In the Supreme Court of India Civil original jurisdiction Case No. Writ petition (Civil) No. 215 of 2005 Petitioner Commom Cause Respondent Union of India anr. Date of Judgement Decided on March 8th , 2018 Bench Dipak Misra, CJI; Justice A.K Sikri; Justice D. Y Chandrachud; Justice Ashok Bhushan & Justice A.M Khanwilkar
The petitioner a registered society filed this Writ Petition before the Supreme Court of India to declare the right to die with dignity as a fundamental right within the right to live with dignity under Art 21 of the Constitution. The petitioners contended that the right to live with dignity is available to a person upto the last minute of his life and so it can be extended to include the right to have a dignified death. And that the modern technology has given rise to a situation whereby the life of the patient is unnecessarily prolonged causing distress and agony to the patient and his relatives.
Against this the respondents contended that intentional killing of patient is against the hipocratic oath of the medical practitioners. There cannot be final conclusions about what is an incurable disease and a patient may not be persistent in his wishes because of the psychological trauma faced by him. So such patients may change their wish after some time. Finally it was also contended that the matter was already decided in the case of Aruna Shanbaug. The Court then examined the contentions of both the parties and gave a note of laws relating to euthanasia in various other countries, the recommendations of the law commission and various international conventions and finally opined that every individual has a right to a dignified procedure of death and the same was held to be part of fundamental right enshrined under Art 21. However the court reiterated that nobody is permitted to cause death of another person even if that is a physician. The Court also stated that the right of execution of an advance medical directive can be exercised by an individual in recognition and in affirmation of his right of bodily integrity and self determination.
The instant Writ Petition preferred under Article 32 of the Constitution of India by the petitioner, a registered society, seeks to declare ―right to die with dignity as a fundamental right within the fold of ―right to live with dignity‖ guaranteed under Article 21 of the Constitution; to issue directions to the respondents to adopt suitable procedure in consultation with the State Governments, where necessary; to ensure that persons of deteriorated health or terminally ill patients should be able to execute a document titled ―My Living Will and Attorney Authorisation‖ which can be presented to the hospital for appropriate action in the event of the executant being admitted to the hospital with serious illness which may threaten termination of the life of the executant; to appoint a committee of experts including doctors, social scientists and lawyers to study into the aspect of issuing guidelines as to Living Wills‖; and to issue such further appropriate directions and guidelines as may be necessary.
The issues raised in the case are:
- Whether the right to a dignified procedure of death can be held to be part of fundamental right under Art 21.
- Whether an individual can by way of advance medical directive decide the extent of medical intervention for a future date.
- Whether an individual have the right to refuse medical treatment including withdrawal from life saving devices.
Arguments in favour of the Petitioner
The arguments put forward by the petitioners are as follows;
1. Each individual has an inherent right to die with dignity which is an inextricable facet of Art 21 of the Constitution. The right to die sans pain and suffering is fundamental to one’s bodily autonomy.
2. The dying process of the patient is unnecessarily prolonged causing distress and agony to the patient and his relatives by the modern medical technology.
3. Right to die is not claimed as a part of right to life but as an inseparable and inextricable facet of the right to live with dignity.
4. Concept of sustenance of individual autonomy inheres in the right of privacy and also comes within the fundamental conception of liberty.
5. Living wills has become a necessity keeping in view the prolongation of treatment inspite of irreversible prognosis and owing to penal laws that creates a dilemma in the minds of doctors to take aid of the modern techniques.
Arguments in favour of the Respondents
The arguments advanced on behalf of the respondents are as follows;
1. The Ministry of Health and Family states that the hipocratic oath of the medical profession is against intentional killing of patient.
2. Progression of medical science in relieving pain and suffering will suffer a set back.
3. A patient may wish to die at certain point of time, but their wish may not be persistent and only a feeing desire out of transient depression.
4. Wish of euthanasia by a mentally ill patient in depression may be treated by good psychiatric care.
5. Defining of bed ridden or quantifying suffering and to understand whether the disease is incurable are all complex and unanswerable questions.
6. The doctors assigned for conducting euthanasia might undergo Psychological pressure and trauma
7. This matter was already decided in the case Aruna Ramachandra Shanbaug v. Union of India and others and the Ministry of Law and Justice opined that the directions given by this Court be treated as law.
The Court arrived at the conclusion that right to live with human dignity would mean the existence of such right up to the end of natural life, and reiterated the Judgement in Gian Kaur’s case that right to a dignified procedure of death is a part of fundamentall right enshrined under Art 21. The court however observed that the Constitution Bench in Gian Kaur’s case did not express any binding view on the subject of euthanasia.
The Court was of the opinion that the right to take a life saving treatment by a person, who is competent to take an informed decision is not covered by the concept of euthanasia as it is commonly understood but a decision to withdraw life saving treatment by a patient who is competent to take decision as well as with regard to a patient who is not competent to take decision can be termed as passive euthanasia, which is lawful and legally permissible.
About persons who are incapable of taking informed decision the Court observed that they are also entitled to rights of bodily integrity and self determination just like the other individuals. And so the Court opined that in such cases, the best interests principle be applied and such decision be taken by specified competent medical experts and be implemented after providing a cooling period to enable aggrieved person to approach the Court of law.
And with regard to right of execution of an advance medical directive by an individual the Court stated that the right do not depend on any recognition or legislation by a State and such rights can be exercised by an individual in recognition and in affirmation of his right of bodily integrity and self determination. Any person of competent mental faculty is entitled to execute an advance medical directive or Living Wills.
The Court also mentioned that the law of the land existing today is that no one is permitted to cause death of another person even if that is a physician administering lethal drug to relieve the pain of the patient. Finally the Court declared that an adult human being having mental capacity to take an informed decision has right to refuse medical treatment including withdrawal from life saving devices.
The Court has aptly reiterated the judgment of the Constitution Bench in Gian Kaur’s Case, reinstating that the right to live can also be extended to include right to a dignified procedure of death however no one has a right to cause death of another person including a physician.
However the Court was cautious enough to ensure individual autonomy to an individual and stated that an adult human being of conscious mind is fully entitled to refuse medical treatment or to decide not to take medical treatment and may decide to embrace the death in natural way.
The stand taken by the Court with regard to the right to execute an advance medical directive is also a good initiative in favor of protection of the bodily integrity of an individual and self determination. It would help an individual to decide on the extent of medical intervention that he wishes to allow upon his own body at a future time when he may not be in a position to specify his wishes.
And also the final decision of the Court that an adult human being having mental capacity to take an informed decision has right to refuse medical treatment will be helpful for many bed ridden patients who have no chances of recovery, who merely stays in vegetative state of existence and also for their relatives who find it difficult to see their loved ones in such condition.