Indian Journal of Law and Legal Research Volume VII Issue I | ISSN: 2582-8878

ROLE OF CONSENT IN EUTHANASIA IN INDIA: LEGAL

AND ETHICAL PERSPECTIVES

Diya Mohan, Christ (Deemed To Be) University

ABSTRACT

Euthanasia is the act of deliberately ending a life to end suffering. That is a

very controversial issue everywhere and does not leave behind any nation,
including India. To date, various rules and guidelines have extensively been
set for euthanasia in India. Indeed, critical concepts that have been placed at
the heart of this debate include that of consent-a distinction between
voluntary and involuntary euthanasia. This paper takes on an exploration role
regarding the role of consent within the Indian legal framework on
euthanasia concerning its ethical and legal implications. This paper develops
in detail the landmark cases, thus giving an exact picture of the law's
recognition of passive euthanasia and the introduction of living wills and
advance directives permitting individuals to make end-of-life decisions. The
paper addresses the issues in obtaining valid consent, such as mental
incompetence, coercion, and family influence, and how Indian courts have
approached these issues. Relating the previous facts brings to discussion the
role of medical boards in ensuring that consent is informed and not subjected
to the pressures of others. In this regard, the paper interposes some ethical
questions on euthanasia. This exercise focuses on patient autonomy,
reflections on medical ethics, and the right to die with dignity.

International practices, especially in countries like the Netherlands and

Belgium, where active euthanasia has been legalized, could give
comparisons to possible reforms that may evolve in Indian laws. The paper
concludes by discussing the prospects of euthanasia in India by
recommending legal and medical reforms to deal with the challenges of valid
consent and protecting the rights and dignity of patients in end-of-life care.

Keywords: euthanasia, consent, rights, autonomy, ethics

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Introduction

Euthanasia is the Greek words "eu" (good) and "thanatos" (death), meaning a good death,
killing oneself to ease suffering, either in a patient who is incurably ill or in agony. There are
two broad classifications for euthanasia: active and passive1. Active euthanasia refers to direct
actions that result in death through the administration of lethal substances. On the other hand,
passive euthanasia is withholding or withdrawing treatment that prolongs life and thus allows
a person to die naturally. Although active euthanasia remains illegal in India, the Supreme
Court has recognized and regulated passive euthanasia, notably in the case of Aruna Shanbaug,
and further enshrined in Common Cause v Union of India. The central core legal and ethical
factor in differentiating between voluntary, non-voluntary, and involuntary euthanasia has been
'consent' in euthanasia.

Voluntary euthanasia occurs when the patient delivers explicit conscious, competent consent
to end their life. Non-voluntary euthanasia is performed when a patient either is incapable of
giving explicit consent or is unconscious and incapacitated; hence, a decision concerning them
is made, often by the family or medical authorities. The taking of a patient's life without his
consent, even though he can give it, falls, without exception, within the head of condemned
actions as violative of human rights. In India, this right has deeply come to be integrated with
that found under Article 21 of the constitution as a matter of right to life interpreted to include
the right to die with dignity.

However, a more formidable question comes in the question of whether the consent is valid,
informed, and not coerced, mainly where issues of terminal illnesses affect the decision-making
capacity of the patient. Thus, by the case series of Aruna Shanbaug and Common Cause, the
Supreme Court has established the legal framework that safeguards the patients' rights to their
autonomy without eroding the misuse of euthanasia. In direct relation to this is the use of the
living will and advance directives2. Euthanasia has been one of the essential subjects of
argument for lawyers, doctors, and patients with terminal illnesses, which has been an issue in
this context. Keeping constant attention to both the ethical and legal implications as well as
practical concerns in an evolving framework of end-of-life care, this paper discusses at a

1
Garrard, E., & Wilkinson, S. (2005). Passive Euthanasia. Journal of Medical Ethics, 31(2), 64–68.
http://www.jstor.org/stable/27719333
2
Foot, P. (1977). Euthanasia. Philosophy & Public Affairs, 6(2), 85–112. http://www.jstor.org/stable/2264937

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considerable level of detail the importance of consent as part of the legal position that India
holds regarding euthanasia.

Historical Background

Euthanasia was initially a good death, as it sounds in the Graeco-Roman context: easy, painless,
with less suffering. This death is often connected with the notion of voluntary death, assisted
by lethal substances like hemlock. The ancient world connected this sort of good death with
the freedom to choose death, a death chosen, typically through others' assistance. With the
influence of influential Christian thinkers such as Josephus, Augustine, and Aquinas,
euthanasia "active" was then shunned in favor of the value of permitting life to enjoy its course.
As the 17th century unfolded, figures such as Francis Bacon expanded the meaning of
euthanasia in many cases to include physician-assisted operations that might accelerate death.
In modern arguments, "the issue has changed from whether to kill as a form of mercy killing"
to dealing with various ethical and legal problems3.

As debates over euthanasia have continued to unfold in the Western tradition, it is increasingly
argued that Christian principles of the sanctity of life are no longer tenable. Proponents say that
euthanasia should consider the quality of life since a painless death maintains dignity. Some
ethicists have attempted to redefine the concept of murder so that it can be made distinct
between unjust killing and the act of euthanasia as a kindly killing. Others have written that
individuals deserve the right to determine decisions over their lives and deaths, unfettered by
the extraneous influence of religious dogma or legal authority. This ongoing argument has
opened boundaries for what one can consider acceptable in giving up one's life. In modern
rhetoric, euthanasia is increasingly presented as "compassionate murder" in terminal illness. A
distinction is also drawn between euthanasia-that would involve initiating the process of ending
a life and discontinuing life-support interventions. The latter method is often allowed in
terminal care settings, though more accepted today than in the past. End.

Now, concerning Hindu concepts, the Indians of classical India separated death into natural,
unnatural-for example, in battle or by accident-and self-willed. Hindu tradition was
chauvinistic about living the entire natural lifespan, marking the ending of a life that was of

3
Coward, H.G., Lipner, J. and Young, K.K. (1989) Hindu Ethics : Purity, Abortion, and Euthanasia. Albany:
SUNY Press (McGill Studies in the History of Religions). Available at:
https://search.ebscohost.com/login.aspx?direct=true&db=e000xww&AN=7556&site=ehost-live.

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natural death with the sraddha funeral rites. On the other hand, death by unnatural causes was
seen somewhat differently; they were more of a religious power, especially for warriors whose
deaths in battle led to heaven. Such a difference between natural and unnatural death still
reflected a broader understanding of the end of life4.

The Hindu self-willed death had various forms: suicide, although generally disapproved of
since it was inspired by passion or despair; heroic voluntary death, also called Mors Voluntaria
Heroica, where warriors or others preferred death rather than being in the hands of others,
calamities, or disgrace. The third form was religious voluntary death, Mors Voluntaria
Religiosa, sought for spiritual reasons, such as attaining heaven or fulfilling one's religious
obligation. This includes practices such as prayopavesana or sallekhana (a Jain practice of
voluntary fasting until death). Over time, Hindu attitudes toward euthanasia changed. In the
classical context, this was sympathetically regarded as in case of incurable illness or extreme
old age5. However, it was considered as a form of willful death rather than a mercy killing.
Euthanasia became criticism a growing strength in the 10th century C.E. through the use of
willful deaths, as it became easily possible to abuse due to which it was viewed through its set
of criticism by society as those deceptions may occur due to coercion or undue influence;
therefore, its legitimacy had to be ensured. British colonial rule altered the Indian legal
landscape.

The Penal Code prohibited all forms of suicides, and this included religious acts like
sallekhana. Under this provision, euthanasia was banned, which was dealt with leniently under
classical Indian traditions. To the law, the different forms of suicide that constituted religious
voluntary death were just the same as others and came under prohibition as well. This legal
framework has been challenged in modern India. Justice T.K. Tukol questioned the extensive
nature of the definition of suicide contained within the Penal Code, mainly as it was applied to
religious fasting unto death, such as sallekhana. He argued that such practices should instead
be understood as moral and religious acts, far removed from the traditional understanding of
suicide. Such is the legal case of one current manifestation of an underlying trend for a
continued struggle to harmonize religious heritage with the legal ethos of the modern world.
As euthanasia in the West transitioned from voluntary death to physician-assisted death,
classical Hinduism maintained a more nuanced relation to self-willed death. It permitted it only

4
Foot, P. (1977). Euthanasia. Philosophy & Public Affairs, 6(2), 85–112. http://www.jstor.org/stable/2264937
5
Id.

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within particular religious and heroic contexts—nevertheless, this allowed it to decline with
time through perceived possibilities of abuse. In many ways, British colonial law continues to
taint Indian practices today as India debates its position on euthanasia, leaving to themselves
questions of the historical traditions that have influenced current legal frameworks.

By the 10th century C.E., religious self-willed deaths like fasting unto death, self-immolation,
and suicide from heights started getting condemned within Hinduism as they were becoming
increasingly prevalent due to propaganda of spiritual causes.

In Hindu lawgivers like Gautama, these acts fell into the category of suicide and were
deprecated from grieving over the person who would commit them. This Kalivarjya system
had developed to govern those activities that once used to be practiced. Still, it was later
forbidden, such as Mahaprasthana (the Great Journey) and self-chosen deaths of wandering
monks afflicted with incurable illnesses or old age. The practice of such actions was strictly
imposed upon Brahmins and Kshatriyas. Social and family pressures also contributed to the
issue since older adults may have faced compelled self-willed death by their younger family
members who wanted inheritance or their authority. Thus, religious voluntary death blended
with suicide, and the practice became an object of more significant concern. Religious
voluntary death, like euthanasia, was attacked because it could well be misused. Although
condoned first by Brahmins, these practices were subsequently renounced because of their
misuse, which goes against their religious aim. Satī, or widow self-immolation, was also
questioned on the count that such self-immolation constituted suicide, though its religious
justification existed. Eventually, it was idealized for females; however, many wondered what
the actual use of such things was. However, foreign criticism, especially from Christian
missionaries and the British colonial government, led to reforms like Regulation XVII of 1829,
which banned sati. Jainism continued to defend controlled religious deaths like Sallekhana.
Towards the 10th century, Hinduism had to restrain religious voluntary deaths due to abuse and
societal pressure on this evolving view about suicide and euthanasia in India.

Legal Provisions and the Concept of Consent in Euthanasia

Euthanasia, or the intentional act of bringing about a person's death to end further suffering,
poses a plethora of knotty questions ranging from legal ethics to the moral plane. The debate
around euthanasia in India is much more evolved around the principle of consent and the right
of an individual to autonomy as against the duty of the state to protect life. The core of this

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discussion lies within Articles 14, 16, 19, and 21 of the Indian Constitution, which have
described those rights that all citizens should enjoy as essential rights to equality, freedom, and
life, amongst other things. The judicial rulings, such as the ones provided in the references, like
Aruna Shanbaug v. Union of India, 20116, and Common Cause v. Union of India, 20187, that
gradually helped develop a legal framework for euthanasia, are still pointing to a more
outstanding force between an individual's autonomy and the interference from the state. The
paper is aimed at understanding how the constitutional provisions that govern equality,
personal freedoms, and the right to life shape the current legal framework for euthanasia in
India in light of the role of consent.

Article 21: Right to Life and the Right to Die with Dignity8

Article 21 of the Indian Constitution, which promises the right to life, would thus form the
central point of argument for the debate over euthanasia. The Supreme Court of India has
progressively enlarged the right to life, further extended to the right to live with dignity and, in
a derivation, the right to die with dignity. The Supreme Court of India, in the landmark
judgment of Common Cause v. Union of India9, declared that euthanasia, or to be more precise,
passive euthanasia, is a constitutional concept because an individual's right under Article 21 to
live with dignity also encompasses the right to withhold or withdraw life-prolonging treatment
in case a patient suffers from a terminal illness or has been in a persistent vegetative state.
Advance directives were legalized. This was people's capacity to give consent to the
withdrawal of life-supporting treatment if, at some future point, they are unable to make those
decisions themselves.

Interpreting principles of Article 21 include that consent be an essential element of euthanasia.

It assumes the individual is fully informed and provides voluntary consent for withdrawal or
refusal of treatment. This puts the patient in the forefront of control of their body and medical
treatment decisions. However, in those instances wherein the patient lacks the competency to
express or provide consent over other choices, such decisions are left to family members or
appointed guardians, hence a source of moral and legal dilemmas on whether such decisions
reflect the patient's wishes. Judicial oversight ensures that the consent does not result from

6
Aruna Ramchandra Shanbaug v. Union of India, (2011) 4 SCC 454
7
Common Cause v. Union of India, (2018) 5 SCC 1
8
Article 21, The Indian Constitution, 1950
9
Supra note at 3.

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coercion and that the decision is in the patient's best interest.

Article 19: Freedom of speech, expression, and personal liberty10

Article 19 extends several guarantees. Speech and expression must, therefore, extend to
freedom to decide on individual affairs regarding one's body and life. Personal liberty, along
with individual autonomy, is a fundamental and grounds-on argument for euthanasia. People
should be able to determine how their lives should end, especially in light of the severe
suffering triggered by illness or disease.

This article relates to euthanasia because it frames an understanding of the role that personal
choice and individual autonomy play, even within such an important issue. In the article, issues
on matters related to death with dignity rights include individual choices and wishes being
communicated about individuals' autonomy, such as the right to refuse medical treatment and
advanced directives. This would be an explicit application of the protections under Article 19
since patients have been established to have the autonomy to make wishes in advance and, to
the greatest extent possible, concerning life-prolonging treatment in circumstances in which
they are no longer competent to communicate.

Article 19's freedoms are not absolute, though. As such, in euthanasia, these constraints are
manifested through legal measures that ensure judicial scrutiny and medical evaluation to avoid
as much interference or influence as possible in the shaping of the will to forego treatment and
a lack of proper communication of all the ramifications. The restrictions must, therefore, draw
between individual autonomy and state interest in the preservation of life and prevention of the
abuses of euthanasia in vulnerable sectors.

Articles 1411 and 16: Equality and Protection Against Discrimination12

Articles 14 and 16 of the Indian Constitution outline the right to equality in the eyes of the law
and protection from discrimination. These provisions are the dicta that form a safeguard against
any inequitable decisions involving euthanasia and bias. Article 14 equality principle allows
no discrimination at all in socio-economic classes, religion, or sex while getting legal

10
Article 19, The Indian Constitution, 1950
11
Article 14, The Indian Constitution, 1950
12
Article 16, The Indian Constitution, 1950

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protection on euthanasia. On the other hand, it requires that those who do not want such life-
prolonging treatment be dealt with equitably and never discriminated against by the legal order.

In an Indian context, socio-economic factors can influence access to healthcare and medical
decision-making, and making euthanasia decisions can be well ensured to be on an equal
platform. More vulnerable segments may be the poor, elderly, and disabled, who may be
susceptible to coercion or abuse in end-of-life care decisions. Article 14, therefore, assures
equality and serves as legal grounds that protect such persons from discriminatory actions and
ensures that their consent towards euthanasia is indeed voluntary and informed as well. Article
16, which also has to do with equality of opportunity in public employment, has implications
for the overall delivery system within the healthcare system. While not euthanasia, ensuring
fairness in access to health care and determination at the end cannot be overlooked in the
pursuit of end-of-life care. Therefore, for instance, equality of access to medical care as regards
access to euthanasia or life-support systems relates to the obligation of the state to a choice in
euthanasia. The need to ensure everyone has adequate and reasonable care about whichever
socio-economic background they possess is considered an overall important aspect that makes
sure that these people's rights are respected and acknowledged concerning the decision of
euthanasia.

Judicial Framework

The Bombay High Court gave a landmark judgment in Aruna Ramchandra Shanbaug vs Union
of India (2011)13, though not directly deciding the case but introducing a broad legal framework
in India on passive euthanasia. Aruna Shanbaug, who was brutally assaulted by a hospital
employee and left in a PVS over more than 37 years, was taken up as the subject of a writ
petition by journalist Pinki Virani to seek permission to end her life through passive euthanasia.
The court distinguished between two vital items in this ruling. It repeats active illegal
euthanasia, which is where one person intentionally does an act-for example, administering an
injection to cause death. Active euthanasia continues to be a murder offense under the
Bharatiya Nyaya Sanhita "because life is considered sacred under BNS.". The Court recognized
further that in the case of passive euthanasia, which involves the removal or withholding of
life-prolonging medical treatment, such as ventilators or feeding tubes, from a patient who is
irreversibly ill or in an irreversible vegetative condition, such practice was not illegal. In its

13
Supra note at 2.

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opinion, it also drew specific limits on the practice of passive euthanasia, which requires careful
medical and judicial review to ward off inappropriate use. A multi-disciplinary medical board
should first of all see the patient's condition before any decision about euthanasia is taken,
which would require judicial clearance. The High Court would further appoint an independent
medical committee to verify the patient's medical condition and check if euthanasia would be
in the best interest of the patient. This code provides the most ethical and within the limits of
legal requirements form of passive euthanasia, with judicial review acting as an oversight
against arbitrary or forced decisions.

The judicial framework for euthanasia in India was vastly expanded and refined back in 2018
by the Common Cause v. Union of India14 case. This case marked a landmark shift in how legal
treatment of end-of-life decisions has been approached in the past, in upholding the
constitutional validity of passive euthanasia and introducing the concept of advance directives-
they also popularized as living wills. The decision built upon previous legal precedents and
provided a more elaborate framework for individuals to express their right over their medical
treatment, mainly when they could no longer consent.

It has quite an essential feature in this judgment: the right to die with dignity. The Supreme
Court also held that, well within the ambit of Article 2115 of the Indian Constitution that
provides for the right to life, a right to die - death with dignity - also falls within that. The Court
argued that a person should have the right to refuse life-prolonging medical interventions in
cases of terminal illness or a persistent vegetative state, especially where such treatment would
inevitably bring on unnecessary suffering. That way, such a ruling would thus ensure that the
law was applying the general ethical principle regarding respect for an individual's control over
her body, even in the latter phases of life.

Another essential matter that constituted this judgment was the introduction of advance
directives. Advance directives enable individuals to legally make choices about future medical
treatment, which may happen in case the patients are incapacitated. It ensures that a patient's
preference on the withdrawal or withholding of life support is respected even though they
cannot communicate those wishes at the moment of treatment. This legal tool allows a person
to outline conditions in which life-prolonging or other forms of medical interventions must be

14
Supra note at 3.
15
Supra note at 1.

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withheld or withdrawn if they suffer from an incurable condition or are terminally ill.

Advance directives16 involve various critical directives to ensure that such directives are validly
executed and binding. To start with, there is a need for a person to prepare and execute the
directive during a time when the person is still of sound mind. It should be clear and mention
under what circumstances life support should be withdrawn. Secondly, the directive should be
authenticated, i.e., signed by two independent witnesses and verified with authentication by a
judicial magistrate to confirm its free and spontaneous formation. Once the advance directive
becomes operational, generally, when the patient loses capacity, the hospital must verify the
document's authenticity, and the attending physicians must comply. Another medical board
should assess the patient's condition to ensure proper compliance. This framework also
includes judicial scrutiny. Suppose there is a disagreement about the validity of an advance
directive. In that case, an application can be made to the High Court requesting such
intervention, which would vindicate the patient's wishes in terms of both the law and medical
ethics.

Scrutiny provides for check-and-balance by being cautious in decisions made regarding the
end will of the patient within their intent.

Ethical Issue

It comforts people by ending their suffering and giving them control over the end of life. Those
against it argue that such a practice vials the sanctity of life, opens it to possible abuse, and the
"slippery slope" argument, denying that such a practice should be extended beyond the issues
of terminal illness. Even at the core of such debates, there is an ascription of the role of consent
such that its decision-making process ensures individual autonomy, voluntariness, and
complete understanding of the result of the end of life. More individualistic self-determination
over death choices characterizes the respectful attention for individuals' autonomy and self-
determination; thus, they acquire control over their destiny. But the slippery slope argument
warns that euthanasia, once legalized, could gradually slip into the messier application cases
and eventually extend to those who are not terminally ill17. Vital consenting processes should
mitigate the threat because one ensures that only clear, voluntary decisions qualify for

16
Supra note at 3.
17
Lillehammer, H. (2002). Voluntary Euthanasia and the Logical Slippery Slope Argument. The Cambridge Law
Journal, 61(3), 545–550. http://www.jstor.org/stable/4508931

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euthanasia. Conclusion The concerns related to vulnerability and abuse support the conception
of protection. This will expressly limit vulnerable individuals - for example, the elderly or
people with a disability - to acceptance of euthanasia. Prevention of this occurs once there is
free consent, and has to be adequately informed about their various options and the effect their
decision will have. The social impact of the legalization of euthanasia is enormous. Indeed,
there are questions regarding the value of life, the health provider's role, and its effects on the
family and community. It will be fundamental in such social debates since consent retains
personal autonomy without exposing vulnerable populations to coercion or undue influence.

Vulnerability and Coercion

Informed consent will then be highly complicated in the case of euthanasia, with the
vulnerability of terminally ill patients open to pressure from family members and medical
practitioners.

Vast socio-economic disparities that are pronounced within India would mean that many
vulnerable people could be compelled to accept euthanasia either for financial or family
considerations. Articles 14 and 21 act as a critical tool that safeguards such people against
coercion and ensures the genuineness of voluntariness of their consent.

Since the Supreme Court has called for judicial review in euthanasia cases, judicial oversight
is a preventive measure against the potential misuse of euthanasia. The judicial sanction will
also ensure that the decision to withdraw life support is being made in the patient's best interest
and not under duress and pressure from others. This is precisely why this omission is critical
in a country like India, where equal access to healthcare and legal resources is currently
incomplete, and vulnerable populations may be placed at risk for exploitation.

The doctrine of Double Effect

Passive euthanasia is also frequently legally and ethically permitted under the doctrine of
double effect, an ethical principle in and of itself. This doctrine, then, holds an action itself,
such as the act of withdrawing life support, morally permissible even though it results in both
a good and evil effect if the intended effect of the action is good, even if the unintended effect
- or the patient's death, for example - can be foreseen. The principle of double effect is invoked
under the Indian context to justify passive euthanasia, wherein it is the intent not to cause death

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but to allow a terminal illness to take its course without unwarranted medical intervention.
Even though the principle of double effect offers a moral basis for passive euthanasia, it also
emphasizes an underlying element of consent. Consent by the patient or their legal proxy is
necessary so that the withdrawal of life-support measures does not run against the patient's
wishes but due to an ulterior motive for hastening death.

Need for Clearer Terms in Euthanasia Discussion

This passage brings out the significance of setting a clear definition of euthanasia and how pro-
choice and pro-life groups use a comprehensive definition of euthanasia to include such
practices as refusing treatment, advance directives, and pain relief and yet declare all these
unacceptable.

Indeed, pro-choice advocates insist that all these practices are acceptable, while pro-life
advocates argue that all are unacceptable; this paradoxical partnership confuses the application
of the term. The author argues that the broad definition is of little help and requires that there
should be a clear differentiation between acceptable practices, which include refusal of
treatment or administration of pain relief that will inadvertently shorten life, and unacceptable
practices like assisted suicide and euthanasia-the intentional killing of another by a person. The
passage emphasizes that these issues must be separated in legislation and public discussion.
The broad definition of euthanasia puts it at risk of actually helping the pro-euthanasia cause
by misleading voters into voting for assisted suicide within a broader context. Moreover, it
continues to remind its readers that the right to refuse treatment and the right to receive pain
relief are already established rights and should not be confused with the euthanasia debate. As
its example is Nancy Cruzan, it concretely demonstrates how confusion comes out through the
use of such broad definitions and only briefly mentions the difference between suicide and
assisted suicide. Anyway, there still is a need to define and distinguish end-of-life practices for
presentation in a different light to help people make proper decisions and avoid mistimed
consequences18.

Conclusion and Recommendations

Summary of Findings

18
Margaret A. Somerville.; Death Talk : The Case Against Euthanasia and Physician- assisted suicide, McGill-
Queen's University Press.

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The doctrine of consent concerning euthanasia, specifically passive euthanasia, is highly

complex and in a state of constant change in the Indian context. So, the Supreme Court's two
flag decisions in Aruna Shanbaug v. Union of India (2011)19 and Common Cause v. Union of
India (2018)20 set legal standards by permitting passive euthanasia with specific criteria,
formally recognizing the right to die with dignity as part and parcel of Article 21 forming the
right to life. This includes the element of consent arising through advance directives or living
wills. The finality is ensured to be within the person's control and all as they would desire at
the end of life. Seriously problematic, though, in the obtaining of valid consent are matters
concerning mental competence, pressure from family members, and whether they were made
with all information. As far as a comparative review of euthanasia laws of the Netherlands and
Belgium is concerned, it reflects that building more robust safeguards against its misuse for
any weak person and strengthening the mechanisms of consent can be beneficial to India21.

Suggested Legal Reforms:

To make sure the performance of euthanasia in India can be carried out in an ethically
transparent and fair manner, several legal reforms are called for:

1. Review and Strengthen Procedures Involving Informed Consent Among patients who
seek passive euthanasia, there ought to be more substantial procedures involving the granting
of consent where necessary. In particular, and as mentioned above, this includes assessing
whether the patient needs a psychological evaluation before performing euthanasia.

2. Improved Safeguards Against Coercion: Accepting the Indian family's nature and socio-
economic scenario, legal safeguards against possible coercion by family members should be
worked out for patients. Sufficiently independent medical and legal review can also be
envisaged when family influence plays a role.

3. Better Provisions Concerning the Protection of Minors and Incapacitated Persons: The
current Indian law does not provide a detailed procedure regarding the process of decisions to
be made in cases of euthanasia for minors or incapacitated people who, due to mental

19
Supra note at 4.
20
Supra note at 5.
21
Smets, T., Bilsen, J., Cohen, J., Rurup, M. L., & Deliens, L. (2010). Legal Euthanasia in Belgium:
Characteristics of All Reported Euthanasia Cases. Medical Care, 48(2), 187–192.
http://www.jstor.org/stable/27798426

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incapacity, could not give consent. Such legal recognition of advance directives should be
extended with more precise guidelines regarding when and how such documents can come into
force.

4. Expansion of the Notion of Suffering: India can consider expanding the legal meaning of
suffering in the same manner Belgium has by including unbearable psychological conditions
if appropriate medical and legal scrutiny is included. It would also reflect a more
comprehensive understanding of the various types of suffering patients may suffer during their
terminal stages.

5. More Public and Professional Education: Similarly, legal education needs to make
healthcare providers and the public at large aware of their rights to euthanasia and advance
directives, with such decisions being made in an educated and uninfluenced form of consent
when it comes to medical treatment towards the end of life.

As a problem for the future of euthanasia and consent in India, the judicial sector, as well as
the policymaking area, has to look at this22.

The future of euthanasia and consent in India depends on how the country balances individual
autonomy with ethical safeguards protecting the vulnerable. As the legal landscape evolves,
India may see more extensive advance directives, more nuanced definitions of suffering, and
perhaps a timid incorporation of active euthanasia at some point. Every decision regarding
euthanasia must be made with the blessings of informed, voluntary, and well-considered
consent. The judicial and legislative systems need to be watchful enough towards it. Certain
international practices make for very pertinent lessons that can strengthen India's legal
framework in this regard23. It is a grand opportunity wherein the country can develop a humane,
ethical, and legally robust approach toward euthanasia, respecting not only individual human
dignity but also societal values.

22
Neil M. Gorsuch (2006) The Future of Assisted Suicide and Euthanasia. Princeton, N.J.: Princeton University
Press (New Forum Books). Available at:
https://search.ebscohost.com/login.aspx?direct=true&db=e000xww&AN=305767&site=ehost-live.
23
Jocelyn Downie (2004) Dying Justice : A Case for Decriminalizing Euthanasia and Assisted Suicide in Canada.
Toronto: University of Toronto Press. Available at:
https://search.ebscohost.com/login.aspx?direct=true&db=e000xww&AN=468082&site=ehost-live (Accessed:
10 October 2024).

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