The Distinction between Active and Passive Euthanasia

The media debate on the Supreme Court's verdict in the Aruna Shanbaug case has proceeded along predictable lines — the same as in the rest of the world. These are decadeold questions —the right of terminally ill patients and their families to seek a dignified end to the suffering; the distinction between active and passive euthanasia.

Most countries have debated these issues, rejected the idea of active euthanasia and very few have legalized it. The Supreme Court has also played safe by suggesting that 'passive' euthanasia can be looked at on a case-bycase basis.

There is, however, a critical linkage which most discussions fail to make, ie, the economic and social dimension. Any debate on euthanasia, which does not take into account the heavily privatized structure of Indian healthcare, is in a sense, incomplete and perhaps, elitist.

Let me begin by saying that many Indian doctors in India have been practicing a form of passive euthanasia for many years, although few are likely to admit it. This may not have 'legal' sanction , but it is a practical approach when it involves a terminally ill patient. In some cases, this is based purely on an assessment of the futility of treatment. But often, there is a critical additional factor, which influences the decision of the team treating the patient. This is the cost of treatment.

Put differently, one of the reasons for 'passive' euthanasia is that the patient or his family could be running out of money. In some cases, this overlaps with the incurability of the disease. In others , it may not. Costly medication and intervention is often withdrawn as the first step of this passive euthanasia process. Sometimes patients are 'transferred' to smaller (read cheaper) institutions or even their homes, with the tacit understanding that this will hasten the inevitable. If a third party is funding the patient's treatment , chances are that the intervention and support will continue. Shocking and arbitrary as this may