Aruna Shanbaug: The debate over active and passive euthanasia

Bengaluru, May 19: The debate on euthanasia is back once again with the death of Aruna Shanbaug who battled it out for 42 long years. After living in a vegetative state for a little over four decades she passed away. Her name was very often associated with euthanasia debates in the country and the Supreme Court had in a landmark verdict in 2011 permitted passive euthanasia in special cases.

Several countries have dealt with euthanasia in different ways. In fact Netherlands became the first country to legalise euthanasia and assisted suicide in the year 2002. In India while passive euthanasia is permitted along with required safeguards, there is a debate on whether to take the Netherlands route.

However legal experts say that the question of active euthanasia or assisted suicide cannot be decided by the Supreme Court. It needs to be done through a legislation and there needs to be a host of safeguards.

Let us take a look at how various countries have dealt with the issue of euthanasia and what are the safeguards and norms that they have in place. Before that let us also examine the position in India and also see what is the difference between active and passive euthanasia.

The difference between active and passive euthanasia:

Active euthanasia takes place when the doctor deliberately causes the patient to die by administering the lethal drug. In active euthanasia, the doctor acts with an intention that it would cause death when the person is beyond cure or is suffering with pain.

In passive euthanasia the doctor lets the patient die by either turning of the life support machines, disconnecting the feeding tube or not giving a life extending drug. This once again is done when the patient is beyond cure or is suffering unbearable pain.

There has been a morale debate over passive and active euthanasia. However if one looks at it, both are relatively the same. Many feel it is moral to withhold treatment when the patient is beyond cure but immoral to inject the lethal drug and kill the patient who is beyond cure.

In fact many would argue that active euthanasia is better compared to passive. In active euthanasia, the legal drug is administered which kills the patient instantly. However active euthanasia which involves stopping of treatment or withdrawing from the life support system would cause the patient more pain as death occurs not instantly but gradually.

Euthanasia in India:

On 7 March 2011 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state. In the verdict the Supreme Court also placed the power of choice in the hands of the individual, over government, medical or religious control which sees all suffering as "destiny".

The Supreme Court also laid down two important safeguards and said that Passive Euthanasia Law shall be permissible for the brain-dead for whom the ventilator can be switched off and those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out and pain-managing palliatives be added, according to laid-down international specifications.

The law in Netherlands and France:

Netherlands became the first country to legalise euthanasia and assisted suicide in the year 2002. In the conditions it mentioned that the patient must be suffering from unbearable pain and the illness must be incurable. The demand must be made in a fully conscious state by the patient.

In France the concept of right to be left to die was introduced in the year 2005. It allowed doctors to decide to limit or stop any treatment that was not useful and has no object but to artifically prolong life.

United States, Germany and Switzerland

In the United States, Oregon was the state to legalalise assisted suicide. Doctors in five states are permitted to prescribe a lethal dose of medicine to terminally ill patients. In the year 1997 a law in Oregon permitted patients with less than six months to live to request a life ending medication.

In Germany and Switzerland, assisted suicide is legal but only in certain circumstances. In Germany it is legal as long as the life ending medication is taken without any help.

In Switzerland assisted suicide is allowed as long as there are no self seeking motives behind it. Switzerland in fact has organizations that it has created which assist in dying services free of cost. However there is a demand to ban these organizations now.

Belgium:

Belgium passed a law in 2002 legalising euthanasia. The law in Belgium states that a doctor can help a patient end his or her life when they express the will to die as a result of unbrearable pain. The patient can request euthanasia before they enter into a vegetative state or coma.

Belgium also has a law which had legalized euthanasia for children. According to this law there is no age bar, but the child must terminally ill or beyond medical help. They would also need the consent of their parents.

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