Should Euthanasia Be Legalised?

Euthanasia, commonly known as mercy killing, is the act of ending someone’s life to relieve suffering, often for terminally ill patients who are enduring unbearable pain. It raises debates worldwide on the right to die with dignity versus the sanctity of life. Euthanasia is generally divided into two main categories: Active Euthanasia, which involves actively taking steps to end someone’s life, such as administering a lethal dose of medication, and Passive Euthanasia, which allows someone to die by withdrawing life-sustaining treatments like ventilators or feeding tubes. It can further be classified as voluntary, where the patient gives explicit consent; non-voluntary, when the patient is unable to give consent (e.g., unconscious); and involuntary, where euthanasia is carried out against the patient's wishes. 

Several countries have made significant strides in legalising euthanasia, such as the Netherlands, the first country to legalise euthanasia in 2002 under the Termination of Life on Request and Assisted Suicide (Review Procedures) Act. In this framework, euthanasia is legal if the patient is suffering unbearably without hope of improvement, makes a voluntary and well-considered request, consults a second physician, and follows medical standards. Belgium also legalised euthanasia in 2002, allowing both adults and, under strict conditions, minors to request euthanasia if they suffer from unbearable pain or terminal illness. 

Irremediable condition

Canada introduced Medical Assistance in Dying (MAID) legislation in 2016, permitting euthanasia for patients who have a grievous and irremediable condition that causes intolerable suffering. The legal framework for euthanasia and the right to die has roots in the broader conversation of human rights. The right to life is a core principle under various international human rights frameworks, including the Universal Declaration of Human Rights (UDHR) and the International Covenant on Civil and Political Rights (ICCPR). While these documents emphasise the sanctity of life, some argue that the right to life also includes the right to die with dignity when living becomes unbearably painful, though neither document explicitly mentions euthanasia, leaving room for interpretation by national laws. 

In Nepal, euthanasia is not legal. The National Penal Code, 2074 explicitly prohibits euthanasia in any form, classifying intentionally causing someone’s death, including assisted suicide, as murder under Section 184. Passive euthanasia, as well, has no legal standing in Nepal, despite Article 16 of the Constitution of Nepal 2072 guaranteeing the right to life with dignity. However, the Article does not clarify whether this includes the right to die with dignity. Nepal has yet to engage in a national debate on whether euthanasia should be legalised, and challenges arise from its religious, cultural, and social structures, which view life as sacred and inviolable. 

A close model for Nepal to consider is India, where euthanasia was illegal until the landmark Aruna Shanbaug case in 2011. Aruna Shanbaug, a nurse in Mumbai, was in a vegetative state for over 40 years after being assaulted, and the Supreme Court of India ruled that passive euthanasia could be allowed under certain conditions with court approval. Furthermore, in 2018, the Supreme Court of India allowed living wills or advance directives, permitting people to express their wishes not to be kept alive through artificial means if they become terminally ill or enter a vegetative state. Nepal could potentially follow this legal path, permitting passive euthanasia under strict judicial oversight to ensure that the process is not misused and that the patient's wishes are respected. 

Euthanasia would also need to be examined through the lens of Hinduism and Buddhism, which regard life as sacred but also recognises the impermanence of the body, viewing death as a transition rather than an end. The practice of Prayopavesa voluntary fasting to death is mentioned in Hindu texts as an accepted practice for those nearing the end of life, suffering from incurable diseases, and who have lost all desire to live. Unlike suicide, Prayopavesa is a peaceful and non-violent way of embracing death, typically practiced by saints and monks. However, most interpretations of Hinduism emphasise the principle of Ahimsa, or non-violence, which extends to euthanasia. The Manusmriti condemns suicide and any form of unnatural death, as it is believed to interfere with the soul’s journey to the afterlife. 

Yet, some scholars argue that passive euthanasia, allowing nature to take its course, could align with Hindu principles, particularly when the suffering of the individual is immense. International court verdicts provide insight into the complexities of euthanasia legislation. In the case of Pretty v. United Kingdom (2002), Diane Pretty, a woman suffering from a terminal illness, sought the right to euthanasia, claiming that Article 2 (right to life) of the European Convention on Human Rights included the right to die with dignity. 

The European Court of Human Rights ruled that the right to life did not imply the right to die, rejecting her appeal. This case highlights the challenge of balancing individual autonomy with societal norms. Similarly, in Washington v. Glucksberg (1997), the United States Supreme Court upheld Washington State’s ban on physician-assisted suicide, ruling that while individuals have rights to autonomy, the state has a legitimate interest in preserving life. However, states like Oregon have since legalised euthanasia under the Death with Dignity Act.

Challenges

Nepal would face several challenges in legalising euthanasia, including its deeply rooted religious and cultural beliefs. Moreover, Nepal's healthcare system lacks adequate palliative care services, which could ease the suffering of terminally ill patients, raising concerns among euthanasia advocates who argue that euthanasia might be necessary in extreme cases until proper end-of-life care is available. 

Legal safeguards would also need to be robust, as without proper oversight, there could be risks of abuse, with vulnerable populations like the elderly or disabled, potentially facing pressure to opt for euthanasia for the benefit of others. Therefore, strict guidelines like those in India or the Netherlands would be crucial. Nepal might first consider the legalisation of passive euthanasia under stringent regulations, akin to India's approach. There is a need for establishing a clear ethical and legal framework, ensuring oversight by both medical professionals and the judiciary. This would prevent misuse and ensure that terminally ill patients can die with dignity when recovery is no longer possible. By adopting a careful and culturally sensitive approach, Nepal could begin to address the delicate balance between the right to life and the right to die with dignity.

(Yadav is pursuing B.A.LL.B at Kathmandu School of Law.)