PHYSICIAN-ASSISTED SUICIDE (PAS)

Komal Agarwal

Capital Law College, Bhubaneswar

Introduction 

The word “Euthanasia” has derived from the Greek word “euthanatos” which means “easy death”. It can be classified into 5 categories such as: Passive Euthanasia, Active Euthanasia, Voluntary, Non- voluntary and Involuntary Euthanasia. 

“Physician-Assisted Suicide (PAS)” is known to be a prescription of toxic medicines which are willingly self-injected by the valetudinarian with the help of a physician (doctor). 

While throwing light on these practices, it has been always seen that a conflict between Right to Life and Right to Die clashes when it is impossible to improve the patient’s life as well as difficult to bid him goodbye by injecting such drugs. The views are that Life is God’s precious gift and only He has the power to take and no one else can thus restricting these practices and becoming a hinder to give the person “Mukti”.1 

One useful difference noted between Euthanasia and Physician-Assisted Suicide is that, in Euthanasia, a doctor is allowed to end a person’s life by the voluntarily consent in a painless way being legal in the eyes of law whereas in Physician-Assisted Suicide, a doctor aids a patient to commit suicide on request.2 

History 

Since 19th Century, Assisted Dying or Euthanasia has been in question. In the year1938, a society for Euthanasia was born to legalize Assisted Dying. ∙ Switzerland has legalized Physician-Assisted Suicide (PAS) during the1960’s movement held for “Right to Die” and “living wills” concept came into way of life where the patient can deliberately utter whether he/she wants health care or not in cases where they are not capable of crafting an alternative. 

In 1999, Passive Euthanasia was welcomed in the United States. Roughly in 2002, Physician-Assisted Suicide was legitimized in Netherland and Belgium. ∙ In 2008, Washington voted for the “Death with Dignity” Act which became Law in the year 2009.3 

Different types of Euthanasia 

  • Active Euthanasia – In this kind of Euthanasia, a person purposely arbitrates to end someone’s life. 
  • Passive Euthanasia – If a patient dies because his life saving treatment was suppressed or annulled is called Passive Euthanasia. 
  • Voluntary Euthanasia – Here, a person is allowed to make a mindful decision regarding his own death by asking a needy hand. 
  • Non-voluntary Euthanasia – In non- voluntary Euthanasia, a second person takes the decision for the patient who is not in a state to give their approval. 
  • Involuntary Euthanasia – Simply it means that a person is assassinated against their spoken desires. 4 

Hippocratic Oath

At First instance, ”First do no harm” strike in one’s mind. The Hippocratic Oath isn’t a law but a leading basis for the doctors which were written by the Greek Physician Hippocrates in 5th century B.C. Being one of the oldest binding documents in history, it has great emblematic prestige for the forthcoming doctors. The Hippocratic Oath is made by Physicians when they become eligible Doctors. The original oath, among other things, enlightens the following words: 

“I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” 5 

Although it has been rewritten multiple times but all medical schools use oath of different versions either the original Greek oath, the Declaration of Geneva or the Oath of Maimonides. 6 

Advantages and Disadvantages of Physician-Assisted Suicide 

Advantages: 

  • The ultimate sufferings of a patient come to an end: Incurable diseases give birth to a lot of physical pain bringing up fear as the patient knows that his life is coming to an end. Euthanasia can help cut short his torment and that of his family when they see him ill. 
  • Saves the decorum: As the Physician-Assisted Suicide (PAS) is officially recognized, patients are able to choose their own death holding on their self-esteem, picking up the favorite music at their final moments. 
  • Heartache maybe easily gripped: When the person’s family and friends informed of his wish in advance, the steps of misery can be easily accepted by all where they are given the chance of reuniting thus letting the patient’s farewell in harmony. 
  • It helps to reduce the Medical Care expenses: Assisted Suicide drugs are quite cheaper in comparison to medical care expenses which help the government, family of the patients to hoard the money. 

Disadvantages:

  • It brings about early death: Euthanasia doesn’t give a second chance to life. 
  • It infringes the Hippocratic Oath: The ban on killing shines as the first promise of self-discipline as per the Hippocratic Oath which considers human life a true blessing. Therefore, a say-so to end the patient’s life vocalized by him does not make the homicide justifiable. 
  • Impaired growth to the soothing care: As Euthanasia acts as the paramount key for seriously ill patients with no aim in living furthermore, on the other hand it becomes an obstruction whose who want to stand on their feet again and live a better life.7 

Euthanasia Drugs 

It is always to be remembered that medicines can save the lives as well as kill us i.e. “the dose makes the poison”. Basing on this concept, the whole regulation of Toxicology and Medicines is laid down. The very well-known symbol of the snake, wound around the bowl of Hygeia (the Greek Goddess of Health) representing medicine as seen in pharmacies and medical centre around the world. 

Barbiturates it is a group of drugs used to end life which slow down the activities of the Brain and Nervous system which are taken in small doses for short-term to treat insomnia or seizures. An overdose of Barbiturates is deadly as it will make the brain slow down to such a point that it will stop telling the body to keep the respiratory system working which leads to stoppage of breathing. 

Also, Secobarbital capsules and Pentobarbital (Nembutal) liquid have been used either alone or in combination for Physician-Assisted Suicide (PAS) or Euthanasia. Their safety and effectiveness in bringing a peaceful, swift and uneventful death has been proven which are in the list of ideal drugs in the Netherlands, Belgium, Switzerland and some USA states where Euthanasia is legally practiced. Both, Nembutal and Secobarbital can be used on animals, but human use is banned as seen in Australia. Due to this, it is difficult to apply the Euthanasia Law in Victoria State. Some have suggested the mixture of Nembutal and Secobarbital will be in powdered form made with pain killers to develop coma which in turn causes respiratory arrest. What is ultimately needed is a drug or a mixture of drugs generating a painless, swift and peaceful death. Humans do not crave to see further any more hardships in the form of seizures, prolonged distress and pain.8 

Countries where PAS or/and Euthanasia is Legal 

Switzerland: Switzerland has permitted Physician-Assisted Suicide (PAS) without any minimum age fulfillment, diagnosis or symptom, becoming the first ever country to legalize PAS. It is to be noted that Euthanasia is not authorized. It has been estimated that about 1.5% of Swiss deaths are cases of assisted suicide. 

Netherlands: Both Euthanasia and PAS are lawful in Netherlands if the patient is undergoing unbearable pain with no hope of recovery. Children below 12 years of age can appeal assisted dying but children less than 16 years need parental approval. 

Belgium: This country permits Euthanasia and Physician-Assisted Suicide for the persons carrying unbearable pain with 0% percentage of development. There is a 1month waiting period for the persons who are not having incurable illness before Euthanasia can be done. 

Luxembourg: Assisted suicide and euthanasia are allowed for adults but subject to condition that the concerned person must have an incurable condition with invariable, intolerable pain having no way of progress. 

Canada: Euthanasia and Assisted Suicide are for the adults going through “dreadful and irreversible conditions” whose death is reasonably probable. 

Australia: The state of Victoria passed Voluntary Euthanasia laws in November 2017 where the patient must raise the proposal of Assisted Dying first and not the concerned Doctor. 

USA: It has been seen in the USA that many states like Oregon, Washington, Vermont, California, Colorado, Washington DC, Hawaii, New Jersey, Maine and Montana permit Physician-Assisted Suicide for fatally ill persons.9 

Death with Dignity Laws 

This law lets terminally-ill adults to request and receive a medical prescription to accelerate their death willingly. Reports of April 2021 say that California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington helped in dying laws. Death with Dignity Laws states the process where qualified individuals may obtain life-ending medications. For obtaining a prescription under Physician-Assisted Dying Laws, he/ she must be an inhabitant of the state accepting the law, 18 years or older, be competent enough of making and responding of one’s own health care decision and must be detected with a lethal illness that will lead to probable death within 6 months.10 

International Code of Medical Ethics 

The International Code of Medical Ethics was adopted by the General Assembly of the World Medical Association in the year 1949 which was based on the Declaration of Geneva to bring about the Ethical principles of the Physicians regarding his general duties towards his patients and his equals.11 

Physician-Assisted Suicide in Indian Context 

The legal position of PAS and Euthanasia in the Indian context is stated in the Indian Penal Code (IPC) 1860, which deals with the issues of Euthanasia and PAS. According to IPC, Active Euthanasia is an offence read under Section 302 (punishment for murder) or under Section 304 (punishment for culpable homicide not amounting to murder). PAS in the eyes of Indian law would be abetment of suicide as per IPC’s Section 306 (abetment of suicide). The issue under Section 309 (Attempt to commit suicide) is a punishable offence with simple imprisonment for a term which may extend to 1 year or with a fine or both. 

Religious concept of suicide in India 

Below are discussed some of the Religions and their view on suicide in the Indian context – 

  • Hinduism:In Hinduism, it has been believed that if a person commits suicide, he/ she does not step in hell or heaven but remains on the Earth as a bad spirit and knock out until he attains his allotted lifespan after that only he enters hell to arrive back on Earth to complete the Karma
  • Islam: Euthanasia is illegal as per Islamic religion because there is an important part of the physician to end the life of the patient by speeding up his death either by lethal injection, electric shock, a sharp weapon etc. This is an act of killing which constitutes a major transgression and outlawed in Islam. 
  • Christianity: The Catholic Church says that the death by means of suicide is a grave sin and that the human life is God’s blessing as well as a gift to this world and nobody has the right to wipe out it excepting the God himself. 
  • Judaism: Supporting and appealing for suicide assistance are forbidden amongst Jews.12 

Indian Judiciary on Euthanasia and PAS 

Aruna Ramchandra Shanbaug vs. Union of India & Ors. (2011) 

Aruna Ramachandra Shanbaug, a staff nurse working in King Edward Memorial Hospital, Mumbai. On 27th November 1973, she was raped by a sweeper by a canine chain around her neck and jerked her back with it. It was declared that the strangulation of the chain stopped the oxygen supply to the brain and her cerebrum got damaged.13 For 36 years she has been suffering PVS (permanent or persistent vegetative state) where a person is practically dead. The appeal for mercy killing was rejected but the “living will” concept was recognised by the court. 

On 18th May 2015, she died because of pneumonia being in PVS for almost 42 years. Later, the Supreme Court framed certain guidelines for Passive Euthanasia. It was legalized and was of the opinion that it would apply to “rarest of the rare” cases only. The court also said that the “Right to Die” comes under the subject matter of the Fundamental Rights and the court also mentioned that the request for Passive Euthanasia should be approved by the High Court ensuring that no wrong motive of relatives or friends is brought about. This judgement tiled a concentrated path for the claim of Passive Euthanasia by giving the Indians their ‘living will’ concept. 

Gian Kaur vs. State of Punjab (1996) 

In this case, the constitutionality of Section 309 (Attempt to commit suicide) under IPC was upheld. This case pointed out noteworthy differences between Physical Assisted Suicide and Passive euthanasia (withdrawal of life-support of the patient). The court stated that Euthanasia and Physician-Assisted Suicide (PAS) is illegal in India and the acts are punishable under criminal law. However, the Supreme Court agreed with their concept, introduced a special right for patients who are terminally ill, i.e. right to die with dignity, patients in PVS or brain-dead choose death over a dejected life. 

Common Cause (A Regd. Society) vs. Union of India (2018) 

A writ petition was filed requesting a strong system for Passive Euthanasia and recognition of the ‘living will’ concept of a person. In this case, the constitutionality of Section 306 of the Indian Penal Code (IPC), 1860 was challenged. The Supreme Court of India recognised the concept of living will. The court also recognised the ‘Right to Die with Dignity’, Right to Self-determination and Right to Autonomy as fundamental rights. 

International perspectives on Euthanasia and PAS

Vacco vs. Quill (1997)

The New York state banned Physician-Assisted Suicide (PAS). The case was filed to challenge the constitutionality of such ban. Mr T. Quill filed a case along with 2 physicians and some severely ill patients. It was argued that the prohibition is violating the 14th Amendment, which provides equal protection. The law legalized Passive Euthanasia whereas Physician-Assisted Suicide (PAS) was regarded as illegal. The ruling of the District Court was against such a challenge. Still, when the case went to the second circuit, the judgement was reversed and was in favour of Mr. T. Quill and later the Supreme Court held that the State’s ban on Physician-Assisted Ban is not unconstitutional. 

Gonzales vs. Oregon (1994) 

In this case, the State of Oregon in the United States passed the Death with Dignity Act dealing with laws that permitted Physical Assisted Suicide with a lethal dose of medicine for terminally ill patients. Later, the act was opposed by the Attorney General of the US. Mr J. Ashcroft stated that the “Death with Dignity Act” violated the Controlled Substances Act, 1970 and also threatened that if any Physician practices Physician-Assisted Suicide (PAS), his/her medical license would be cancelled. Oregon State challenged this in the federal district court, the court and the circuit held that his declaration was illegal. The case went to the Supreme Court, it was held that the use of the controlled substance for Physician 

Assisted Suicide (PAS) does not violate the Controlled Substances Act and in addition to that, the act did not allow the Attorney General to ban the use of such substances for Physician-Assisted Suicide.14 

Conclusion 

It was seen that Aruna Ramchandra Shanbaug Case better explained the issues revolving around Euthanasia and laid down guidelines for Passive Euthanasia for Indians. As being a landmark judgement, it recommended that the method to be continued in a space that has not been administered upon i.e., where the Legislation has not yet been made by the Parliament. In India, Active Euthanasia is not allowed whereas Passive Euthanasia can be administered as per the prerequisites laid down by the Court.15 

In the present time, all jurisdictions of the US have decriminalized the “aid-in-dying” and only Physician Assistance in Suicide (PAS) is legal and Euthanasia is not. The US is exceptional in this regard. For Example, Canada, The Netherlands, Belgium, Luxemburg and Colombia, both PAS and Euthanasia have been legally recognized.16 

Supporters of Active Euthanasia argue that killing the patients is not worse than letting them die themselves whereas supporters of Voluntary Euthanasia say that the person should have the Right to do what they want to do in respect of their own lives. The advocates of Mercy Killing argue that the patients in vegetative states without any scene of recovery, by letting them die, stops the future needless and pointless treatment efforts. If they are suffering then by their homicide, prevents further more suffering. Advocates of Physician-Assisted Suicide (PAS) say that a physician aiding a terminally ill person is just simply helping that patient to “die with dignity” at his desire. 

Critics of Euthanasia dispute that killing is always wrong, whether it be Non- voluntary or Involuntary Euthanasia ultimately breaching the Patient Rights or that Physician-Assisted Suicide (PAS) contravenes a commitment to do no harm. “Right to Life” and “Right to Health” is meant for all the people and true investment in the Health care Systems is needed at the earliest.17

CITATIONS

1 Dr. Shaikh Shahanawaz Islam, Right to Life and Personal Liberty and Euthanasia: A critical Analysis, Volume 03, IJMSS, 121, 121-123, (2015)
2 Medical News Today, https://www.medicalnewstoday.com/articles/182951#euthanasia-and-assisted-suicide, (last visited on 23rd July, 2021)
3 Diganth Raj Sehgal, Legal aspects related to assisted suicide, iPleaders, (07 Jan, 2021)
4 Types of Euthanasia, https://computerscience.johncabot.edu/courses/F2014CS130/ddimaggio/Pages/Types.html (last visited 21st July, 2021)
5 Medical News Today, https://www.medicalnewstoday.com/articles/182951#history (last visited on 22nd July, 2021)
6 Study.com | Take Online Courses. Earn College Credit. Research Schools, Degrees & Careers, https://study.com/academy/lesson/what-is-the-hippocratic-oath-definition-parts.html#:~:text=Lesson%20Summary- ,The%20Hippocratic%20Oath%20is%20a%20sworn%20agreement%20made%20by%20physicians,help%20anothe r%20to%20use%20one. (last visited on 22nd July, 2021)
7 NYLN.org, https://nyln.org/doctor-assisted-suicide-pros-and-cons-list, (last visited on 22nd July, 2021)
8 ABC News, Dying a good death: What’s needed from voluntary euthanasia drugs, ABC News, (20th Oct, 2017), https://www.abc.net.au/news/2017-10-20/assisted-dying-what-is-need-from-drugs-for-voluntary euthanasia/9069896
9James Ashford, Countries where euthanasia is legal, The Week UK, (28th August, 2019), https://www.theweek.co.uk/102978/countries-where-euthanasia-is-legal
10 Death With Dignity, https://deathwithdignity.org/learn/access/#Going_Through_the_Process_of_Obtaining_Medications, (last visited on 22nd July, 2021)
11 Wikipedia, https://en.wikipedia.org/wiki/International_Code_of_Medical_Ethics (last visited on 22nd July, 2021)
12 Farooq Khan, Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!, Indian journal of psychological medicine, (January 2013), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701348/
13 Aruna Ramachandra Shanbaug vs.Union of India and Ors. (2011) SC 4 SCC 454.
14 Diganth Raj Sehgal, Legal aspects related to assisted suicide, iPleaders, (7th Jan, 2021), https://blog.ipleaders.in/legal-aspects-related-assisted-suicide/#Indian_Perspective
15 Rajeswari Rajesh, Case Analysis: Aruna Ramchandra Shanbaug v. Union of India (2011), Legal Bites – Law And Beyond, (6thJune, 2021), https://www.legalbites.in/case-analysis-aruna-ramchandra-shanbaug/
16 Jozef V. Welie J, When Given a Choice, Patients Prefer Euthanasia Over PAS, Graduate School | Creighton University, (9th May, 2019), https://gradschool.creighton.edu/blogs/when-given-choice-patients-prefer-euthanasia over-pas
17 Euthanasia – MU School of Medicine, https://medicine.missouri.edu/centers-institutes-labs/health ethics/faq/euthanasia (last visited 23rd July, 2021)

Note: This work is published as a part of the Article Writing Competition organized by The Legal Boffin in 2021.

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