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Source: News 18

Context

The Terminally Ill Adults (End of Life) Bill was passed by the UK Parliament in the House of Commons, allowing terminally ill patients with less than six months to live to choose assisted dying in England and Wales.

What is Assisted Dying?

Assisted dying is the practice of assisting someone who is suffering from a terminal illness or unbearable pain to end their own life, usually with medical assistance. 

It has two major forms:

• Assisted Suicide: A doctor provides the means (such as prescribed lethal medication), but the patient takes the final decision to end their life.
• Euthanasia is when a doctor or medical professional directly administers a substance to end a patient's life, usually to alleviate suffering.
• Active Euthanasia: Taking direct action to end life (for example, administering a lethal injection).
• Passive euthanasia entails discontinuing or withholding life-sustaining treatment (for example, turning off a ventilator).

UK Terminally Ill Adults (End of Life) Bill

• A proposed legislation in the UK enabling terminally ill adults to legally end their lives under strict legal and medical oversight.
  
  
• Applicable only in England and Wales.
  
  
• Eligibility: Patients must have less than 6 months to live.
  
  
• Requires approval from:
  
  
• Two doctors
  
  
• A psychiatrist
  
  
• A senior lawyer
  
  
• A social worker
  
  

What is Euthanasia?

• Derived from Greek, meaning "good death".
  
  
• Refers to the intentional act of ending a person's life to relieve them from unbearable pain or terminal illness.
  
  
• Typically considered when there is no hope of recovery.
  
  

Types of Euthanasia

1. Active Euthanasia
   
   
• Involves deliberate actions to end life (e.g., lethal injection).
  
  
• Example: Administering a fatal dose of medication.
  
  
2. Passive Euthanasia
   
   
• Involves withholding or withdrawing life-prolonging treatments.
  
  
• Allows natural death.
  
  
• Example: Removing a ventilator in a vegetative state.
  
  
3. Voluntary Euthanasia
   
   
• Performed with patient’s consent.
  
  
• Example: A terminally ill patient formally requesting assisted death.
  
  
4. Involuntary Euthanasia
   
   
• Conducted without the patient’s consent.
  
  
• Considered illegal and unethical, akin to murder.

Key Provisions of the UK’s Assisted Dying Bill

• Eligibility Criteria: The bill only allows adults aged 18 and up who are mentally competent to apply.
• They must have been diagnosed with a terminal illness and have a six-month or shorter survival time.
• Medical evaluations: Two independent doctors must evaluate the applicant to ensure that the eligibility criteria are met and that there is no coercion.
• Oversight Panel: This panel is in charge of ensuring procedural integrity and safeguards and must approve the application.
• Reflection Period: A 14-day waiting period must be observed following final approval and before the prescription is issued.
• This period may be reduced to six days if the applicant's death is imminent.
• New criminal offense: Life in prison for illegally administering the drug. And 14 years in prison if death is inflicted through coercion.

Legal Position of India 

• Active euthanasia (where a person is directly administered a substance to cause death) is not permitted in India and is considered culpable homicide under the Bharatiya Nyaya Sanhita, 2023.
• Following the Supreme Court's 2018 decision in Common Cause v. Union of India, passive euthanasia (the withholding or withdrawal of life support) is permitted in limited circumstances.

Landmark cases: 

• Assisted Dying: Aruna Shanbaug Case vs Union of India (2011): The Supreme Court permitted passive euthanasia in principle for patients in a permanent vegetative state, but only with High Court approval on a case-by-case basis. 
• It was India's first recognition of euthanasia, albeit with limited scope.
• Common Cause vs. Union of India (2018): The Supreme Court ruled that the right to die with dignity is a component of Article 21. 
• It legalised passive euthanasia across the country and acknowledged the validity of living wills, with specific safeguards.
• It enabled the creation of a living will (advance directive), allowing terminally ill patients to express their preferences for end-of-life decisions.
• The Supreme Court modified the guidelines in 2023 to make the right to die with dignity more accessible; however, active euthanasia is still illegal due to concerns about misuse.

Way Forward

• Need for a More Comprehensive Discussion: India must address assisted dying within the context of healthcare ethics, legal oversight, and cultural sensitivity.
• Strengthen palliative care: Increase access to high-quality palliative and end-of-life care to prevent euthanasia due to a lack of alternatives.
• Safeguards and oversight: To prevent misuse, set up independent medical boards, mandatory psychological assessments, and grievance redressal mechanisms.

Practice Question Q. What is Assisted dying? What are the ethical and moral implications for this practice?