“Tears come from the heart and not from the brain.”
– Leonardo da Vinci
In a landmark verdict, the Supreme Court has ruled that in specific circumstances, a person has the right to decide against artificial life support by creating a living will. The apex court held that the right to life and liberty, enshrined under Article 21 of the Indian Constitution, also includes the right to die peacefully and with dignity. The national debate over the legalization of passive euthanasia was sparked by a favourable 2011 Supreme Court judgment in the case of 66-year-old Mumbai nurse Aruna Shanbaug, who was in a permanent vegetative state for more than 40 years after being sexually assaulted. Now the Constitution Bench has expanded the jurisprudence on the subject by adding to it the principle of a ‘living will’, or an advance directive, a practice whereby a person, while in a competent state of mind, leaves written instructions on the sort of medical treatment that may or may not be administered in the event of her reaching a stage of terminal illness. A five-judge constitutional bench led by Chief Justice of India Dipak Misra upheld a person’s right to choose passive euthanasia by creating an Advance Medical Directive—commonly referred to as a living will—in the eventuality of a terminal illness with no hope of recovery, an irreversible coma or a permanent vegetative state.
The top court pronounced the verdict on a plea seeking legal sanction for passive euthanasia under which a person suffering from a terminal disease and in his/her last stage of life with no chance of recovery is allowed not to sustain life through artificial support system. The petitioner, NGO ‘Common Cause’, had approached the court seeking a direction for recognition of ‘living will’. The ruling, besides recognising an individual’s choice to live, will have significant social and economic implications. For hundreds of Indian families, who keep on spending time and money on medical treatment of their terminally ill relatives because of a moral dilemma, the top court’s pronouncement will be a great relief. An advance directive or a “living will” will only salvage relatives from moral dilemma.
Living will is a written document that allows a patient to give explicit instructions in advance about the medical treatment to be administered when he or she is terminally ill or no longer able to express informed consent. It includes authorising their families to switch off life support in case a medical board declared that they were beyond medical help. During the hearing, the government expressed its opposition to the concept of living will. It argued that a living will be misused and may not be viable as a part of public policy. The apprehension of its misuse and abuse is valid — for, there can be no law that is manipulation-free — especially in cases where healthcare costs would overwhelm emotions. The guidelines for passive euthanasia will now hold the key to sanity. With the passage of time, these might be subjected to revision in the eventuality of emerging predicaments. The apex court has called for legislation to this effect, which means that parliamentarians cannot shy away from their duty. The apex court, however, had observed that there should be adequate safeguards and implementation of living will would be subject to medical board’s certifying that the patient’s comatose state is irreversible.