New Delhi: With religious beliefs against premature death held strong in India, right to life may weigh over the right to die with dignity that has just been granted legal sanction by the apex court.

Requests from patients suffering from terminal medical conditions across India, have led to government and courts professing for palliative care policies. Yet the debate has been around issues that are legal, ethical, human rights-related, health-related, religious, economic, spiritual, social and cultural.

Even though the Supreme Court has recognised the right to die with dignity as a fundamental right, major hurdles might be posed by religious communities, who mostly oppose euthanasia in India.

“In Hinduism Atma-gatha meaning suicide—the intention to voluntary kill—was prohibited in Hindu culture. Indian Muslims also don’t favour euthanasia however they haven’t made any public statements on the subject. Muslims believe that no one has a right to die before the time decided by the God," said Scaria Kanniyakonil, Professor of Moral Theology at Paurastya Vidyāpītham, Pontifical Oriental Institute of Religious Studies in Kerala.

“According to both Sunnis and Shias, killing a terminally ill person, whether through active euthanasia (physician assisted suicide) or passive euthanasia (stopping life support or medicine), is considered as an act of disobedience against God. Similarly, Indian Christians, especially the Catholic Bishops Conference of India, are against euthanasia. The Catholic Church forever promotes the sanctity of life, thus euthanasia is contrary to its teachings," Kanniyakonil said.

Medical professionals hold that passive euthanasia is already a common event in majority of the hospitals all across the country as many poor terminally ill patients or their family members choose to withdraw treatment because of the huge costs involved in treatment to keep them alive. However, for the few who can afford such treatment, maintaining life with advanced medical technologies and palliative care has become more routine. “Earlier diseases outcome was discussed in terms of cure but in the contemporary world of diseases such as cancer, AIDS, diabetes, hypertension and mental illness are debated in terms of care, since cure is distant," said Suresh Bada Math, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS).

The government has already been promoting palliative care policies for elderly, poor and terminally ill patients who are most likely to opt for euthanasia. “There are several programs for health and welfare of elderly, people inflicted with AIDS, cancer, terminal kidney disease and neurological disorders. The latest National Health Protection Scheme is an answer to quality healthcare for poor managing serious terminal diseases. Patients want good care and if we provide it to them, why would they opt for euthanasia?" said a senior health ministry official requesting anonymity.

Public health experts said it is essential to assess the mental health status of the individual seeking euthanasia. “The main reasons for opting euthanasia are depression, hopelessness, pain and lack of care. Patients can overcome their decision on euthanasia or to receive natural death when they are well taken care of. Studies show that when patients receive adequate palliative care, requests for euthanasia decrease. Many of them are not aware of modern pain management techniques," said Kanniyakonil.

According to Roopkumar Gursahani, Consultant Neurologist and Epileptologist, P.D. Hinduja Hospital, Mumbai, taking charge of one’s last days is a basic human right but there is a lot left to do. “India does not have a comprehensive law on End of Life decision-making. The Supreme Court judgement is one step forward in handing control over to the individual. As a society we need to normalise death and to remove the taboo around discussing it. All doctors need to be aware of the basic principles of palliative care so that we can offer care when cure is no longer possible," said Gursahani.

The issue of euthanasia rose to prominence in India after several noteworthy cases including that of Aruna Shanbaug, a nurse who spent 42 years in a vegetative state as a result of a violent sexual assault. ‘Passive Euthanasia’ was legalized by the Supreme Court on 7 March 2011. Also, based on the recommendations of the Law Commission, ministry of health and family welfare had prepared a draft of The Medical Treatment of Terminally Ill patients (protection of patients and medical practitioners) in May 2016.

Upholding the right to die with dignity, the Supreme Court 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.

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