The ethical and philosophical arguments for passive euthanasia

 Legislation is a dry affair—a meticulous balancing of rights, obligations and economic and administrative imperatives. But on occasion, it must address ethical concerns that run deep and broad. The proposed Medical Treatment of Terminally-Ill Patients (Protection of Patients and Medical Practitioners) Bill regarding passive euthanasia—its draft is posted on the health ministry website for public feedback—is one such instance. It is a step in the right direction, even if it has shortfalls to be addressed.

The question of whether a terminally ill person—or in the case of someone rendered medically incapable, the relatives and medical professionals—should be allowed to choose when to forgo treatment or life-prolonging medical support speaks to fundamental issues of a human life’s intrinsic value and the authority to end it. It is not an easy one—less than a dozen countries in the world currently have legal provisions for euthanasia. India is one of them via the Supreme Court’s 2011 verdict in the Aruna Shanbaug case. There, it rejected the euthanasia petition filed by journalist Pinki Virani but established the legal framework for allowing passive euthanasia (as opposed to active euthanasia, which would entail the doctor administering drugs to end the patient’s life). The current bill seeks to codify and regulate that framework.

There are two perspectives on the issue. The first is the legal. The state has an understandable interest in maintaining its monopoly on the right to—in crude terms—end a citizen’s life. This is foundational to its legitimacy and authority. There are other practical concerns as well. Euthanasia is difficult to regulate and laws allowing it can be vulnerable to malicious intent. At the very least, moral pressure could be exerted on the terminally ill to choose this option.

Yet, these concerns do not outweigh the individual’s inalienable right to choose how to conduct their private life when that conduct does not cause harm to other individuals or the state. This is particularly so when a patient has no hope of recovery and is suffering greatly, or is in a vegetative state and kept alive by medical apparatus.

For the state to insist for its own benefit that the patient continue to spend financial and physical resources in order to continue suffering is perverse.

There is also a broader ethical and theological perspective. India’s Constitution draws upon Western liberal ideals and the constitutions wherein they are enshrined.

A direct line can be drawn back from those ideals to the philosophy of Enlightenment thinkers such as Immanuel Kant, whose formulations of universally applicable laws and humanity as an end in itself would argue against euthanasia. The line goes further back to Thomas Aquinas, priest, philosopher, theologian and one of the founding figures of modern jurisprudence with his formulation of natural law. The sanctity of life inherent in his philosophy would argue against euthanasia as well.

But as Pratap Bhanu Mehta argued in The Indian Express in relation to the case Nikhil Soni vs Union of India in 2015, Indian philosophical and theological traditions across various strands of thought—from Jainism to Buddhism and Hinduism—have a more nuanced understanding of an individual’s right to decide on their life and the ethical considerations therein. That understanding dovetails here with the evolution of democratic thought and the limits of state power.

But while the government has done well to propose this bill, its formulation fails on one front. In Clause 9, it says that relatives, medical personnel and the like can apply to the relevant high court for “witholding or withdrawing medical treatment of... a competent patient who has not taken an informed decision”.

This is dangerous. The bill defines informed decision in subjective terms pertaining to an individual’s understanding of the nature of their illness and the forms and consequences of treatment. As long as the individual is competent, it must not be left to anyone else to judge the merit of their understanding in something as fundamental as their life. This has the potential for misuse and is antithetical to an individual’s fundamental rights. It must be amended before the bill is introduced.

Although the ethical and philosophical arguments for passive euthanasia apply equally to active euthanasia, the government has made the correct decision in addressing only the former at the moment. By doing so, it has curtailed the potential for misuse of the proposed legislation. A revised bill would be a significant step towards allowing suffering individuals a measure of human dignity.

By: Mona Kaushal