Introduction

A 3-year-old girl from the Jain community, battling terminal brain tumour, died through the practice of Santhara (fasting unto death).  Concern has been raised weather the child was able enough to make informed decision. 

Additionally, France approved a Bill that allows adults suffering from unbearable and incurable illnesses to choose assisted dying (medical personnel assists a person to die). The above incidents highlight the principles of Right to Die with Dignity. 

About the Right to Die with Dignity 

• Meaning: It refers to the idea that terminally ill individuals should have the right to make their own end-of-life decisions, like determining the pain and suffering they should endure. 
  • Euthanasia (means "good death") is an essential means to realise this right for a terminally ill person. It is of two types
    • Active: Killing a patient by active means like administrating lethal drug. It is illegal in India. 
    • Passive: Intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube.
• Status in India: 
  • In 2011, the Supreme Court in Aruna Shanbaug Case vs. Union of India allowed passive euthanasia for the first time.
  • In Common Cause vs. Union of India & Anr. (2018) case, the Supreme court ruled that the right to life under Article 21 of the Constitution encompasses the 'Right to die with dignity' and upheld legality of passive euthanasia and laid down procedure for living wills in India.

Key Stakeholders and Associated Ethical Issues

Ethical Dilemma involved in Right to Die with Dignity

• Quality of Life vs Sanctity of Life: Is survival meaningful when pain or loss of dignity overwhelms life?
• Constitutional Morality vs Respect for Autonomy: Should personal choice override legal and moral constraints?
• Palliative Care vs Justice: Should we rely only on care, or allow dignified death where care fails?
• Non-maleficence vs Principle of Double Effect: Should doctors provide relief from pain even if it shortens life?

Arguments in Favor of Right to Die with Dignity

• Quality of Life: Quality of life transcends simple survival, encompassing psychological well-being, cognitive function, and the capacity for meaningful relationships
  • Life with unbearable pain or loss of function may not be worth continuing.
• Respect for Autonomy: Autonomy represents the cornerstone of human moral agency. Competent individuals should have the right to choose death.
  • Bhishma Pitamah (Bhagwat Gita) opted for Iksha Mrityu and Socrates chose death over exile.
• Principle of Double Effect: It is acceptable for a doctor to prescribe drugs with the intention to relieve pain, despite knowing that the drugs will shorten the patient's life. 
  • Justice: When curative medicine fails and palliative care cannot adequately control suffering, continuing treatment may cause more harm than good. 
• Justice demands equal access to compassionate end-of-life options. Prolonged period of emotional and financial strain are damaging for the person and family. 

Arguments Against Right to Die with Dignity

• Sanctity of Life: It considers human life as an intrinsic good, of irreducible value making it always impermissible to kill an innocent human.
  • E.g., Buddhism preaches the sacredness of life through the concept of Ahimsa (Non-violence) and no harm. 
• Constitutional Morality: Religious practices even if they constitute an essential part should not infringe the principle of Right to Life. 
  • E.g., Freedom of religion under Article 25(1) is made subject to public order, morality and health.
• Palliative Care: Good care can manage suffering without euthanasia. Also, medical science is evolving everyday. What is incurable today may be curable tomorrow.
• Non-maleficence: The principle of non-maleficence (do no harm), underlines the importance of not causing harm to the patient. 
  • The principle is also in consonance with the Hippocratic Oath of medical professionals, that aims at not doing harm. 
• Contradicts Kantian Philosophy: As per Kant, preserving life is the universal duty. Life has intrinsic value; ending it undermines moral duty.
• Potential for Misuse: In case of minor (young and sensitive individual) and terminally ill patients (lacking rational mind), autonomy principle could be abused. 
  • Further, physicians might pressure the patients to opt for death to cover up their medical mistakes. 

Way Forward on Ensuring the Right to Die with Dignity

• Establishing Interpretative Dialogues: Regular communication facilitates understanding the patient's opinion towards their life, health, and sickness. 
• Effective Regulation: Practice of Euthanasia should be effectively regulated to ensure it is performed only under hospital settings with the certification of at least 2 physicians. 
  • It must be actively documented to justify its execution after analysing all other medically available alternatives. 
• Prevent Misuse: Before executing euthanasia, there should be a thorough psychological evaluation, counselling, wait period, to ensure that the patient is not improperly influenced. 
• Care Ethics Approach: Apply a care-based approach, especially for minors and mentally vulnerable patients. Focus on understanding lived experiences and responding to emotional needs with empathy.

Conclusion

Medical advances may extend life, but they cannot always relieve suffering. When pain becomes unbearable, the right to die with dignity deserves thoughtful consideration—supported by strong ethical guidelines and strict regulations to prevent misuse.

As physicist Stephen Hawking rightly said:

"I believe those who suffer from a terminal illness and experience great pain should have the right to choose to end their own life, and those who assist them should be free from prosecution."

This reflects a compassionate, humane approach to one of the most profound moral questions of our time.