it is in his best interests that treatment which has the effect of artificially prolonging his life should be continued, that question can sensibly be answered to the effect that it is not in his best interests to do so.”

On the contrary, while delving into the best interests of the patient, it is important to critically examine whether the patient is absolutely brain dead or is capable of reacting to external stimuli. Additionally, it is also significant to look into what the artificial support includes. Like, in the Aruna Shanbaug case, it was held that withdrawing mashed food (her life support) would amount to starving her instead of giving her a painless death. Thus, the court rejected the petitioner’s plea to administer passive euthanasia to Aruna Shanbaug.

4. Rational Choice v. Risk of Subtle Coercion

An informed decision is at the heart of the debate on assisted dying. Incompetent patients, such as those who are minors, of unsound mind, or unable to make an informed decision, cannot voluntarily give consent to undergo passive euthanasia. However, this vulnerable part of the population, due to financial, emotional or social pressure, might be coerced into giving consent. Receiving treatment for the ailment is a medical right, but if assisted dying or euthanasia is legalised, then receiving medical treatment will be optional. Receiving this optional treatment will no longer be understood as a right, but will be seen as a privilege. Elderly, vulnerable populations usually see themselves as a ‘burden’ on their family, and in order to avoid the suffering of their family members, they may succumb to the internalised pressure. The survey conducted in Austria revealed that 32% of the potential population who might undergo euthanasia cited not wanting to be a burden on the family. There is a high chance that such a situation may also arise in India if the choice of euthanasia is open to the public. This is because the feeling of not wanting to be a burden on one’s family is natural for any person enduring prolonged suffering, irrespective of their nationality. This subtle psychological coercion of feeling as a ‘burden’ has the effect of hampering the rational choice of the patient.

Conclusion

In a nutshell, it can be said that the right to die with dignity is gradually getting recognised in various countries as a human right. But at the same time, it is accompanied by legal, moral, as well as ethical dilemmas. By analysing the evolution of this right within our legal system, we can understand the implications of recognising such a right and the way in which the social perception of the right has changed over the decades. With the changing times, it has become essential to incorporate the right to die with dignity in a uniform and universal legislation or convention on human rights. Granting this right the status of a human right across member countries will not only clarify the legal position but also serve as a testament to its social acceptance. And, most importantly, such a step will alleviate the suffering of many, thereby proving that the main objective of recognising a human right is to ensure the welfare of the people.