“No life that breathes with human breath has ever truly longed for death.”
~ Alfred Tennyson

The news of a former Dutch Prime Minister opting for “Duo-Euthanasia” along with his wife has caught the eyes of the hoi polloi. This has triggered the wave of ‘romanticisation’ of Euthanasia and has brought into the limelight the legal and ethical considerations behind Euthanasia as a concept, its objective and its consequences. The term ‘Euthanasia’ literally means a ‘good death’. Also euphemised as “mercy killing”, it refers to the deliberate acceleration of a patient’s death to alleviate their continued agony, presenting a dilemma between the right to live and the right to die. Various jurisdictions, such as the Netherlands, Australia, Spain, and Canada, et al. have laws governing the administration of Euthanasia. Does India require a framework for the same?

Euthanasia: Between the Devil and the Deep Blue Sea
According to some authors, Euthanasia makes the cut for the top ten list of hotly contested moral issues. All the controversy surrounding Euthanasia boils down to one question – Is it immoral to legalize Euthanasia, or is it the autonomy of the individual to decide for themselves?
Currently, in most countries with legalised Euthanasia, the physicians have the final say in assessing the individual who has initiated the request for aid in dying. Euthanasia gives too much power to the doctors. Any legalization of Euthanasia, regardless of stringent regulations, places doctors in an objectionable position of authority.
This brings us to the slippery slope argument, which proposes that an action must be refrained from as it will trigger a sequence of events, culminating in an undesirable outcome. Legalising voluntary Euthanasia is the start of a slippery slope that could lead to involuntary Euthanasia and subsequent abuse of the legal process.
In many cases, it is not only the disability or the pain that is driving patients towards ending their lives but psycho-social suffering like poverty can also contribute towards making such a decision. Encouraging people to opt for euthanasia for “living in unjust social circumstances” is unjust.

Evaluating through the Legal Lens
A. The Netherlands
Euthanasia and Physician-assisted suicide (hereinafter “PAS”) have been lawful in the Netherlands since 2002, subject to six specific conditions , which include enduring unbearable suffering, no prospect of relief and even a long-held, independent wish for death. The terms “long-held, independent wish for death” and “unbearable suffering” appearing in their legislation are quite ambiguous and subjective as one can never specify the duration which would qualify as “long-held”. The same can be said about the term “unbearable suffering”.
Euthanasia involves a physician administering a lethal dose of medication to a patient upon their explicit request. Similarly, PAS is where the physician provides the medication, but the patient self-administers it.
The frequency of Euthanasia cases in the Netherlands has surged significantly post the enactment of the legislation, escalating from fewer than 2,000 instances in 2007 to nearly 6,600 cases in 2017. This pattern underscores the likelihood that when a law is established, it will be used or, in this case – misused.

B. Spain
In 2021, the Spanish Congress approved the law regulating Euthanasia, named Law No. 3/2021, which legalises both Euthanasia and PAS. Notably, the law does not require the requesting party to be a Spanish citizen as it permits individuals with legal residency in Spain to avail themselves of this “right”. This can have serious ramifications as it can make Spain a hub for “death tourism”.
The primary problem with the legislation is the lack of a clear distinction between the practices of Euthanasia and PAS, which creates confusion and ambiguity for healthcare professionals and patients. Moreover, it fails to define the role of doctors and nurses involved in each procedure.
Further, there is an absence of regulation concerning palliative care (end-of-life care). This is crucial because high-quality palliative care is a prerequisite for considering requests for Euthanasia. Incurable is never synonymous with un-care-able. The judgment that an illness is incurable cannot mean that care has come to an end.
The state is always under an obligation to ensure that people get access to good healthcare facilities. This law brings forth the idea of unapologetically providing facilities for “death at doorstep”. Therefore, the development of a national law on palliative care should have been prioritized before bringing into law for the regulation of Euthanasia.

C. Canada
Until 2015, PAS was prohibited by the law in Canada. In the Carter case, the Supreme Court of Canada made way for mentally competent adults who are under great suffering to seek Euthanasia. The reasoning being that if Euthanasia is prohibited by law, a person is forced to live a life of intolerable suffering. In such a scenario, the person is left with two choices – either to bear the suffering until a painful death or to end their own life by suicide.
Medical Assistance in Dying (hereinafter “MAiD”) is the legalized process of Euthanasia in Canada. In the Truchon case , the court observed that having a fatal condition is not a requirement for Euthanasia. This raises concerns as it prevents the patients from accessing all the reasonably available treatments, even for non-fatal diseases.
Although medical practitioners are obligated to follow the applicable laws, there is no formal procedure or regulatory authority to supervise their role in administering MAiD. It is also subjective and difficult to determine the real motives of the person applying for MAiD.
Canadian Law has been vocal about the legalization of Euthanasia, but it should be dealt with cautious optimism. Many loopholes still exist in the current law, which need to be corrected. Otherwise, it would lead to opening the floodgates of misuse of the law.

The Legal Landscape Surrounding Euthanasia in India
The development of the legal scape around Euthanasia has been gradual in India. The distinction between Active and Passive Euthanasia has been crucial in understanding the periphery of what is legal and what is not. The former involves an effort to end the life of the patient by deliberately injecting lethal medications, whereas the latter is based on the concept of withdrawing the life-support extended to a patient to end their life.
The school which advocates for Passive Euthanasia believes that it does not involve the active killing of a person, but it just amounts to not saving them. The apex court in Aruna Shanbaug observed that a person could not be punished for not saving a life. The act of switching off life support by the doctor amounts to omission, and that omission is not a breach of duty.
The developments can be traced back to Rathinam, wherein the court read the Right to Life into the Right to Die, which was then overruled in Gian Kaur, wherein the court held that the Right to Life does not include the Right to Die and that both Euthanasia and PAS were illegal in India.
The courts in India have acknowledged this distinction and have consequently held Active Euthanasia to be illegal and a crime under Section 302 of the Indian Penal Code (hereinafter “IPC”). PAS is a crime under Section 306 of IPC (abetment to suicide). The key difference lies in who administers the lethal medication. In the case of Active Euthanasia, it is a physician or a third party who administers it, while PAS is a self-administered method of Euthanasia on the advice of a physician.
Even the court has been cautious in giving leeway to Euthanasia and has acknowledged concerns about how, for instance, it can be misused by unscrupulous persons who wish to inherit some property by using Euthanasia as a tool.
The doctrine of Parens Patriae implies that the King is the “father of the country” and is under an obligation to look after the interests of his subjects who are unable to do so. In the modern context, the State has replaced the King. The court opined that in the case of an incompetent person such as a minor or person of unsound mind, the ultimate decision-making authority is the court as a State, although the views of near relatives, next friends and doctors must be given due regard.
With reluctance, the courts have recognised that the Right to Die with dignity is a fundamental right. In Common Cause, the Supreme Court focussed on terminally ill patients, where there is no hope of recovery. Accelerating the natural process of death to reduce the period of suffering constitutes a Right to Live with dignity. Right to Live with dignity can also be construed as the facilitating of the process of dying in case of a patient with an irrecoverable fatal disease.

The Way Forward
Today, India is not the only country in which active Euthanasia is prohibited due to fear of a slippery slope. Active Euthanasia is prohibited in the United States of America for similar reasons, and PAS is prohibited in 41 out of 50 states. Currently, only 6 countries in the world allow active Euthanasia and PAS. Moreover, for the rest of the world, it remains illegal. The best public policy on Euthanasia is no policy at all.
Popular choice is not always the right choice. Although people and various civil rights advocacy groups are favouring Euthanasia, currently, there is no robust legal framework to address the policy issues and legal concerns efficiently. Legalizing Euthanasia at this juncture would do more harm than good, as highlighted by the slippery slope argument. Passive Euthanasia, to some extent, is feasible to bring about, but Active Euthanasia is not justifiable morally, socially or legally. It would be a herculean task to make a framework so comprehensive and infallible to curb its misuse completely or even to a large extent, as can be gauged from the examples of various countries stated above. Moreover, when it is a matter of life and death, any flaw in the framework would prove to be a fatal mistake.

Saumya Tripathi and Supriya Raghuvansh are Second Year Students at Dr. Ram Manohar Lohiya National Law University.