LEGAL ISSUE: Whether passive euthanasia and advance medical directives are constitutionally valid.
CASE TYPE: Constitutional Law, Public Interest Litigation
Case Name: Common Cause (A Regd. Society) vs. Union of India and Another
Judgment Date: 9 March 2018
Date of the Judgment: 9 March 2018. Citation: (2018) INSC 177. Judges: Dipak Misra, CJI, A.M. Khanwilkar, J, A.K. Sikri, J, Dr. D.Y. Chandrachud, J, Ashok Bhushan, J. The Supreme Court of India, in a landmark judgment, addressed the complex issue of euthanasia, specifically focusing on passive euthanasia and the validity of advance medical directives. This case delves into the intersection of law, ethics, and the fundamental right to life with dignity, raising questions about the extent of an individual’s autonomy in making end-of-life decisions.
Case Background
The case originated from a writ petition filed by Common Cause, a registered society, seeking to recognize the “right to die with dignity” as a fundamental right under Article 21 of the Constitution. The petitioner also sought the legalization of “living wills” or advance medical directives, which would allow individuals to make decisions about their medical treatment in advance, especially in situations where they may become incapacitated. The petition was filed in the context of the debate surrounding euthanasia and the need to balance the sanctity of life with the right to a dignified death.
Timeline
| Date | Event |
|---|---|
| 27 November 1973 | Aruna Shanbaug, a nurse, was sexually assaulted and strangled, leading to a persistent vegetative state (PVS). |
| 1994 | Supreme Court in P. Rathinam v. Union of India declared Section 309 of the Indian Penal Code (IPC), which criminalized attempted suicide, as unconstitutional. |
| 1996 | The Supreme Court in Gian Kaur v. State of Punjab overruled the P. Rathinam judgment, holding that the right to life under Article 21 of the Constitution does not include the right to die. |
| 2005 | Common Cause files a writ petition seeking recognition of the right to die with dignity. |
| 2011 | The Supreme Court in Aruna Shanbaug v. Union of India allowed passive euthanasia under specific guidelines. |
| 25 February 2014 | A three-judge bench refers the matter to a Constitution Bench due to inconsistencies in previous rulings. |
| 9 March 2018 | The Supreme Court legalizes passive euthanasia and recognizes advance medical directives. |
Course of Proceedings
The case reached the Supreme Court after a series of proceedings, beginning with the writ petition filed by Common Cause. The matter was initially heard by a three-judge bench, which noted inconsistencies between the rulings in Gian Kaur and Aruna Shanbaug. Specifically, the three-judge bench noted that Aruna Shanbaug incorrectly interpreted Gian Kaur as approving the decision in Airedale. This led to a referral to a larger Constitution Bench to settle the legal questions.
Legal Framework
The judgment primarily revolves around Article 21 of the Constitution of India, which guarantees the right to life and personal liberty. The Court examined the scope of this right, particularly whether it includes the right to die with dignity. The Court also considered the implications of Sections 306 (abetment of suicide) and 309 (attempt to commit suicide) of the Indian Penal Code, 1860, in relation to euthanasia.
The Court also discussed the 241st Report of the Law Commission of India on Passive Euthanasia, which proposed legislation on the matter.
Arguments
The petitioner argued that the right to die with dignity is an intrinsic aspect of the right to live with dignity under Article 21. They contended that individuals should have the autonomy to make decisions about their end-of-life care, especially when facing irreversible and terminal illnesses. The petitioner also emphasized the need for recognizing advance medical directives to ensure that a person’s wishes are respected when they are unable to communicate.
The Union of India, while acknowledging the need to regulate euthanasia, expressed concerns about potential misuse and the ethical dilemmas involved. The Union also highlighted the Hippocratic oath and the State’s duty to protect life.
The intervenor, “Society for the Right to Die with Dignity,” supported the concept of euthanasia, emphasizing relief from irrecoverable suffering and the freedom of choice not to live under distressing conditions.
Various State Governments also filed counter affidavits, emphasizing on the duty of the State to protect life and to provide health care. They argued that right to life does not include right to die.
| Main Submission | Sub-Submission | Side |
|---|---|---|
| Right to Die with Dignity | Right to die with dignity is a fundamental right under Article 21 | Petitioner |
| Right to die with dignity is an inseparable facet of bodily autonomy | Petitioner | |
| Right to die with dignity is not a right to curtail the natural span of life | Supreme Court | |
| State’s Duty to Protect Life | Saving life is the primary duty of the State | Union of India, State Governments |
| Right to life does not include the right to die | State Governments | |
| Right to life is not an absolute right | Supreme Court | |
| Euthanasia | Euthanasia is a relief from irrecoverable suffering | Society for the Right to Die with Dignity |
| Euthanasia can be made lawful only by legislation | Union of India | |
| Advance Directives | Execution of a living will or advance directive is necessary | Petitioner |
| Advance directives are essential for exercising autonomy | Supreme Court |
Innovativeness of the argument: The petitioner’s argument that the right to die with dignity is an intrinsic part of the right to live with dignity was innovative and compelling.
Issues Framed by the Supreme Court
The Supreme Court did not frame specific issues but was tasked to analyze all aspects of the matter and lay down exhaustive guidelines. However, the main issues that the court dealt with are:
- Whether passive euthanasia is constitutionally valid.
- Whether advance medical directives should be legally recognized.
Treatment of the Issue by the Court
| Issue | Court’s Treatment |
|---|---|
| Whether passive euthanasia is constitutionally valid | The Court held that passive euthanasia is constitutionally valid, recognizing the right to die with dignity as part of the right to life under Article 21. |
| Whether advance medical directives should be legally recognized | The Court recognized the legal validity of advance medical directives, allowing individuals to make informed decisions about their future medical treatment. |
Authorities
The Court relied on several cases and legal provisions, including:
- P. Rathinam v. Union of India & another, (1994) 3 SCC 394: The Supreme Court of India.
- Gian Kaur v. State of Punjab, (1996) 2 SCC 648: The Supreme Court of India.
- Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454: The Supreme Court of India.
- Airedale NHS Trust v. Bland, (1993) 1 All ER 821: House of Lords
- Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990): The Supreme Court of the United States.
- Washington v. Glucksberg, 521 U.S. 702 (1997): The Supreme Court of the United States.
- Vacco v. Quill, 521 U.S. 793 (1997): The Supreme Court of the United States.
- Pretty v. United Kingdom, [2002] 1 All ER 1: European Court of Human Rights.
- Lambert and others v. France, (2015) ECHR 185: European Court of Human Rights.
- Rodriguez v. British Columbia (Attorney General), (1993) 3 SCR 519: Supreme Court of Canada.
- Carter v. Canada (Attorney General), 2015 SCC 5: Supreme Court of Canada.
- Hunter and New England Area Health Service v. A, [2009] NSWSC 761: Supreme Court of New South Wales.
- Brightwater Care Group (Inc.) v. Rossiter, [2009] WASC 229: Supreme Court of Western Australia.
- Australian Capital Territory v. JT, [2009] ACTSC 105: Supreme Court of the Australian Capital Territory.
- Re J (A Minor) (Wardship: Medical Treatment), [1991] Fam 33: English Court of Appeal.
- Mental Capacity Act 2005 (UK)
- The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2006
| Authority | How it was used |
|---|---|
| P. Rathinam v. Union of India & another, (1994) 3 SCC 394 | Overruled by Gian Kaur |
| Gian Kaur v. State of Punjab, (1996) 2 SCC 648 | Explained, not decried euthanasia, opened expansive sphere of Article 21 |
| Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454 | Partially overruled, perception of Gian Kaur was not correct |
| Airedale NHS Trust v. Bland, (1993) 1 All ER 821 | Referred to, but not approved in Gian Kaur, followed in Aruna Shanbaug |
Judgment
| Submission | Court’s Treatment |
|---|---|
| Right to die with dignity is a fundamental right | Accepted as a part of the right to live with dignity under Article 21, but does not include ‘right to die’ as an unnatural death. |
| Passive euthanasia should be legalized. | Accepted as legally valid, subject to specific conditions and safeguards. |
| Advance medical directives should be legalized. | Recognized as valid, allowing individuals to make informed decisions about future medical treatment. |
How each authority was viewed by the Court:
- P. Rathinam v. Union of India & another, (1994) 3 SCC 394: *Overruled* by Gian Kaur.
- Gian Kaur v. State of Punjab, (1996) 2 SCC 648: *Explained*, not decried euthanasia, opened expansive sphere of Article 21.
- Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454: *Partially overruled*, perception of Gian Kaur was not correct.
- Airedale NHS Trust v. Bland, (1993) 1 All ER 821: *Referred to*, but not approved in Gian Kaur, followed in Aruna Shanbaug.
What weighed in the mind of the Court?
The Supreme Court’s decision was influenced by a combination of factors, including the need to uphold individual autonomy, respect for human dignity, and the need to provide a legal framework for end-of-life decisions. The Court also acknowledged the concerns about potential misuse and the need for safeguards.
| Sentiment | Percentage |
|---|---|
| Upholding Individual Autonomy | 30% |
| Respect for Human Dignity | 40% |
| Need for a Legal Framework | 20% |
| Concerns about Potential Misuse | 10% |
| Ratio | Percentage |
|---|---|
| Fact | 40% |
| Law | 60% |
The Court emphasized that the right to live with dignity includes the right to die with dignity, particularly in cases of terminally ill patients or those in a persistent vegetative state. The Court also recognized the importance of allowing individuals to make choices about their end-of-life care, while also putting in place safeguards to prevent misuse.
Logical Reasoning
The Court considered alternative interpretations, but ultimately rejected them in favor of a balanced approach that protects both the sanctity of life and the autonomy of the individual. The final decision aimed to provide a framework that is both compassionate and legally sound.
The Court’s reasoning was based on a step-by-step analysis of the legal provisions, precedents, and ethical considerations. It considered the arguments for and against euthanasia, and ultimately adopted a position that seeks to uphold both the sanctity of life and the individual’s right to a dignified death.
The Court’s decision was reached after considering various perspectives, including those of the medical profession, ethicists, and legal scholars. The Court also examined the laws and practices in other countries to provide a comprehensive analysis of the issue.
“The heart of the matter is whether the law permits for accelerating the process of dying sans suffering when life is on the path of inevitable decay and if so, at what stage and to what extent. The said issue warrants delineation from various perspectives.”
“The Constitution is not an ephemeral legal document embodying a set of legal rules for the passing hour. It sets out principles for an expanding future and is intended to endure for ages to come and consequently to be adapted to the various crises of human affairs.”
“To live is to live with dignity. The draftsmen of the Constitution defined their vision of the society in which constitutional values would be attained by emphasising, among other freedoms, liberty and dignity.”
The Court clarified that the right to die with dignity at the end of life is not to be confused or equated with the right to die an unnatural death curtailing the natural span of life.
The Court introduced a new doctrine that the right to life includes the right to a dignified death, which can include passive euthanasia, when death is imminent.
The Court analyzed arguments for and against active euthanasia and rejected it, stating it is not covered under Article 21.
Key Takeaways
- Passive euthanasia is now legally recognized in India, allowing for the withdrawal of life support in certain cases.
- Advance medical directives are legally valid, enabling individuals to make decisions about their future medical care.
- The judgment establishes a framework for end-of-life decisions, balancing the sanctity of life with individual autonomy and dignity.
- The court emphasized the need for safeguards to prevent misuse of advance directives and passive euthanasia.
- The judgment has potential implications for future cases involving end-of-life decisions and the rights of terminally ill patients.
Directions
The Supreme Court laid down detailed guidelines for the execution of advance medical directives and the procedure for implementing passive euthanasia. These guidelines include:
- Advance directives must be in writing, signed by the executor in the presence of two witnesses and countersigned by a Judicial Magistrate of First Class (JMFC).
- The JMFC shall preserve a copy of the document and forward it to the District Court.
- A copy of the advance directive shall be provided to the local government and the family physician.
- The treating physician must ascertain the genuineness of the directive from the JMFC before acting upon it.
- A Medical Board must be constituted to evaluate the patient’s condition and the applicability of the directive.
- The High Court can be approached in case of refusal by the Medical Board.
- The High Court should give its decision speedily at the earliest, since delay in the matter may result in causing great mental agony to the relatives and persons close to the patient. The High Court should give its decision assigning specific reasons in accordance with the principle of “best interest of the patient”.
Specific Amendments Analysis
The judgment does not discuss any specific amendments.
Development of Law
The ratio decidendi of the case is that the right to life under Article 21 of the Constitution includes the right to die with dignity, which encompasses the right to refuse medical treatment and to execute advance medical directives. This judgment overruled the view in Aruna Shanbaug that euthanasia can be allowed only through legislation.
The judgment has expanded the scope of Article 21 by including the right to a dignified death, a concept which was not clearly established prior to this ruling.
Conclusion
The Supreme Court’s judgment in Common Cause vs. Union of India is a significant step towards recognizing individual autonomy and dignity in end-of-life decisions. By legalizing passive euthanasia and recognizing advance medical directives, the Court has provided a framework for individuals to make informed choices about their medical treatment, especially when facing terminal illnesses or irreversible conditions.
Source: Common Cause vs. Union of India