New Delhi: A constitution bench of the Supreme Court headed by Chief Justice Dipak Misra on Friday gave legal sanction to passive euthanasia and execution of a living will of persons suffering from chronic terminal diseases and likely to go into a permanent vegetative state.

The apex court accorded primacy to the constitutional values of liberty, dignity, autonomy and privacy as it laid down procedural guidelines governing the advance directive of a living will. The guidelines will operate till a legislation is put in place.

The verdict by the constitution bench came on a PIL filed by NGO Common Cause seeking recognition of ‘living will’ made by terminally-ill patients for passive euthanasia.

Human rights activists, doctors and health experts have hailed the apex court ruling.

Human rights activist and author Pinki Virani, who had sought mercy killing for Aruna Shanbaug, a nurse who was in a vegetative state for 42 years before dying in 2015, hailed the Supreme Court judgment in favour of passive euthanasia. “I am deeply grateful to the Supreme Court of India for upholding the landmark judgment of March, 2011 on passive euthanasia," she told PTI.

Virani had approached the Supreme Court in 2009 as the “next friend" of Shanbaug, who was in a vegetative state after being assaulted and raped by a wardboy-cum-sweeper at the KEM Hospital in Mumbai in 1973. Shanbaug, who became the face of the debate on euthanasia in the country, died in May, 2015.

The Indian Medical Association (IMA) said the judgement was long due and would pave the way in ensuring that everybody is granted the “right to die with dignity".

Reacting to the judgement, AIIMS’ assistant professor in the geriatrics department and founder president of Healthy Aging India, Dr Prasoon Chatterjee said recognising the concept of “living will" would give an opportunity to the elderly to opt for ‘do not resuscitate (DNR)’, a concept already established in developed nations.

“The law says, if a patient is not in mentally or physically stable condition to decide on his own, then the next of kin can take a call on whether he or she should be put on ventilation or not. The concept of ‘living will’ will help doctors use their skills and knowledge to take call in the benefit of larger population. It is a landmark decision in a resource-constraint country and would save a lot of salvageable patient by giving them opportunity to avail ventilatory support," Dr Chatterjee, who is also joint editor of Indian Academy Geriatrics, said.

Secretary general of IMA, Dr R.N. Tandon said, “Just as every person has the right to life, they also have the right to die with dignity."

Dr Abdul Ansari, director of the critical care services of Nanavati Super Speciality Hospital said that the “right to die" was a landmark ruling which would allow people to “die with dignity".

He said, “We come across many terminally ill patients and families who feel burdened and express the feeling to die in peace rather than getting subjected to the dehumanising experience of being stranded on futile life support."

Threats of misuse

Vice president of Confederation of Medical Associations in Asia and Oceania, and former IMA president Dr K.K. Aggarwal, said strict guidelines should be put in place to ensure that there is no abuse of the ‘living will’ by relatives of the patient.

The caregiver may get fed up and frustrated, and unconsciously may make the patient feel that he or she has become a burden and should not live anymore, he said, adding, “This is one aspect which we need to focus on. When a person seeks (passive) euthanasia, the attitude of the relatives providing care should be considered and opinion of doctors should be taken."

Senior Kerala priests said the Supreme Court judgment also fear that the judgement could be misused. Terming it “unfortunate and condemnable", Kerala Catholic Bishop Conference president Archbishop Soosa Paikam said the verdict was “painful" and would have disastrous consequences.

“The right of life is in the hands of God. It was not acceptable for anyone who believes in humanity to kill a person suffering from old age or sickness due to sympathy," he said. The order that stipulates guidelines to undergo passive euthanasia could be misused, Paikam said.

Father Paul Thelakkat, editor of the church-run Sathyadeepam magazine, said the church apprehends that the verdict could be misused as a right of dignified killing of terminally ill patients. “No one has the right to put an end to human life. The ultimate aim of the medical science is to save life from death. If we move away from this principle, there would be far-reaching repercussions in our society," he told PTI.

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