Governance and Regulations: An Analysis of Euthanasia Laws

David Hume, a Scottish philosopher contended in his article titled "On Suicide" that taking one’s own life was an extension of the right to free will and human autonomy. His theory was a departure from the conventional principles which often denounced taking one’s own life and often declared it as immoral or irrational. 

David was an agnostic and therefore his arguments gave a modern traction to this debate. He reflected on the facet of quality of life and mentioned that in certain cases like old age, ailment, or misfortunes  life would be unbearable. In such cases continuance of life could be worse than non-existence. He emphasized that suicide should not be considered as a criminal conduct. 

His perspective paved the way for the ethical dilemma around taking one’s own life which has now transpired into the debates surrounding practices like euthanasia or physician-assisted suicide (PAS) . From principles like the Hippocratic oath to religious beliefs, there have been a range of challenges against this principle. However, inspite of these contentious debates, the culmination of diverse morals and principles circling the issue has boiled down to law reforms across the world. In fact, owing to these reforms 300 million people across the world now have access to assisted dying. 

Euthanasia and its varied manifestations

Euthanasia has been characterized as the deliberate act of ending one’s life to alleviate suffering. It has been further narrowed down to classifications based on the form of consent viz., voluntary, non-voluntary and involuntary or the method i.e., active and passive. As a result, different forms of euthanasia are now legalized in various countries like the Netherlands and Belgium where it is even legal for individuals suffering from severe psychiatric disorders. 

The Belgian euthanasia Act lays out distinct requirements that must be met in order for it to be authorized under the law. First of all the decision should be voluntary. The other criterion specify that the person seeking euthanasia be of sound mind, have been thoroughly considered, and not be affected by outside pressure. Additionally, the person must be legally competent at the time of the request and be in a condition where they are experiencing medical futility, which is defined as having a severe illness for which there is no effective treatment or hope for recovery. The law also permits minors to have euthanasia granted with no age restrictions. In fact, in 2014 Belgium became the first nation to legalize child euthanasia. 

However, there are nations like Canada, which have imposed a higher set of standards in such cases. The process is known as Medical assistance in dying (MAID), which was initiated in 2016 encapsulating standards like a minimum age of 18 years along with mental competency. Also visitors to Canada are not allowed to avail this process, with restrictions on mental health not being the sole condition of such eligibility.

Now, Switzerland is a nation, which has quite a unique approach. While assisted suicide is permitted in Switzerland, euthanasia is not (the sole difference being that in assisted suicide the mechanism of death should be performed by the individual themselves). In fact, euthanasia is illegal. But inspite of this unique framework, there are loads of people who travel to Switzerland every year, as Switzerland is one of the few nations which allow foreigners to apply for the process. This has lead to an increase in "suicide tourism," wherein people travel to Switzerland to end their lives even though it might be illegal in their nation. 

A lot of other countries are also revising their laws to make way for such liberal principles. The Terminally Ill Adults (End of Life) Bill has been introduced in the UK and will make significant changes to the legal stance on assisted dying once approved. Other nations like Australia, USA have also made major changes amounting to legal validity for such actions.

The Indian Jurisprudence: 

India has also had a tumultuous history on this issue. Now, India had a provision titled S.309 under the Indian Penal Code, 1860 which criminalized the attempt to commit suicide. There were efforts to repeal the provision and then overrule the repeal in the P Rathinam v. Union of India and the Gian Kaur v. State of Punjab case respectively. 

As a result, there was a consistent debate if the right to life principle envisaged under the Article 21 of the Indian Constitution included the “right to die” as well. This was eventually addressed in the landmark case of  Aruna Ramchandra Shanbaug v. Union of India. The case instigated the much needed dialogue on the topic of euthanasia in India. 

The judgment in the Aruna case made a stark distinction between active and passive euthanasia. Active euthanasia is a process which involves steps which may end a patient’s life whereas passive euthanasia is the one wherein all forms of life support mechanism which help the patient survive are withdrawn. It established that passive euthanasia would be thereon legal in the nation with a range of safeguards and pre-requisite conditions. However, active euthanasia would still be a crime under S. 309 of IPC. This was further reiterated under the case Common Cause Vs Union of India, wherein it was established that active euthanasia can only be legalized through an act of legislature. 

The case also highlighted a few essential requisite procedures in the light of the process of passive euthanasia. From issuing guidelines regarding advance medical directives to enable terminally ill patients in making effective choices, to establishing the right to ‘right to die with dignity’ within the ambit of Article 21, the case did pave the way for significant changes. However it was later realized that the existing process was too cumbersome, which was why it was later streamlined in 2023, wherein a time limit of 48 hours was introduced. Under the 48 hours limit, both the primary and secondary medical boards allocated for the case had to arrive on a decision within a stipulated time. Also the eligibility criteria to be a member of a medical board was further lowered down to the experience of 5 years. 

However, even after this amendment, the entire process places a huge burden on the applicant. The bureaucratic processes along with the review of two medical boards for the implementation of the directives make the entire procedure ineffective. In fact, the decision of the medical boards can only be challenged through a writ petition to the High Court under Article 226 of the Constitution which only adds up to the problem. 

The bureaucratic hurdles impinge upon a right which has been established by the Court under Article 21 itself. It should be realized that it is a decision which is incredibly hard and further delays only worsen the quality of lives of those involved. Therefore there is an ardent requirement of structural and policy changes and it needs to be addressed as soon as possible. 

Conclusion: 

As nations across the globe are slowly transforming their stance into this arena, it is time to look into the actual state of the realization of rights. There are nations like Switzerland which have turned into a haven for such patients, it cannot be denied that the entire process has become too expensive. Even in India, the bureaucratic hurdles are adding up to the problem. All of this leads to the realization that there are additional facets apart from the mere establishment of a right, which needs to be looked into. There is a need for further research to understand the situation in different nations in a better way and to implement these rights in an effective manner.