Euthanasia Definition And Types Law Medical Essay

Published Date: 02 Nov 2017

Prashant Pranjal [] 

This article will define and employ the modern concept of euthanasia in that form in which most proponents favour its legalization. The object is to explore the interaction and the law. Therefore, euthanasia will be discussed against the background of murder, suicide, constitutional law, standing and judicial decisions. It is necessary to consider how euthanasia is treated by the law today in the view of recent judgement passed by the Supreme Court of India, as well as exploring possible legalization through the existing framework of legal history and laws governing euthanasia in various nations. An effort has been made to confine discussion to purely legal issue. It must be noted, however, that the literature of euthanasia is composed predominantly of articles concerning relevant religious and moral considerations. It is, therefore, inevitable that some of these non-legal considerations would be discussed. Another goal of this paper is in form of an appeal and suggestions to the legislature. Accordingly, this article does not deal with involuntary euthanasia, rendered over the objection or without the express consent of the patient. Nor does it deal with euthanasia designed to eliminate the physically or mentally deformed, or any other group of supposed societal misfits.

I. INTRODUCTION

No Longer simply the Greek term for "good", "easy" of "happy" death, [1] euthanasia is now well known as synonymous with mercy killing. Euthanasia or mercy killing or Physician Assisted Suicide (PAS) is the bringing about of the gentle death of a patient in the case of a painful, chronic and incurable disease. In time past there was no need for legislation in the area of euthanasia. If a person got sick, one of two things happened; he either got well, or he died. Today, the medical advances of the last few decades have given the medical profession a two-edged sword; the extension of human life by artificial means and the painlessly termination of life by drugs. [2] "The ability of man to wield this sward has moral and ethical as well as practical considerations that are mind-boggling." [3] It is because of these medical advances that euthanasia and related subjects have become so important in the eyes of so many. Unfortunately, while medicine has been surging ahead, the development of our law has been lagging behind, to the point that it is more correct to call it "non-development". "Where the issues are ones of life and death, the law must strive for the greatest certainly that can be had." [4] 

The medical revolution in of the last few years has increased longevity to the point where "...death may be desired long before medicine lets it occur." [5] Medical advances have enabled physicians to achieve not only cures, but half cures, prolonging the lives of the terminally ill in situations where death would be welcome blessing. In addition, technical advances have enabled the medical profession to prevent, in many cases, the full appearances of all the conditions enabling a doctor to certify death. As a result, there have been an increasing number of writers calling for the legalization of voluntary euthanasia, or mercy-killing.

The claim to a "right to die" demands more than a right to one’s own death. It means a right to be put to death, which necessarily involves a duty on others to partake in the active inducement of death. If there were indeed a "right" to kill oneself, a fireman who prevented a would-be suicide from splattering himself on the pavement might find himself susceptible to a tort action. It may even be looked upon as morally presumptuous to try to persuade a man not kill himself.

II. EUTHANASIA: DEFINITION AND TYPES

Generally, the word euthanasia is defined as the act or practice of painlessly putting to death or withdrawing treatment from a person suffering an incurable disease. [6] From the definition, one can say that euthanasia is an unethical act as much as it is a great sin for those who strongly believe in God. Euthanasia is intentionally killing another person to relieve his or her suffering. [7] It is not the withdrawal or withholding of treatment that results in death, or necessary pain and symptom-relief treatment that might shorten life, if that is the only effective treatment. [8] 

A discussion on euthanasia is long overdue. A serious debate is necessary on the issue of euthanasia. [9] Euthanasia is one of the most perplexing issues which the courts and legislatures all over the world are facing today. [10] The topic has religious and moral overtones. Human life is inviolable. Life is a gift from God and no one, not even the individual himself has right to take it. But if the life of a person becomes inhuman, painful, fruitless and full of sufferings, should the person get rid of their life? A solution for such a problem is not just legalizing the mercy killing. It is not desirable or workable as each case has to be judged individually.

There are two types of euthanasia: active euthanasia and passive euthanasia. Active euthanasia is defined as taking an immediate action such as using lethal injection to painlessly put a terminally-ill patient to death. Passive euthanasia is withdrawing treatment while the life of the patient is still dependent on it and when it is believed that treatment is more burdensome than beneficial. Passive euthanasia allows the patient to die naturally and is often considered more acceptable. [11] 

In Aruna case [12] , Justice Katju discriminated between active and passive euthanasia and said, "Active euthanasia entails the use of lethal substances or forces to kill a person e.g. a lethal injection given to a person with terminal cancer who is in terrible agony. Passive euthanasia entails withholding of medical treatment for continuance of life, e.g. withholding of antibiotics where without giving it a patient is likely to die, or removing the heart lung machine, from a patient in coma." [13] In India active euthanasia is illegal and a crime under section 302 or at least section 304 IPC. Physician assisted suicide is a crime under section 306 IPC (abetment to suicide). [14] The difference between "active" and "passive" euthanasia is that in active euthanasia, something is done to end the patient's life’ while in passive euthanasia, something is not done that would have preserved the patient's life. [15] 

There are two more types of euthanasia i.e. voluntary and non voluntary euthanasia. In voluntary passive euthanasia a person who is capable of deciding for himself decides that he would prefer to die (which may be for various reasons e.g., that he is in great pain or that the money being spent on his treatment etc.), and for this purpose he consciously and of his own free will refuses to take life saving medicines. In India, if a person consciously and voluntarily refuses to take life saving medical treatment it is not a crime. [16] In contrast, non voluntary passive euthanasia implies the question whether to allow a person to die who is not capable to give consent at all. [17] 

III. LEGAL ASPECTS OF EUTHANASIA

Controversies on legalization of euthanasia in Europe and America are continuing. Legalizing euthanasia would basically change the way we understand ourselves, human life and its meaning. We create our values and find meaning in life by buying into a "shared story" - a societal-cultural paradigm. [18] Humans have always focused that story on the two great events of every person's life, birth and death. [19] In a secular society - even more than in a religious one - that story must encompass and protect the "human spirit."

After a very recent Supreme Court of India decision in Aruna case [20] , India now joins a handful of nations, including Belgium [21] , Luxembourg [22] , the Netherlands [23] and Switzerland [24] , and the U.S. states of Oregon and Washington [25] in allowing some form of euthanasia. India has no law on the issue, making the guidelines legally binding. As outlined, "Passive" euthanasia is allowed in exceptional cases after a review by medical experts and approval of the high court. [26] While Active euthanasia, in which a patient is given life-ending drugs or other lethal intervention, is not allowed. [27] This is the first time in India when Supreme Court allowed any kind of euthanasia.

Some exponents say that euthanasia should not be legalized at all. If so, then what about those who are living an inhuman life, or those who are in a permanent vegetative state and have on chance to recover back to normal, or those who are in coma or paralytic from a very long period? Similarly, there are many other question regarding the pros and cons of euthanasia which we would look into them one by one.

The law draws a bright line between lawful practices which result in a patient’s death (withholding/withdrawing life prolonging medical treatment and providing palliative care which may, incidentally, shorten life), and unlawful practice which have the same effect (euthanasia and physically assisted suicide). This means that the doctors are allowed to help their patients to die provided that they happen to be connected to a ventilator or nasogastric feeding tube. They can also potentially shorten the lives of those who happen to require life-threatening doses of painkillers. Some commentators argues that access to medical assistance in dying should not depend upon a patient’s fortuitous need for life support or substantial dosed of diamorphine. Others believe that there is a fundamental difference between doctors letting their patients die and killing them, and that the integrity of the medical profession demands an absolute prohibition upon doctors acting deliberately to terminate their patient’s life. Who is right?

Before we review arguments for and against legalizing euthanasia and physician assisted suicide, it is worth pointing out one if the basic difference between the positions adopted by proponents and opponent of assisted dying. Someone who argues in favour of access to assisted dying does not impose their views on others. Rather, they believe that assisted dying should be available to people who actively seek it in order to avoid a frightening or distressing death. In contrast, someone who argues that assisted dying should be prohibited is not just saying that they themselves would not want access to it – that position would entirely consistent with legalization. Rather, opponents of euthanasia believe that people whose values are different, and who believe that assisted dying would help reduce their pain or distress at the end of their life, should be denied the assistance they require because of other’s people beliefs about the undesirability of legalization.

A. PRO EUTHANASIA ARGUMENTS

Perhaps the strongest argument made on behalf of legalizing euthanasia or assisted suicide is that it, like abortion, is a ‘choice’ issue. Proponents argue that euthanasia is the ‘ultimate civil right’, and that to deprive mentally competent, terminally ill people who want to end their suffering of a peaceful "aid in dying" is to fundamentally disrespect their right to personal autonomy. [28] Legalizing euthanasia would help alleviate suffering of terminally ill patients. It would be inhuman and unfair to make them endure the unbearable pain. [29] In case of individuals suffering from incurable diseases or in conditions where effective treatment wouldn’t affect their quality of life; they should be given the liberty to choose induced death.

The proponents of euthanasia argue that it is cruel to prolong intense suffering of one who is mortally ill and desires to die. In a response no doubt dictated by compassion and humane motives, the demand for mercy-killing legislation reflects a change in social attitudes which demands less government control over what is seen as unwarranted intervention in matters of personal and private choice. "The underlying principle is that the choice of life or death should always be with the individual concerned, and that the choice of what happens to him should be in accordance with his values and not the values of others." [30] It is then asserted that it is a logical extension of the "right to die" argument that it is not wrong for the person to ask another to help him carry out his desire, nor is the other wrong in doing so.

It is undoubtedly true that we all have a profound interest in how we die. To die quickly and painlessly, perhaps at home and surrounded by the people we love, is obviously preferable a lonely, protracted, and frightening death. As Sylvis Law [31] suggests, giving patients some control over how they die might then appear to be an especially important aspect of respect for autonomous decision-making.

The term "right to die" is in fact a misnomer. People do die, and will continue to do so whether the "right" is given or not. It hardly seems necessary to enact legal measures to enforce the right to bring about one's death, since anyone who wants to commit suicide is not likely to be prevented. What is really sought when the phrase "right to die" is used, is that it be made respectable to commit suicide and to involve others in that decision. "It is asked of us that we ‘integrate’ suicide into the fabric of our lives, participate in the decision, provide ritually sanctifying means." [32] Right to life should also encompass the right to choose how one wants to die as well. Euthanasia should be allowed to patients who are begging to be freed from their sufferings. The suffering of an ill patient need not be prolonged by forcefully keeping him alive with all the pains and sufferings. Life that does not have total control over limbs and senses is like stagnant water. It is better to allow euthanasia rather than letting a patient rot in bed till natural death as if he is serving life imprisonment. Euthanasia is a matter of personal choice; law should not have any say in it. If I want my life not to be supported with any machine, then I must be allowed to do so. A person’s last wish should be honoured, even if it means mercy killing.

A different sort of argument for legalization could be framed in terms of the principle of beneficence. When curing a patient and restoring her to full health is no longer possible, the doctor’s duty to ‘do good’ encompasses doing whatever she can to relieve the patient’s suffering. If the only way that a patient’s distress can be relieved is by ending her life, it could be argued that allowing doctors to take this step is compatible with their duty to act beneficently. It has been suggested that some patients are so fearful of a protracted and distressing death that they take their own lives prematurely while they are still capable of doing so. Other patients may go to Switzerland while they are still able to travel, whereas if they could have access to assisted dying at home, they could wait until they become more incapacitated. For such patients, the availability of legalized euthanasia would, in fact, prolong their lives.

B. CONS OF EUTHANASIA - REASONS AGAINST EUTHANASIA

Ours is a democratic country where Judiciary, Executive and Legislature should work in tandem. Besides, age old laws/acts should be updated with the time we pass by and it is a continuous process. In Aruna’s case, the criminal escaped with just 7 years imprisonment for committing such a heinous crime because of our weak legal system and Aruna has been paying very high price for no fault of hers. Before enacting this new legislation on euthanasia, the legislature should work on updating old rusty laws which was made when India was neither independent nor a democratic republic.

A majority of the people agreed with the Supreme Court's judgment and said that Pinki Virani who filed the application on her behalf, had no right to do so. While there are people who say that Aruna should be granted euthanasia. They say, "Aruna is in a permanent vegetative state and there is no sign of recovery. She is suffering every minute then what is the use of keeping her alive?"

For answering this question on life of Aruna, the author would like to take an example. Suppose for an instance, there is a person who keeps her pet bird in a nest. He feeds her, spends time with her and he’s somehow emotionally attached to her which is justified by him, but if we see from bird’s perspective, then the question arises, "is that bird living a natural life? Is she living a life like other birds or a life which she was made to live?" The answer is ‘absolutely no’.

Similarly, for Aruna that hospital room is like a nest in which she is living from past 37 years. Then why is the same person who keeps her pet bird in a nest saying that Aruna is living an inhuman, painful, fruitless life and euthanasia should be allowed for her. Only her near and dear ones know that she is there and how important she is for them, but for others she is just a motionless object. Many appreciated the efforts of the hospital staffs but most thought that they are unnecessary prolonging her agony. Only hospital staffs know how she love them when they speak to her or look in her eyes, or feed her or clean her. The staffs of the hospital deserve the highest praise for understanding the meaning of ‘love and compassion’.

Mercy killing is morally incorrect and should be forbidden by law. It’s a homicide and murdering another human cannot be rationalized under any circumstances. Human life deserves exceptional security and protection. Advanced medical technology has made it possible to enhance human life span and quality of life. Palliative care and rehabilitation centres are better alternatives to help disabled or patients approaching death live a pain-free and better life. No society has right to take anyone’s life without their explicit consent. Euthanasia is a sensitive issue and law can be misused, so decision on allowing it should be weighed case by case. In a country like India, where there is no access to public health care system for the poorest of the poor, this is a law which would be open to misuse. One should live life till the last breathe, so it should not be made a legal issue. Life takes its own course, man should not play god. God has given us life and we have no right to take away our life. When a person is born, only the god decides how many breathe he has to take.

For two different reasons, it is sometimes argued that the legalization of euthanasia is unnecessary. First, improvements in palliative care lead some opponents of legalization to contend that no patient should ever have to die in intolerable agony. The second reason for arguing that legalization is unnecessary derives from the recognition that, in practice, does help their patients to die. If euthanasia were readily available, elderly patients would be pressurised into electing a premature death. In some cases, pressure to opt for euthanasia might come overtly from unscrupulous or greedy relatives. But it is also common for elderly people to perceive themselves to be a burden to their family, and if death were an opinion, there is a danger that they might request euthanasia for altruistic reasons, despite their own desire to go on living. Legalization would also have a profoundly deleterious impact upon the doctor-patient relationship, and would damage the integrity of medical profession. There are two interrelated aspects of this argument. First, from the point of view of patient, it might be argued that knowing their doctor would kill them would reduce patients trust. Secondly, from the point of view of doctor, if ‘killing’ were to become a treatment option, the ethical foundations of the medical professions would be undermined, and this in turn would replace patients’ willingness to trust their doctors.

IV. THE SUPREME COURT OF INDIA ON EUTHANASIA: ARUNA CASE

The Supreme Court of India for the first time ruled on the issue of euthanasia in the groundbreaking Aruna case. [33] Aruna Shanbaug 62 years old women who was a nurse in Mumbai is brain dead since she was attacked by a rapist, a hospital staff in November 1973. A petition for mercy killing had been made by a journalist Pinki Virani to SC, who suffered a brutal sexual assault 36 years ago and has been lying in a vegetative state in a Mumbai hospital. Petitioner argued that Aruna was terminally ill and in a persistent vegetative state that she might be permitted to terminate her life by a premature extinction of her life in those circumstances. She further added, "this category of cases may fall within the ambit of the ‘right to die’ with dignity as a part of right to live with dignity, when death due to termination of natural life is certain and imminent and the process of natural death has commenced. These are not cases of extinguishing life but only of accelerating conclusion of the process of natural death which has already commenced." [34] The contention of the state was that Aruna had a right to live and her present state or condition did not justify terminating her life. It was said, "termination by any means will be cruel, inhuman and intolerable. Withdrawing or withholding medical support is contrary to Indian law; also, it would undermine 30 years of efforts put by the hospital staff. Indian families are emotional and care-oriented. Also, legalization of euthanasia would lead to relatives conspiring with the doctors to inherit property etc."

Finally court came to a conclusion and said that there is no right to die (suicide) under Article 21 of the Constitution and attempt to suicide is a crime under Section 309 [35] Indian Penal Code (hereinafter IPC). The Court also held that the right to life includes the right to live with human dignity, and in the case of a dying person who is terminally ill or in a permanent vegetative state he may be permitted to terminate it by a premature extinction of his life in these circumstances and it is not a crime vide Gian Kaur's case [36] . Under the law, euthanasia is administered only to patients who are in continuous, unbearable and incurable suffering. [37] A second opinion is that, the patient must be judged to be of sound mind, and his or her request to die must be made voluntarily, independently and persistently. [38] There was no indication of Aruna wish to die and her brain is not dead. She expresses her likes/dislikes with sounds and movements. She smiles when she is given her favourite food; disturbed when people enter her room and clams down when touched gently. Staffs of the hospital that have looked after her alone is in a position to decide whether she should continue to live. Any decision regarding her treatment has to be taken by KEM Hospital.

Court also laid down certain condition which needs to fulfilled for a person going for euthanasia. It was said, "Passive euthanasia withholds medical treatment, without when a patient is likely to die, like removing a ventilator from a patient who is in an irreversible coma. It is allowed to a person who is in a permanent vegetative state or terminally ill. Before allowing passive euthanasia, one has to individually take approval from the High Court and the High Court will refer to medical board before taking a decision. Such plea can be moved by patient himself and if the patient is medically unable, it can be moved by next of kin or surrogate taking care of the patient."

SC further added that till parliament makes a new law, this judgement would apply to relevant cases. This judgement suggests that this is the time to change the old law and bring up a new law for euthanasia. The court recommend to Parliament to consider the feasibility of deleting Section 309 from the Indian Penal Code because a person attempts suicide in a depression, and hence he needs help, rather than punishment.

V. EUTHANASIA: EXPERIENCE IN OTHER COUNTRIES

On April 1, 2002, legislation regarding the practice of euthanasia and assisted suicide became effective in The Netherlands. [39] With this new law the Netherlands earned the distinction of becoming the first nation in the world to legalize euthanasia. [40] Although this event made many headlines, the practice of euthanasia in the Netherlands had already achieved a status of de facto legality through Dutch jurisprudence and prosecutorial policy. Even though it is in many respects simply a codification of past jurisprudential development, the law is significant inasmuch as it is a creature of politics. Additionally, the Dutch act is likely to exercise considerable influence internationally as other jurisdictions are likely to use it as a guide. [41] 

In 1973 a Dutch court indicated for the first time that euthanasia must be acceptable in certain circumstances. In the Postma case [42] a doctor was prosecuted for giving her mother a fatal dose of morphine. Dr Postma’s mother had had a cerebral haemorrhage which had left her very seriously disabled. She had unsuccessfully attempted to commit suicide and had repeatedly expressed her desire to die. The District Court convicted her under Article 293, it imposed a symbolic suspended sentence of a week’s imprisonment. Furthermost, the court took the opportunity to indicate that, despite Article 293, euthanasia could be acceptable if performed in certain circumstances: (1) the patient should be incurably ill; (2) the patient should be experiencing unbearable sufferings; (3) the patient should have requested that his or life be terminated; and (4) the termination is performed by the patient’s own doctor, or in consultation with him or her.

The first case to come before the Dutch Supreme Court was Schoonheim case [43] . The Supreme Court in this case offered some guidelines for how the justification of necessity was to be considered. The Court noted, "one would have expected the Court of Appeals to have considered... whether, according to responsible medical opinion, subject to the applicable norms of medical ethics, this was, as claimed by the defendant, a situation of necessity." [44] The "necessity" referred to by the Court is based on the defendant’s argument that he was presented with a conflict of duties (one duty to obey Article 293 and the competing duty to relieve the suffering of his patient). [45] Reference was also made to "unbearable suffering," "loss of personal dignity," and the possibility that the patient might not be able to "die in a dignified manner". [46] The Court set "responsible medical opinion" tempered by the "norms of medical ethics" as the standard by which courts should decide whether physician action was justified by necessity. This deference to the medical community is remarkable’ as "the Court appears to abdicate to medical opinion the power to determine the circumstances in which killing attracts the necessity defence. [47] The decision of the Supreme Court is also remarkable inasmuch as the allowance for the necessity defence was traditionally limited to situations in which the preservation of life was the goal. [48] Finally, the judgment is curious inasmuch as there is an absence of any discussion of why exactly the duty to relieve suffering trumps one of the traditional duties of the doctor-the duty not to kill. [49] 

Schoonheim represents the first case in which no criminal liability was ascribed to a physician who had committed euthanasia. Physicians engaging in euthanasia are now having available the defence of necessity. Some deaths administered by physicians in the Netherlands are made without a patient's explicit request. [50] 

The Northern Territory of Australia is the only place in the world where active euthanasia has ever been legal. The Northern Territory Rights of the Terminally Ill Act 1995 was passed and also affirmed by a Supreme Court of the Northern Territory Ruling; on March 23rd 1997 it was effectively overturned by the Australian Senate.

The Belgian parliament legalized euthanasia in late September 2002 [51] by passing the Termination of Life on Request and Assistance with Suicide Act. The Belgium Euthanasia Act does not apply to assisted suicide; only euthanasia has been legalized, provided certain conditions are met. The legislation established the conditions under which doctors may end the lives of patients who are hopelessly ill and suffering unbearably. Potential candidates for euthanasia need to reside in Belgium to be granted this right. Patients must be at least 18 years old and make specific, voluntary and repeated requests that their lives be ended. [52] The patient’s request must be made in writing. The document should be drawn up, dated and signed by the patient. If the patient's condition makes this infeasible, her request will be taken in writing by an adult of the patient's choice. That person must not benefit financially from the death of the patient. That person will specify that the patient is unable to express her request in writing and why. In such cases, the request will be written in the presence of the physician and the aforesaid person will name the physician in the document. This document must be included in the medical record. The patient may rescind the request at any time and in any manner, in which case the document is taken out of the medical record and returned to the patient. This provision was also granted under the Australian Northern Territory Act [53] and is granted under the Oregon Death with Dignity Act. [54] 

In the United States, a distinction has been drawn between euthanasia – which is illegal throughout the US – and physician-assisted suicide, which is a matter for individual states. A decision of Supreme Court in 1997 confirmed that there is no constitutional right to assisted suicide, but the legalization is not unconstitutional. [55] Oregon was the first state to vote in favour of legalization of assisted suicide. The Death with Dignity Act 1994 was the result, but its introduction was delayed as a result of a number of legal challenges, all of which was ultimately unsuccessful. [56] It came into force in 1998, and in its first year there were fifteen assisted suicide in Oregon. This act provides that a physician may comply with a competent, terminally ill, adult patient’s voluntary request for a prescription of drugs, which will allow her to end her life in a humane and dignified manner. The patient must make an initial oral request, followed by a formal written request. At least 15 days after the written request the patient must repeat their request orally, and a further 48 hours must elapse before the prescription can be filed. The patient’s request must be witnessed by two people other than the doctor, at least one of whom must not be a relative, an heir or an employee of an institution in which the patient is receiving care. The patient must be asked to notify her family. A second doctor must confirm the patient’s diagnosis and the patient is competent and acting voluntarily. The patient must have received complete information about her diagnosis, prognosis, and alternative treatments, such as pain control. If there is any suggestion that a patient is depressed or has a psychiatric disorder, she must be referred to a psychiatrist or psychologist.

Legislation on euthanasia in Switzerland permits assisted suicide. In Switzerland, assisted suicide falls under Article 115 of the Swiss penal code which came into effect in 1942 (having been approved in 1937), considers assisting suicide a crime if and only if the motive is selfish. The code does not give physicians a special status in assisting suicide; however, they are most likely to have access to suitable drugs. Ethical guidelines have cautioned physicians against prescribing deadly drugs. Article 115 was interpreted as legal permission to set up organizations administering life-ending medicine only in the 1980s, 40 years after its coming into effect. Article 115 does not specify that the suicide must be assisted by a doctor, nor does the patient have to be terminally ill or in intolerable pain. The only precondition for the act’s legality is that the motive must be unselfish.

VI. THE NEXT STEP

After the Aruna [57] judgement, the scenario has completely changed regarding euthanasia in India. The Supreme Court said that although Section 309 IPC has been held to be constitutionally valid in Gian Kaur's case [58] , the time has come when it should be deleted by Parliament as it has become anachronistic. [59] A person attempts suicide in a depression, and hence he needs help, rather than punishment. [60] It is therefore recommend to Parliament to consider the feasibility of deleting Section 309 from the Indian Penal Code. [61] The court also clarified that until Parliament enacts a law, its judgement on active and passive euthanasia will be in force. [62] Now the government is considering over making a law for euthanasia. [63] Governments around the world also fear legalising euthanasia would spark a wave of assisted suicides of disabled but otherwise healthy people, hence making a mockery of the supposedly noble value of human life. [64] 

There should be legislation on euthanasia because without a law we cannot resort to this kind of a decision with a judicial order. There would be a lot of humanitarian points to be looked into and said such petitions cannot be used as "an instrument" to kill somebody. [65] 

The author would like to make certain suggestions to the law makers for regarding codifying and enforcing legislation on euthanasia. A patient had to be over 18 and be mentally and physically competent to request his or her own death. The patient should be in a permanent vegetative state and is having no chance to recover and must be fully aware of his/her condition, prospects and options. The patient's request for euthanasia must be voluntary and persist over time i.e. the request cannot be granted under the influence of others. The request had to be supported by two or more than two expert doctors, including a specialist who confirmed that the patient is terminally ill and a psychiatrist who certified that the patient is not suffering from treatable depression. Also, as it is directed in the Aruna’s case, a petition for death must be filed in the high court and court has to give its approval.

VII. CONCLUSION

As we have seen in this article, end-of-life decision-making raises some extraordinarily difficult and ethically contentious question. The right to have one's life terminated at will is subject to social, ethical, and legal structures. The legalization of euthanasia must be seen as desirable for our society. The question that should euthanasia be legalized is not an objective question. It is a subjective one which depends more upon the cases and circumstances. It would be inhuman and unfair to make patients endure the unbearable pain. If the process of natural death has started, you can only help in that process on natural death. The person should be in a Permanent Vegetative State, or in coma, or living with a dead brain. The consent to discontinue life support of the patient should be must. If the patient is not in a state to give his consent, then in that case a decision has to be taken either by the parents or spouse or other close relatives or in the absence of any of them, such a decision can be taken even by a person who is his next friend. It can also be taken by the doctors attending the patient. However, the decision has to be taken bona fide in the best interest of the patient. If a person who has neither a relative nor a close friend of the patient and he is not in a state to give his consent, then in that case the court would direct the expert doctors to submit a medical deport of that person and court would look over that subject. Though the law have other alternative solution to this problem, the author believes that striking down Section 309 of Indian Penal Code and legalizing euthanasia would help to alleviate suffering of terminally ill patients.