Switzerland's New Euthanasia Device & Where India's Law Stands

Switzerland has approved the use of a sarcophagus, or 'Sacro', a 3D printed device to aid in painless death meant to be used for assisted euthanasia.

'Sacro' works by replacing the oxygen inside the coffin-like pod with nitrogen and inducing hypoxia, leading to a quick, painless and quick end.

But, the futuristic capsule that looks like something straight out of a black mirror episode has found itself in the epicentre of controversy and sparked a recurring debate around the world—that of the morality of assisted suicide and euthanasia.

Questions have been raised about whether the capsule causes death a bit too quickly (less than a minute is what the makers promise), and how it may perhaps 'industrialise suicide'.

Euthanasia: Active, Passive and the Moral Question

Euthanasia refers to the painless killing of a patient who is suffering from a terminal illness or is in an irreversible vegetative state.

The act itself may be classified as voluntary, or involuntary, and active or passive.

Writing for FIT, Dr Ashwini Setya explains the difference between active and passive euthanasia saying, "In active euthanasia, a poisonous / toxic substance is administered to bring death which may even be an overdose of a prescribed drug." Active euthanasia is usually administered by someone else, and is illegal in most jurisdictions.

On the other hand, passive euthanasia is often seen as being the more favourable and ethically sound option. "It is caused by withdrawing the life support system or omission of medical care. It is refraining from the action that would delay death, thereby allowing natural death to occur. So the death is caused by disease and not external factors," Dr Setya explained.

Passive euthanasia may involve,

• Taking a person off life support machines

• Withholding life extending drugs, surgery

• Removing feeding tubes

The question of legalising euthanasia and PAS (Physically Assisted Suicide) has been embroiled in heated debate and polarised views because of the permanency of the act, its sensitive nature, and the moral and ethical dilemma associated with it.

The 'Swiss Model'

While Euthanasia is illegal in many countries, some countries like Switzerland also extends the right to assisted suicides to people who are not necessarily terminally ill.

Assisted suicide has been legal in Switzerland for a while now. Legally, a doctor can prescribe lethal injections to a patient on request (but the act must be performed by the patient themselves).

For the right to be granted, the person must be making the choice themselves, in a sound state of mind, is not influenced by anyone else, performs the act themselves, and there is no vested interest for anyone else.

"We want to remove any kind of psychiatric review (from a doctor) from the process and allow the individual to control the method themselves.”

Philip Nitschke, the inventor of the sacro capsule as quoted by Swiss info

"Our aim is to develop an artificial intelligence screening system to establish the person’s mental capacity," he adds.

The Law in India

In India, passive euthanasia was made legal in 2011, for exceptional cases. These typically extend to people who are terminally ill and or in an irreversibly vegetative state. Active euthanasia and assisted suicide are both illegal.

Each case is rigorously evaluated as a stand-alone case when it comes to granting a person allowance to undergo euthanasia.

According to the 2011 ruling, doctors had to approach the courts and file petitions for withdrawing life support of certain patients.

But in March 2018, the Supreme Court further bolstered the legal provision by declaring the right to die with dignity, a fundamental right, and providing more allowance to individuals to make this choice.

The Supreme Court passed a law allowing people to draw up a 'living will' during their lifetimes seeking euthanasia (passive) in case they go on to develop a terminal illness or end up in an irreversible vegetative state.

This living will may be submitted to the court and is activated if and when such a time comes.

What is the Living Will?

A living will is a pre-emptive document written by a person when they are of 'sound mind' seeking passive euthanasia if and when they reach a vegetative state due to terminal illness.

Some important criteria that a person needs to meet to be able to write a living will are,

• They must be an adult.

• The must be of a 'sound and healthy state of mind'.

• The must be able to communicate, relate and comprehend the purpose and consequences of executing the document.

• It must be a voluntary choice, and an informed decision without any coercion or inducement or compulsion.

• The document should have specific instructions and clearly state put down the decision to withhold or withdraw life prolonging treatment, and at what stage.

Passive euthanasia and the living will law in India, however, are not without their issues.

Many advocates of legalising active euthanasia in India argue that passive euthanasia doesn't promise the dignified death that the Supreme Court in 2018 observed, was a fundamental right.

In some cases, simply withdrawing treatment may lead to the patient experiencing great pain and discomfort for days before they die.

Secondly, there is no clarity on how the courts are going to determine if the documents were indeed written up by the person themselves without any coercion.

The course that the law in India takes regarding euthanasia is still unfolding, but in the meantime, real world evidence of successful implementation of devices like sacro in other parts of the world may encourage lawmakers within India to consider allowing greater autonomy and provide more options for those wanting to opt for euthanasia.