Ethical Debate- Active and passive euthanasia 19 March 2018
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Euthanasia In India
Active passive euthanasia
What is “common cause”?
- Common Cause is a public interest organization of long standing, which has been striving for governance reforms through action research, advocacy and public interest litigation.
What is Passive euthanasia?
- It is the removal of life-support mechanisms from persons who, for the most part, have slipped into a persistent vegetative state in order to allow them to die in the natural course of things — and laid down a set of detailed procedural guidelines to facilitate this process.
- These include “advance directives” and “living wills”.
- These are instructions issued by a person specifying what should be done to her in the event of a terminal illness, and who will decide if she herself is incapacitated from giving or withholding consent.
- The court also addressed situations where a patient was terminally ill, but had not issued an advance directive.
- In such situations it held that the consent of the patient’s close family, subject to the supervision of and concurrence by trained medical personnel, would substitute for the advance directive.
What is active euthanasia?
- Active euthanasia is defined as the intentional act of causing the death of a patient experiencing great suffering.
What is the basis of the Common Cause v. Union of India decision?
- The SC expounded the basis of its 2011 ruling in Aruna Shanbaug v. Union of India which permitted “passive” euthanasia, including “involuntary” passive euthanasia for mentally incompetent patients, in certain terminal cases.
- Ruling that Article 21 of the Constitution guaranteed the “right to die with dignity”, the court also issued interim guidelines to enforce individuals’ living wills in case of future incompetence.
- Aruna Shanbaug and Common Cause have incorporated the judicial APD evolved primarily by the U.K. courts.
What is the moral difference between killing and letting die?
- Many people make a moral distinction between active and passive euthanasia.
- They think that it is acceptable to withhold treatment and allow a patient to die, but that it is never acceptable to kill a patient by a deliberate act.
- Some medical people like this idea. They think it allows them to provide a patient with the death they want without having to deal with the difficult moral problems they would face if they deliberately killed that person.
There is no real difference
- Since stopping treatment is a deliberate act, and so is deciding not to carry out a particular treatment.
- Switching off a life supporting system requires someone to carry out the action of throwing the switch.
- If the patient dies as a result of the doctor switching off the respirator then although it’s certainly true that the patient dies from lung cancer (or whatever), it’s also true that the immediate cause of their death is the switching off of the breathing machine.
- In active euthanasia the doctor takes an action with the intention that it will cause the patient’s death.
- In passive euthanasia the doctor lets the patient die.
- when a doctor lets someone die, they carry out an action with the intention that it will cause the patient’s death.
- So there is no real difference between passive and active euthanasia, since both have the same result: the death of the patient on humanitarian grounds.
- Thus the act of removing life-support is just as much an act of killing as giving a lethal injection.
Is active euthanasia morally better?
- Some (mostly philosophers) say that active euthanasia is morally better because it can be quicker and cleaner, and it may be less painful for the patient.
Points on which ‘passive’ euthanasia was constructed
- Active Passive Euthanasia Distinction (ABD) is an elaborate and flawed judicial construct arguably necessitated by overarching policy concerns.
- It has the potential for abuse by unscrupulous individuals and the spectre of criminal prosecution of benign doctors and families, etc.
What is the way forward?
- Common Cause signals that APD’s days numbered. Whether couched as “dignified death” or “bodily autonomy”, there is no reasonable basis for negating the right vis-à-vis a patient whose circumstances warrant assistance to exercise it.
- There must be proper legalization and regulation of active euthanasia.
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