Right to Die with Dignity: Common Cause v. Union of India (2018)

Guna Sai Venkat Jagatha is a fourth-year B.A LL.B student at Guru Gobind Singh Indraprastha University, Delhi. Read More

Introduction

The right to die with dignity has long been a contentious issue, blending legal, ethical, and philosophical concerns. The landmark 2018 judgment in Common Cause v. Union of India reshaped the Indian legal landscape by recognizing the legality of passive euthanasia and living wills, thus affirming an individual’s right to die with dignity. The Supreme Court’s decision extended the interpretation of Article 21 of the Indian Constitution, which guarantees the right to life, to include the right to a dignified death.

Prior to this judgment, the legal stance in India on euthanasia was restrictive, as reflected in earlier case laws like Gian Kaur v. State of Punjab (1996), where the Court held that the right to life did not encompass the right to die. However, the debate persisted, with advancements in medical technology raising ethical questions about prolonging life through artificial means. The Common Cause petition sought to address these dilemmas by advocating for the right to passive euthanasia and the legal recognition of living wills, allowing individuals to refuse life-sustaining treatment.

This article delves into the case, the arguments presented, the judicial reasoning behind the verdict, and the significance of this judgment in upholding human dignity in end-of-life decisions.

Legal Background

The legal discourse around euthanasia and the right to die with dignity has evolved over time in India, culminating in the 2018 Common Cause v. Union of India judgment. Before this landmark decision, the Indian legal system had a stringent approach to euthanasia and suicide-related matters, primarily based on Sections of the Indian Penal Code (IPC) and prior Supreme Court rulings.

Section 309 of the Indian Penal Code, which criminalizes attempted suicide, reflected the legal system’s stance on matters related to ending one’s life. While active euthanasia (intentionally ending a person’s life, such as through lethal injection) remained illegal, there was ambiguity about passive euthanasia (allowing death by withdrawing life support).

The first significant legal ruling came in Gian Kaur v. State of Punjab (1996), where the Supreme Court addressed the right to die. The Court held that the right to life under Article 21 of the Indian Constitution does not include the right to die, affirming that any act of euthanasia or assisted suicide would remain illegal. However, the Court also acknowledged that a dignified life was part of Article 21, hinting at future developments in cases related to end-of-life decisions.

Further discourse occurred in Aruna Shanbaug v. Union of India (2011), a case that brought the issue of euthanasia back into the spotlight. Here, the Supreme Court permitted passive euthanasia under strict conditions, like obtaining approval from a medical board and the patient’s close relatives. This ruling, while progressive, did not address living wills and was seen as a case-specific ruling rather than setting a broad legal precedent.

The Common Cause petition followed the trajectory set by Aruna Shanbaug, arguing for the legal recognition of living wills and passive euthanasia, and seeking a comprehensive legal framework for patients facing terminal illness. This set the stage for the 2018 judgment, where the Court formally recognized passive euthanasia as a constitutional right.

The Case: Common Cause v. Union of India (2018)

Common Cause v. Union of India (2018) is a landmark case that expanded the constitutional interpretation of the right to life under Article 21 to include the right to die with dignity. The case was brought by Common Cause, a non-governmental organization (NGO), which filed a Public Interest Litigation (PIL) in 2005, seeking clarity on the legality of passive euthanasia and the recognition of living wills in India. The petition addressed critical gaps in the legal framework for end-of-life care, especially concerning patients suffering from terminal illnesses or in a permanent vegetative state.

 Background of the Case

The petitioners argued that individuals suffering from terminal illnesses should have the right to refuse life-sustaining treatment, which prolongs their suffering and undermines their dignity. The petition emphasized the right to make informed decisions about one’s own body, especially during the final stages of life. The Common Cause petition primarily called for two legal recognitions:

1. Passive Euthanasia: The withdrawal or withholding of life-sustaining treatment in cases where the patient has no reasonable hope of recovery.
2. Living Wills or Advance Directives: Legal recognition of documents through which individuals can specify their wishes regarding medical treatment in the event that they become incapacitated and unable to communicate their preferences.

The petitioners argued that the denial of such rights infringed upon the constitutional guarantee of the right to life with dignity under Article 21. Furthermore, the petition highlighted that several countries, including the Netherlands, Belgium, and certain states in the USA, had legalized some form of euthanasia or advance directives, and India should move in the same direction.

 Legal Issues Raised

1. Right to Die with Dignity: Does the right to life under Article 21 of the Indian Constitution include the right to die with dignity? The petitioners argued that prolonging life artificially, in cases where there is no hope for recovery, compromises human dignity and autonomy.
2. Legality of Passive Euthanasia: The petition sought clarification on the legality of passive euthanasia, which had been addressed partially in the Aruna Shanbaug case, but not codified into a comprehensive legal framework.
3. Recognition of Living Wills: Should the legal system recognize living wills, enabling individuals to express their medical treatment preferences in advance? The petitioners contended that the absence of this provision violated patients’ autonomy and self-determination.

 Arguments of the Petitioner (Common Cause)

The petitioner’s counsel argued that the right to life under Article 21 encompasses not just the right to live but also the right to live with dignity. The petitioners maintained that forcing terminally ill patients to endure unnecessary pain through life-prolonging measures violated the essence of this right. They stressed that recognizing living wills and passive euthanasia would allow patients to have control over their bodies and medical treatment decisions, in line with their personal values and dignity.

Furthermore, they emphasized that advancements in medical technology had prolonged the process of dying, which had led to ethical dilemmas in end-of-life care. The petitioners argued that individuals should have the autonomy to refuse medical intervention in hopeless cases and that the state should protect this right as part of personal liberty.

 Arguments of the Respondent (Union of India)

The Union of India, representing the government, opposed the petition initially, raising concerns about the potential misuse of euthanasia and living wills. The government contended that legalizing these provisions could open the door to abuse, particularly in cases where patients are vulnerable or unaware of the full implications of their decisions. They also argued that allowing euthanasia could create a slippery slope, leading to non-voluntary or involuntary euthanasia in some cases.

The Union of India emphasized that strong safeguards would be needed to ensure that euthanasia, if legalized, is not misused by relatives, medical practitioners, or the state. The government sought to balance the petitioners’ plea with broader societal concerns, particularly in a country like India, where medical care and oversight are often inconsistent.

The Role of the Supreme Court

Given the complexity and ethical sensitivity of the issue, the Supreme Court formed a five-judge Constitution Bench to address the matter. The Bench was tasked with examining whether the right to die with dignity could be considered part of the right to life and whether India should recognize passive euthanasia and living wills within a legal framework.

The Court held extensive hearings, considering legal precedents, ethical concerns, and international practices on euthanasia. Medical, legal, and ethical experts were also consulted to provide a holistic view of the implications of the case.

The Court’s ruling in 2018 marked a significant shift in India’s legal stance on euthanasia, recognizing passive euthanasia and living wills as part of the right to die with dignity, with strict safeguards to prevent misuse.

Arguments Presented

In Common Cause v. Union of India (2018), both the petitioners (Common Cause) and the respondents (Union of India) presented arguments that revolved around complex ethical, legal, and medical issues concerning passive euthanasia and living wills.

 Petitioner’s Arguments (Common Cause)

The primary argument of the petitioners was that the right to life under Article 21 of the Indian Constitution includes the right to live with dignity, and this dignity should extend to a dignified death. They contended that forcing terminally ill patients to continue life through artificial support violates their dignity, especially when no hope for recovery exists.

The petitioners argued for the legalization of passive euthanasia, where life-sustaining treatments can be withdrawn to allow the natural death of a patient in a permanent vegetative state or with a terminal illness. They also advocated for living wills, which would allow individuals to express their wishes regarding future medical treatment in case they become incapacitated. By recognizing living wills, individuals would have the autonomy to refuse medical interventions that would merely prolong suffering.

The petitioners cited international precedents from countries like the Netherlands, Belgium, and the USA, where euthanasia and advance directives have been legalized with appropriate safeguards. They emphasized that recognizing passive euthanasia and living wills would align with modern medical ethics and the values of personal autonomy and human dignity.

 Respondent’s Arguments (Union of India)

The Union of India, representing the government, raised concerns about the potential misuse of euthanasia and living wills. They argued that India lacked the robust healthcare infrastructure and oversight mechanisms necessary to regulate passive euthanasia and advance directives without abuse.

The government also contended that legalizing euthanasia could lead to a slippery slope, where vulnerable individuals, such as the elderly or mentally incapacitated, might be coerced into decisions against their will. The government argued that while individual autonomy is important, it must be balanced against the broader societal interests of protecting life.

The state’s focus was on ensuring that stringent safeguards would be in place if passive euthanasia were legalized, to prevent any exploitation or misuse in a country where healthcare systems are often overstretched.

 Judicial Considerations

Both sets of arguments made the Supreme Court address the legal and ethical dilemmas surrounding end-of-life decisions. The Court had to balance the autonomy of individuals to make decisions about their bodies and lives, with the concerns raised about misuse and potential harm to vulnerable populations. The eventual judgment recognized the petitioners’ arguments, but incorporated strong safeguards, addressing the concerns of the respondents.

The Judgment and Its Significance

In its landmark ruling on Common Cause v. Union of India (2018), the Supreme Court of India delivered a comprehensive judgment that recognized the right to die with dignity as part of the constitutional right to life under Article 21. The five-judge Constitution Bench unanimously upheld the legality of passive euthanasia and validated the concept of living wills or advance directives, marking a pivotal moment in Indian legal history.

 Key Aspects of the Judgment

1. Right to Die with Dignity: The Court held that the right to life includes the right to die with dignity. It emphasized that individuals should not be forced to live in a vegetative state or endure unnecessary suffering due to artificial life support when recovery is impossible. This broadened the scope of Article 21 to ensure that life is not just about living but about living with dignity, even at the end of life.
2. Legality of Passive Euthanasia: The Court recognized the legality of passive euthanasia, permitting the withdrawal or withholding of life-sustaining treatment in cases where a person is terminally ill or in a permanent vegetative state. This decision built on the precedent set in the Aruna Shanbaug case (2011), but expanded it with clearer guidelines and a formal legal framework for allowing passive euthanasia.
3. Living Wills/Advance Directives: For the first time, the Supreme Court recognized the legality of living wills, allowing individuals to document their wishes regarding future medical treatment. The judgment laid down specific guidelines for executing living wills, including requirements that they be written by a competent adult and witnessed by a notary. In addition, the Court established a multi-layered approval process for implementing a living will, involving medical boards and judicial oversight to prevent misuse.
4. Safeguards: To address concerns raised by the government and respondents regarding potential misuse, the Court introduced strict safeguards. These include:

•  The requirement for medical boards to evaluate the patient’s condition and approve the decision to withdraw life support.
•  Involvement of close family members or next of kin to ensure that the decision aligns with the patient’s wishes.
•  Judicial oversight, where a magistrate must ensure that all legal formalities are adhered to before passive euthanasia is carried out.

 Significance of the Judgment

1. Protection of Individual Autonomy: The judgment affirms the autonomy of individuals to make decisions about their own bodies, particularly in the context of end-of-life care. It empowers patients to take control of their medical treatment and make informed decisions about their death, thus preserving human dignity.
2. Advancement of Medical Ethics: By legalizing passive euthanasia, the Court has aligned India’s legal framework with modern medical ethics, which increasingly emphasize patient autonomy and dignity over prolonging life through artificial means.
3. Legal Clarity: The judgment provides much-needed clarity on the legality of passive euthanasia and living wills, filling a gap in India’s legal framework. The strict safeguards ensure that the right to die with dignity is not abused and that vulnerable individuals are protected.
4. Broader Societal Impact: This ruling has the potential to change how Indian society perceives death and dying. It encourages conversations about terminal illness, palliative care, and end-of-life decisions, providing a legal basis for humane treatment of patients in their final stages of life.

In sum, the judgment in Common Cause v. Union of India is a monumental step in recognizing the dignity of life and death, balancing individual rights with societal concerns while ensuring a compassionate legal framework for those facing terminal illnesses.

Critical Analysis and Public Reception

The Supreme Court’s judgment in Common Cause v. Union of India was largely celebrated for its progressive stance on the right to die with dignity. However, it also sparked significant debate, with both praise and criticism from various quarters.

 Positive Reception

The judgment was hailed as a milestone in protecting individual autonomy and human dignity. Advocates of human rights and patient rights lauded the decision for empowering individuals to make end-of-life decisions through passive euthanasia and living wills. Medical professionals, especially those in palliative care, saw the ruling as a necessary development that acknowledges the limitations of life-sustaining treatments in cases of irreversible illness. The decision aligned India with other progressive nations that have legalized passive euthanasia, marking a significant step forward in India’s legal and medical framework.

Human rights groups argued that this decision allows individuals to have control over their own bodies, even in death, ensuring that they are not forced to endure prolonged suffering. The legal recognition of living wills was seen as a victory for personal liberty, enabling individuals to make decisions about their future medical care while they are still competent.

 Concerns and Criticism

Despite the positive reception, there were concerns about the potential for misuse. Critics argued that the safeguards, though robust, might not be foolproof in a country with an overstretched healthcare system and varying levels of medical oversight. Some feared that vulnerable populations, particularly the elderly or disabled, could be coerced into signing living wills or passive euthanasia could be used unethically to ease financial burdens on families.

Religious groups and conservative voices opposed the ruling, citing concerns about the sanctity of life. They argued that life, irrespective of its quality, should be preserved, and that legalizing passive euthanasia could erode respect for life in broader societal contexts. Some ethicists also raised the “slippery slope” argument, worrying that allowing passive euthanasia could open the door to more lenient attitudes towards active euthanasia or non-voluntary euthanasia.

 Broader Impact

In Indian society, the judgment sparked discussions about death, dying, and the ethics of prolonging life through medical interventions. It also encouraged individuals and families to think about end-of-life decisions more openly. Over time, this judgment could lead to a shift in societal attitudes toward palliative care and the dignity of terminally ill patients.

In sum, while Common Cause v. Union of India was widely regarded as a progressive decision, it also raised important ethical questions about life, death, and the potential for abuse. The judgment continues to shape discourse on the right to die with dignity in India.

Conclusion

The Supreme Court’s judgment in Common Cause v. Union of India (2018) marked a transformative moment in Indian jurisprudence, recognizing the right to die with dignity as an extension of the right to life under Article 21 of the Indian Constitution. By legalizing passive euthanasia and validating the concept of living wills, the Court empowered individuals facing terminal illnesses or irreversible conditions to make critical end-of-life decisions, thus protecting their dignity in death.

The ruling balanced the autonomy of individuals with the need for robust safeguards to prevent misuse, introducing a framework that involves medical boards, family consent, and judicial oversight. This decision aligned India with global practices while considering the unique socio-legal context of the country.

Despite the positive reception, the judgment raised ethical concerns, particularly about the potential exploitation of vulnerable individuals and the erosion of the sanctity of life. These concerns highlight the importance of continually refining the legal framework to protect patients while respecting their autonomy.

In conclusion, Common Cause v. Union of India is a monumental step forward in ensuring humane and dignified treatment for terminally ill patients in India. It reflects a compassionate legal approach to end-of-life care while maintaining a delicate balance between individual rights and societal concerns.

References

1. Common Cause v. Union of India (2018)
2. Gian Kaur v. State of Punjab (1996)
3. Aruna Shanbaug v. Union of India (2011)
4. Indian Constitution – Article 21
5. “Constitution of India” by P.M. Bakshi
6. Bar & Bench – Explained: The Supreme Court’s landmark judgment on passive euthanasia