Dying with Dignity: Balancing Autonomy with Ethics

Abstract

This paper explores the concept of euthanasia, tracing its historical roots and examining how it has gradually evolved to find recognition within modern legal frameworks. Once perceived as a cruel and morally questionable act, euthanasia—also known as mercy killing—was historically practiced to relieve individuals from unbearable pain and terminal illness in the absence of effective medical interventions. From its controversial origins, including instances of infant euthanasia based on medical diagnoses in the 20th century and widespread mercy killings in countries like the Netherlands, the practice has continuously challenged societal norms and ethical standards. In the contemporary context, however, euthanasia has taken on a more nuanced character, especially in light of legal developments concerning the right to life and personal liberty. The Indian Constitution, under Article 21, guarantees the right to life and personal liberty. This paper argues for a broader interpretation of this right—to also include the “right to die with dignity”. Recognizing this right allows individuals suffering from incurable conditions to make autonomous decisions about their own lives, thereby restoring agency and compassion to end-of-life care. Landmark judgments, have played a pivotal role in shaping India’s legal stance on passive euthanasia. These rulings have laid the foundation for a more humane and progressive outlook, influencing subsequent legal reforms and public discourse.

Introduction

Should right to die with dignity be considered a fundamental right? Euthanasia or the Right to die refers to an act of ending a person’s life, who is suffering from an incurable disease. Any individual with the virtue of being born, has the right to life his / her life with dignity however the same does not possess the right to die with dignity. Right to life on one hand is a basic human right which requires every individual to life their life by having access to basic facilities of life such as access to food, water, shelter and health facilities, on the other hand right to die with dignity appears contradictory to this as it enables a person to end one’s life. The right to die is not a legal right alone, but is bound by moral constraints. This right is bound by a set of different perspectives which forces us to ponder upon it from multiple angles. This paper delves into the core aspects Euthanasia, its surrounding legal aspects and also addresses the question as to whether it should be a fundamental right or not?

Constitutional Framework

The constitutional framework regarding the right to die begins with Article 21 of the Constitution which declares that the right to live with dignity is a fundamental right, when the issue of euthanasia was discussed it was brought to light that right to die with dignity also came within the purview of this right.—at its core. Initially, in the case of P. Rathinam v. Union of India (1994), it was held that Article 21 included the right to die, the court had struck down Section 309 of the Indian Penal Code, which criminalized attempted suicide. However, this was overruled in Gian Kaur v. State of Punjab (1996), where a five-judge bench held that the right to life did not include the right to die, but it recognized that the right to die with dignity could be a part of Article 21 in case if a person was suffering from terminal illness.

The discussion went further with Aruna Ramachandra Shanbaug v. Union of India (2011), where the Supreme Court allowed passive euthanasia under strict guidelines. The most significant development came in Common Cause v. Union of India (2018), where the court explicitly recognized the right to die with dignity as a fundamental right under Article 21. The Court permitted passive euthanasia and  living will, thereby allowing terminally ill patients to refuse life support systems .

This reflects the ability of the court to balance legal framework with ethical guidelines, allowing for the enjoyment of individual autonomy and dignity, , while also recognizing the dynamic nature of fundamental rights. The Court’s guidelines were further updated in 2023, , making the right to die with dignity more accessible. In several nations active euthanasia still remains prohibited, and the Judicial precedent serves as law until Parliament decides to enact specific legislation.

Passive v Active Euthanasia

Active euthanasia involves a deliberate attempt to end a patient’s life, by administering a lethal injection or a fatal dose of medication. This directly causes the patient’s death , however it is done with the intention of relieving the patient from their state of suffering. This form of euthanasia is however illegal in most countries, as it is seen as intentional killing. Passive euthanasia, on the other hand, occurs when a person deliberately withdraws life-support systems  allowing the patient to die from their chronical illness, without getting treated. This includes actions like turning off a ventilator, stopping medications or refusing to performe life-extending surgery. The moral and legal distinction is often based on the difference between directly causing death of the patient (active) and withdrawing medications,  letting them die normally due to their illness (passive). While passive euthanasia is often viewed as a morally acceptable means of ending one’s life, active euthanasia on other hand is viewed as a cruel means, which rather than relieving one’s pain, inflicts greater amount of pain, leaving them to die painfully. Both forms, raise complex ethical questions about bodily autonomy, consent, and the responsibilities of healthcare providers.

Moral grounds

The practice of undertaking Euthanasia has moral aspects to it. In the olden day people performed a similar practice referred to a ‘mercy killings’ which often allowed a person to end another person’s life, in order to free them from pain and misery that they suffered. However back in the day, unborn babies or fetuses were discovered by doctors using highly advanced mechanisms to help identify and cure diseases such as the RH disease, later this method was used to diagnose babies with various other medical conditions- like the down syndrome, in those days if a baby was identified with being suffered with down syndrome it was later killed. This practice was prevalent in the 1970s-1980s, new born babies with defects were diagnosed with the sole purpose of killing them. In Holland during the 1960s, mercy killing became a widespread practice across the country, where patients suffering from terminal illnesses such as cancer were relieved from their pain by killing them, this was also because the country did not have pain control measures for the patients which forced them to resort to severe measures such as the mercy killing. It may seem that this right has a long standing history which deems it fit to a right however, this practice has been censored in various nations, citing moral and legal constraints pertaining to prevailing social order and law. It appears to a double etched sword which one hand supports this practice on the grounds that a relieves a person from suffering while on the other gives the right to the person to end one’s life as they deem fit.

Doctrine of Eclipse

The Doctrine of Eclipse is a principle which was initially used to address the status of pre-constitutional laws, laws enacted before the Constitution of India came into force in 1950. It was observed that such laws inconsistent with the Fundamental Rights guaranteed in Part III of the Constitution, cannot completely cease to function but only to the extent of its consistency with the fundamental rights ,as mentioned under article 13(1) of the Constitution, which explicitly states that any law which was in force before the commencement of the Constitution , if found to be inconsistent with the provisions of Part III shall, to the extent of such inconsistency, be void. The Doctrine of Eclipse portrays a two fold situation, where in one hand any law which is found to be inconsistent with the fundamental rights, provisions of part and constitution is deemed void, however, if that’s the case, then should pre-constitutional laws found to be inconsistent with the provisions of parties in Constitution, law enacted in such a manner that it comes in consonance with the provisions of Indian constitution. The doctrine further clarifies that such a law does not become null and void since the beginning or void ab initio. Instead, it becomes void only to the extent of its inconsistency with Fundamental Rights enjoyed by the citizens of India. On the other hand, the law appears to be “eclipsed” or overshadowed by the Fundamental Rights but does not cease to function, it continues to apply to non-citizens who are not entitled to those rights. If the inconsistency in the law is later removed,by a constitutional amendment or by a judicial decision the law becomes enforceable again. This poses serious questions credibility of judicial precedents and legislative authority to make laws. This further raises a crucial question pertaining to division of powers between the organs of government. In this case, the legislature and the judiciary. If laws are found to be inconsistent with the fundamental rights, they can be struck down, but if a judicial decision is taken in a manner that it contravenes with the law, can the decision be disregarded?

Case Laws

• Aruna Ramchandra Shanbaug v. Union of India [2011]

Aruna Ramchandra Shanbaug was an Indian nurse who worked at King Edward Memorial (KEM) Hospital in Mumbai, she was brutally assaulted by Sohanlal Bhartha ,hospital sweeper, after she caught him stealing food meant for hospital dogs. The attack caused her to go blind, deaf, paralyzed, forcing her to be in a consistent vegetative state for several years.. In 2009, Pinki Virani, a journalist filed a petition before the Supreme Court of India seeking permission for euthanasia on Aruna’s behalf, arguing citing ethical concerns over her prolonged state of illness. The Supreme Court, rejected the plea for active euthanasia but allowed for conduct of  passive euthanasia under strict guidelines. The Court set up a panel of consisting of medical practitioners to examine Aruna’s condition. The panel ultimately decided to withdraw life support, citing the care and affection she received from hospital staff. Aruna Shanbaug passed away in May 2015 after developing pneumonia, having spent nearly several years in a vegetative state. 

• Common cause v. Union of India [2018]

This case challenged a previous judgment of the court, seeking to get right to die with dignity, recognized as a fundamental right under Article 21. This was demanded to ensure patients living in a vegetative state due to their chronical illness, could get their life support systems withdrawn and could die peacefully. This posed the court with a peculiar question not just pertaining to law but also towards morales and ethics. During this case, a reference was made to the P. Rathinam v. Union of India [1994], in which it the court had struck down Sec 309 of the Indian Penal Code, which criminalized attempted suicide. The court held recognized the right to die with dignity under Article 21 of the Indian Constitution and further clarified that in the case of Gian Kaur, the concept of passive euthanasia was not well defined, the court further went on to explain the distinction between active and passive euthanasia, while citing ethical concerns and implications of law, clarified further as to why passive euthanasia could be legally recognized while active euthanasia was considered illegal.

Conclusion

The Indian constitutional framework, particularly through Article 21, has evolved to recognize the right to die with dignity, balancing legal, cultural, and ethical considerations. The Supreme Court’s interpretation of Article 21 now includes not just the right to life, but also the right to a dignified end, especially for those suffering from terminal illness. The Doctrine of Eclipse has played an important role by allowing pre-constitutional laws that conflict with fundamental rights to remain partially functional rather than void, enabling the judiciary to adapt and modernize the law corresponding to the evolving societal norms. This flexibility has been crucial in inculcating and accepting the practice of passive euthanasia and advance directives in India. Medical ethics and human morals also determine the legal approach, emphasizing on bodily autonomy, compassion, and the prevention of suffering. The Supreme Court’s guidelines ensure that end-of-life decisions are made transparently, with due regard for both patient wishes and ethical standards in medicine. In summary, India’s recognition of the right to die with dignity is the result of a thoughtful blend of constitutional principles, cultural beliefs, legal doctrines, and ethical medical practice, ensuring respect for both individual autonomy and societal values.