J Punjab Acad Forensic Med Toxicol 2012;12(1):43

Case Study
EUTHANASIA: INDIAN SCENARIO POST 07/ 03/2011

Dr Mrinal Kanti Jha, Assistant Prof, KPC Medical College, Jadavpur, Kolkata-32
Professor (Dr.) Ranabir Pal, Professor, Community Medicine, Sikkim Manipal Institute of Medical
Sciences,
Gangtok, Sikkim
Dr Promukh Bhattacharrya, MD(Microbiology) DRDE Gwalior
Dr S. S. Oberoi, Professor, Department of Forensic Medicine & Toxicology, Government Medical College
Patiala
Dr Anil Garg, Assistant Professor, Department of Forensic Medicine, Gian Sagar Medical College, Rajpura,
Patiala

Article history Abstract

Received Feb 23, 2012
Received in revised form May 24,
2012
Accepted on June 10, 2012
Available online June 25, 2012
Corresponding author
Dr Mrinal Kanti Jha,
Phone: +918902686688,
+919932701994
Email: mjha6119@yahoo.co.in
Keywords: Euthanasia, India
The concept of euthanasia is based on the philosophy of humanism
and compassion. It recognizes the autonomy of an individual,
freedom of choice to live or die with dignity. It is a very sensitive
issue that polarized the world. Euthanasia is one of the most
perplexing issues which the world faces today. Few developed
countries have given nod to active euthanasia. India too has joined
the club of euthanasia and can jubilate on Supreme Courts
Judgment on March 07 2011. Nod was given to passive euthanasia
in Aruna Ramchandra Shanbaug Vs Union Of India & Ors, date of
judgment 7/3/11 writ petition (Criminal) No 115 of 2009. For
enhanced understanding of the issue two cases as reported in
leading newspaper is selected and discussed, not forgetting the
dictum We cannot add life to this world, so we have no right to
take away any life
2012 JPAFMAT. All rights reserved

Introduction for relief if pain is dying. In Netherlands, over

The word euthanasia, coined by an
english philosopher and statesman Sir Francis
Bacon in early 17th century, literally means
good death [Greek : -, eu- (well or Athens could obtain a dose of poison which
good) + , thanatos (death)]. It refers to
the practice of ending a life in a painless manner
"a deliberate intervention undertaken with the
express intention of ending a life, to relieve
intractable suffering". Euthanasia and assisted
suicide involve taking deliberate action
(intention) to end or assist in ending the life of
another person on compassionate ground. [1, 2]
Views against euthanasia can be
summarized as 1) Humanitarian 2)
Constitutional 3) Legal 4) Hippocrates Oath and
5) Religious. Views in favour of Euthanasia are
1) Relief of intolerable pain 2) Enhancement in
quality of patients life because of incurable and
painful disease where cure or palliation is not
feasible 3) Freedom of choice 4) Individual
autonomy and self-determination, 5) Euthanasia
can become a means of health care cost
containment to free up medical funds to help
other sick people. [3]
Every day, ailing people all over the
world plead to die. Some of them want to die
because of pain and the only way open to them
80% of those who received euthanasia suffered
from cancer. [4, 5] Euthanasia was practiced
since ages. With official permission, residents of
would allow them to choose death over
suffering. [6] In 1906, first euthanasia bill was
drafted in Ohio, USA but it could not succeed. [7]
The worst calamity in the name of euthanasia
was created by Nazi regime. In October 1939
amid the turmoil of the outbreak of war Hitler
ordered widespread "mercy killing" of the sick
and disabled. Code named "Aktion T 4," the Nazi
euthanasia program to eliminate "life unworthy
of life". It was first focused on newborns and
very young children. the Nazi euthanasia
program quickly expanded to include older
disabled children and adults. This so called
mercy killing destroyed more than 70,000
innocent lives. [8] In 1952, the Euthanasia
Society of America petitioned the United Nations
Human Rights Commission to declare that
people dying from an incurable disease have the
right to die. The United Nations did not grant the
request, believing that its efforts to promote
human rights were best applied to matters
regarding life, not death. [9] The watershed
event in the history of euthanasia was the Dutch
 J Punjab Acad Forensic Med Toxicol 2012;12(1):44
Supreme Courts decision in 1984 to permit
Netherlands to become the first country to give
legal sanction to some forms of assisted suicide
and euthanasia. [10] This study is conducted to
justify if the judgment passed by the Supreme
Court of India is keeping up with the aspiration
of Indian population with a view of fast changing
socio-political scenario occurring all over the
world including India and South- East Asia.
Two cases as appeared in the leading
newspapers of India were selected and
discussed for a better understanding of this
issue of euthanasia.
Case Study: 1
On the night of Nov 27,1973, A 25 years
old bubbly, spunky nurse, Miss Aruna (name not
changed being a registered Supreme Court Case)
from Kerala, was strangulated by a dog chain.
She was then sodomized in the basement of
Mumbais King Edward Memorial Hospital by a
ward boy a day before she was proceeding for
her weeding with her Doctor Fiance. The ward
boy walked free from jail after six years of
imprisonment and is supposedly working in a
Delhi Hospital.
The strangulation caused hypoxic
damage to her brain cells and left her paralyzed,
blind and deaf virtually a vegetable. Presently
she is 64 years old and has not seen sun-light for
three and half decades. She has been lying in an
old room with no contact to the outside world.
She is religiously and sincerely fed by the sisters
of the hospital; also looked after by the hospital.
No one from her family is concerned about her
existence. Her parents expired. Pinki Virani, a
journalist from Mumbai brought this incidence
to light through newspaper and published a
book on Arunas state. Pinki Virani, in 1999
single handedly filed a case saying Aruna should
be allowed to die with dignity. The Supreme
Court admitted the plea. On 07 March 2011
Supreme Court passed its landmark Judgment
on passive euthanasia though it rejected the
appeal of mercy killing in case of Aruna. [11]
Case Study: 2
A 77 years old brain dead South Korean
woman died on Sunday more than 200 days
after being taken off life support, in the
countrys first case of legal euthanasia in Seoul.
A woman identified only by her family name,
Kim, was pronounced dead in afternoon, 202
days after her life support system was removed
in accordance with her familys wishes and a
court order. A court in December 2008
approved the familys request, saying that the
patient had no chance of recovery and that her
wish to die could be inferred. The higher Court
upheld the lower courts decision in favour of
the children. [12] According to the doctors of
University Health System, that runs the Hospital,
she continued to breathe on her own after her
respirator was removed on 23 June 2009. This
case has stoked up huge public debate over a
persons right to die with dignity.
Discussion
In Indian scenario, a persons right to
die with dignity finally got approval on March
7, 2011 from Supreme Court. Looking back at
the milestones on the development of
euthanasia is not a very smooth one.
Euthanasia is usually equated to be a
synonym of homicide committed at a request
made by the patient. [13]
In the Netherlands and Belgium, where
euthanasia has been legalized, still remains a
criminal homicide although it is not prosecuted
and not punishable if the perpetrator (the
doctor) meets certain legal exceptions. In
Netherlands, when a patient is deemed to be
mentally competent to make the request and
means it, and when his suffering is agreed to be
severe, patient may lawfully be helped to die
usually, by a lethal injection administered at
home by his doctor. Since 1973, Dutch doctors
have been openly providing euthanasia on
request, and if they were brought to court, they
generally successfully plead necessity, to escape
from a charge of murder. This system
understandably caused considerable
uncertainty and anxiety among the medical
profession. In 2002 the law was changed by the
introduction of the Termination of Life and
Assisted Suicide (Review Procedures) Act,
which regularized and legitimized the position
of doctors. According to the terminology used in
the Netherlands, euthanasia means voluntary
euthanasia or voluntary assisted suicide. All
the cases of voluntary euthanasia are supposed
to be reported to the authorities; but the rate of
reporting seems to be relatively low (just over
50 per cent). Belgium Parliament introduced the
act in 2002, legalizing voluntary euthanasia but
not assisted suicide. To qualify for euthanasia,
the patient must be in a futile medical condition
of constant physical or mental suffering that
cannot be alleviated. [5, 14, 15, 16]
In US only three states, Oregon,
Washington and Montana have legalized mercy
killing for terminally ill adults. Death with
Dignity Act in Oregon was first passed as a
result of individual initiative in 1994. However,
it was passed then by only a small majority of
the state electorate, and its implementation was
halted by an injunction until it was put to the
 J Punjab Acad Forensic Med Toxicol 2012;12(1):45
vote again and passed into state law by an
increased majority in 1997. [17]
In Switzerland, there are two relevant
articles in the Penal Code. Article 114 makes
voluntary euthanasia illegal; but Article 115
makes it lawful to help someone commit suicide
if, and only if, the motive is entirely honorable,
to bring suffering to an end. Acting under this
exemption, there are several voluntary
organizations which help to commit suicide at
the time of individuals choice for a fee. The law
does not actually require that the patient be
assisted only if he is terminally ill; but this is laid
down in a code of practice for the medical
profession. An increasing number of citizens of
other European countries are availing
themselves of the service who cannot get help in
their own country. To those who believe that
there should be a general legal right to assisted
dying, it is an outrage that those who can afford
it are forced to go abroad (in Switzerland) for
what they are, as they think, wrongfully denied
in their own countries, while most people
cannot afford to avail themselves of this help.
[18,19]
Netherlands is the first country to
legalize euthanasia in 2001 and Germany
became the fifth country in the world to legalize
euthanasia in June 2010. However, it is subject
to guidelines, such as the nature of the illness,
patients suffering and willingness to die.
England considers euthanasia as unlawful at
common law. Euthanasia, abetment of suicide
and attempt to suicide are all punishable
offenses under the Indian Penal Code. However,
consensus for legalizing euthanasia for the
terminally ill is gaining momentum among the
countrys jurists and social scientists. [20, 21]
The debates on Euthanasia became a
live issue when the Supreme Court of India in
1994 passed a verdict that attempted suicide is
not a crime. According to the Indian Penal code,
which was mainly adopted from British Penal
Code, attempted suicide was a crime. India has
one of the best constitutions of the world and
yet continuing with the Indian Penal Code, 200
year old legal document inherited from the
British rulers. [22]
The Karnataka high court in September
2010 argued that Sections 306 and 309 of the
IPC, which relate to suicide, go against Articles
14 and 21 of the Constitution. It pointed out
during a case that Article 21 grants the right to
life, but that does not imply that one has a right
to death. [23]
In the judgment of Aruna Ramchandra
Shanbaug Vs Union Of India & Ors, the relevant
portion of judgment by Justices Markandey and
Gyan Sudha Misra is as We could have
dismissed this petition on the short ground that
under Article 32 of the Constitution of India
(unlike Article 226) the petitioner has to prove
violation of a fundamental right, and it
has been held by the Constitution Bench
decision of this Court in Gian Kaur vs.
State of Punjab, 1996(2) SCC 648 (vide
paragraphs 22 and 23) that the right to life
guaranteed by Article 21 of the Constitution
does not include the right to die. Hence the
petitioner has not shown violation of any
of her fundamental rights. However, in
view of the importance of the issues
involved we decided to go deeper into the
merits of the. case
On going deeper into the merits of this
case the following are the highlights:
Supreme Court rejected appeal for
mercy killing because Aruna was not brain dead
Supreme Court allowed passive
euthanasia (technically to brain dead person
and not to persistent vegetative state ), in case
of person kept alive by mechanical means,
through life support system, like ventilator. It
allowed withdrawal of life support system.
Supreme Court ordered NO to ACTIVE
euthanasia, which is injection of lethal drugs to
induce death
Supreme Court allowed High Courts to
give nod for passive euthanasia till Parliament
enacts a law. The guide line of Supreme Court to
High Court on Passive euthanasia:
When consciousness of a patient is lost.
When patient is kept alive mechanically
at least for a few years. When there is no
possibility of the patient to come out of it.
When plea has been filed by near
relatives, next friend, doctor or Hospital staff
praying to withdrawal life support.
The Chief Justice of High Court would
constitute Bench of at least two judges. The
bench would take opinion of a panel of 3
reputed doctors preferably a neurologist,
psychiatrist and physician. High Court then hear
the near relative and state after giving them a
copy of panels report and make expeditious
decision.(24)
Conclusion
To sum up, doctors responsible for the
end of life care are often placed in dilemma of
ethics regarding life and death. Euthanasia can
put an end to the suffering of long-term NO
CURE illnesses, by death. Pain, peace and
happiness are subjective feelings, so the point at
which one experiences intolerable pain to end
up life may be different from someone who has
more tolerance to pain. There can be no end to
 J Punjab Acad Forensic Med Toxicol 2012;12(1):46
this debate. At this point of time it can be well
commented that Supreme Court has proceeded
along the predictable lines as the rest of the
world. History of Mankind has taught us
euthanasia could be grossly misused as we have
seen with Hitler, destroying more than 70,000
innocent lives. Judiciary as responsible as
Supreme Court of India and Constitution of India
gives highest value to Life and Democracy.
Supreme Court cannot give a free hand to
anyone regarding decision to end life. It has kept
High Courts as a strong filter or a safe guard
mechanism for all the cases of euthanasia. Also
Supreme Court has not allowed active
euthanasia, to prevent any form of criminal
practice against life. It can certainly be said say
that Supreme Court of India has taken step in
right direction, this step also concurs with the
decision of first Asian Country which has made
euthanasia legalize and also at the same time it
has guarded innocent lives.
Conflict of Interest
None Declared
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This article can be cited as:

Jha MK, Pal R, Bhattacharrya P, Oberoi SS, Garg A. Euthanasia: indian scenario post 07/ 03/2011. J Punjab Acad
Forensic Med Toxicol 2012;12(1):43-7.