What is active, passive euthanasia and ‘living will’?


  • The Supreme Court, in a landmark judgment on Friday, decided that passive euthanasia will be legally allowed henceforth in India. The apex court also laid down guidelines for “living will” made by terminally-ill patients who beforehand know about their chances of slipping into a permanent vegetative state.
  • These guidelines include who will have the power to decide on administering of passive euthanasia on the patient as well as how the respective medical board would go about taking this decision.
  • A five-judge Constitutional bench, headed by Chief Justice of India Dipak Misra, said these guidelines will be in force till legislation is passed by Parliament to deal with the issue.

What prompted this ruling in the Supreme Court?

  • Last year, the central government had informed the apex court that it is assessing the drafting of a bill to allow passive euthanasia. Termed the Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, the draft was released by the Union Health Ministry in 2016 based on the Law Commission of India’s Report No. 241 (August 2012). The government, however, also said it does not support granting people the right to make “Living Wills”, which would let them decide whether they want to be put on life support in case of terminal illness.
  • This ruling also draws from the Aruna Ramchandra Shanbaug vs Union Of India & Ors (March 7, 2011) case, filed in the Supreme Court by a “next friend” of nurse Aruna Shanbaug. In this case, the petitioner pleaded that former nurse Aruna Shanbaug, who had been brutally sexually assaulted in Mumbai KEM hospital in 1973 and had slipped into a permanent vegetative state as a result, be allowed to die peacefully by putting a stop to the mashed food that she was being fed, which helped her to stay alive.
  • This case would typically fall under the passive euthanasia category. Shanbaug had been in a vegetative state for 36 years, and stopping life-supporting treatment to her would result in her life ending peacefully, as opposed to her undergoing constant pain since close to three-and-a-half-decades.

What is active and passive euthanasia?

  • The apex court, in the Aruna Shanbaug case, said that active euthanasia “entails the use of lethal substances or forces to kill a person, e.g. a lethal injection…”. This means that a terminally-ill patient is administered a lethal drug or substance intentionally in order for them to pass away peacefully, in this case, in the event of terminal illness.
  • While legalising passive euthanasia on Friday, the chief bench defined Active euthanasia as “a positive act or affirmative action or act of commission entailing the use of lethal substances or forces to cause the intentional death of a person by direct intervention, e.g., a lethal injection given to a person with terminal cancer who is in terrible agony.”
  • Passive euthanasia also called negative euthanasia or non-aggressive euthanasia, on the other hand, was defined by the apex court, as that which “entails withholding of medical treatment for continuance of life, e.g. withholding of antibiotics where without giving it a patient is likely to die…”. This means that if a patient has been kept alive by the use of life-saving medical equipment, such as a ventilator, or drugs or substances, such as food administered through a pipe or medicines, then these would be stopped and the patient would be allowed to die a ‘natural course of death’.

What is ‘living will’?

  • The “living will” is a person’s right to issue advance directive on the course of his/her treatment, including withdrawal of life support, should such a situation arise. However, there is no way a living will provision can be made foolproof requiring no intervention of the doctor or immediate decisionmakers around a person.


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