Right to live includes right to die: Supreme Court

HIGHLIGHTS

• Supreme Court on Friday legalised passive euthanasia.

• It approved 'living will' to provide terminally ill patients or those in persistent and incurable vegetative state a dignified exit by refusing medical treatment or life support.

In a milestone verdict expanding the right to life to incorporate the right to die with dignity, the Supreme Court on Friday legalised passive euthanasiaand approved 'living will' to provide terminally ill patients or those in persistent and incurable vegetative state (PVS) a dignified exit by refusing medical treatment or life support.

The verdict, the latest in a string of boosts for individual freedoms by the apex court, was delivered by a constitution bench of Chief Justice Dipak Misra and Justices A K Sikri, A M Khanwilkar, D Y Chandrachud and Ashok Bhushan.

It empowers a person of sound mind and health to make a 'living will' specifying that in the event of him/her slipping into a terminal medical condition in future, his/her life should not be prolonged through life support system. The person concerned can also authorise, through the will, any relative or friend to decide in consultation with medical experts when to pull the plug.

Given Indian sensitivities about life and death, testing the legality of the idea posed a complex medical, philosophical, constitutional and religious jigsaw for the bench.

Displaying a rare unanimity of thought to weave a common constitutional principle, CJI Misra led his colleagues on the bench to harmonise the inevitable yet opposite facets — life and death — and say in unison that "right to die with dignity is an intrinsic facet of right to life guaranteed under Article 21".

With this ruling, the SC has recognised that an individual with terminal illness or in a state of irreversible vegetative condition has the agency to decide whether he/she would like to die, a sphere which was so far constitutionally reserved for the state, which alone could deprive a person of his/her life in accordance with law.

In a cumulative 538-page judgment containing four opinions, the SC said passive euthanasia, or a provision for passive euthanasia through 'advance directive' or 'living will', would save "a helpless person from uncalled for and unnecessary treatment when he is considered as merely a creature whose breath is felt or measured because of advanced medical technology".

"There comes a phase in life when the spring of life is frozen, the rain of circulation becomes dry, the movement of body becomes motionless, the rainbow of life becomes colourless and the word 'life' which one calls a dance in space and time becomes still and blurred and the inevitable death comes near to hold it as an octopus gripping firmly with its tentacles so that the person 'shall rise up never'," CJI Misra said.

However, to prevent possible misuse by greedy relatives eyeing the patient's property, the SC provided for stringent guidelines for preparing and giving effect to 'living will' and administration of 'passive euthanasia' by involving multiple medical boards comprising several experts and even judicial officers.

Writing the lead judgment with Justice Khanwilkar, CJI Misra said, "A dying man who is terminally ill or in PVS can make a choice of premature extinction of his life as being a facet of Article 21. We must make it clear that as a part of the right to die with dignity in a case of a dying man who is terminally ill or in PVS, only passive euthanasia would come within the ambit of Article 21 and not the one which would fall within the description of active euthanasia in which positive steps are taken either by the treating physician or some other person."

Linking life and death with the thread of dignity, the SC said administration of life support system and medicines merely to prolong heart beat in a patient who was not even aware that he/she was breathing amounted to denial of dignity to that person who had no choice but to "suffer an avoidable protracted treatment". The SC also ruled that a patient had the right to refuse medical treatment.

Justice Sikri adopted an unorthodox comparison of rights in his separate yet concurrent judgment and said, "Right to health is part of Article 21. At the same time, it is also a harsh reality that everybody is not able to enjoy that right because of poverty or other reasons. The state is not in a position to translate into reality this right to health for all citizens. Thus, when citizens are not guaranteed the right to health, can they be denied the right to die in dignity?" He also questioned the rationality of limited and costly life saving facilities getting occupied by rich patients in the 'no return zone' to deprive others who could be revived.

Justice Chandrachud opened yet another aspect of right to life by ruling on autonomy of an individual over his/her body and ruled in his concurring judgment, "The state cannot compel an unwilling individual to receive medical treatment. While an individual cannot compel a medical professional to provide a particular treatment (this being in the realm of professional medical judgment), it is equally true that the individual cannot be compelled to undergo medical intervention."

Justice Bhushan, while agreeing with the others, said, "An adult human being having mental capacity to take an informed decision has the right to refuse medical treatment including withdrawal from live saving devices." He also referred to passive euthanasia in varied forms being practised in India by followers of Jainism and Buddhism.

CJI Misra and Justice Khanwilkar said, "His 'being' (existence) exclusively rests on the mercy of the technology which can prolong the condition for some period. The said prolongation is definitely not in his interest. On the contrary, it tantamounts to destruction of his dignity which is the core value of life. In our considered opinion, in such a situation, an individual's interest has to be given priority over state interest." (Source: The Times of India)