Editorial 1: The long and complex road to assisted dying
Context
The intricacies involved — as the debate in the United Kingdom shows — should not detract from the fact that this is also an issue linked to dignity and the alleviation of suffering.
Introduction
On November 29, 2024, while introducing the Terminally Ill Adults (End of Life) Bill 2024-25 (The Assisted Dying Law) to the British House of Commons, the Member of Parliament, Kim Leadbeater told a rather distressing story of an “agonising death”.
Case Overview: A 47-Year-Old Music Teacher's Suffering
A 47-year-old music teacher with a young son, Ms. Leadbeater said, had suffered from bile duct cancer which obstructed his bowel. On his last day, this saw him vomit faecal matter for five consecutive hours, before he choked and died. The vomiting was so violent that he could not be sedated and, what is worse, he had stayed conscious through the ordeal. All the while, his wife pleaded with doctors to help. But the physicians treating him were helpless. The look of horror on his face as he died, his family say, is something that will never leave them.
Ms. Leadbeater's Advocacy for the Right to Die
Ms. Leadbeater narrated the teacher’s case to illustrate the suffering that many others face from deadly illnesses, with no choice available to them to seek assistance in ending their pain. The draft law — which gives terminally-ill adults (in England and Wales), with less than six months to live, the right to die, once they have a request signed off by two doctors and a high court judge — was intensely debated. Eventually, the Bill was passed with a majority of 55 votes, with 330 members voting for it and 275 against.
The Draft Law: The Right to Die for Terminally-Ill Adults
In somewhat unusual circumstances, the Members of Parliament had been released from the tethers imposed on them by their party whips. They had been asked to decide as their conscience willed. As a result, what ensued was all manners of interesting voting patterns. Prime Minister Keir Starmer and his Conservative predecessor Rishi Sunak voted in favour. The Deputy Prime Minister, Angela Rayner, and the Health Secretary, Wes Streeting, rejected the draft.
The complexity of the issue
- Bill's progress in the commons: With its passing in the commons, the proposal is now slated for review by a public bill committee, which will scrutinize, fine-tune, and suggest amendments to its various clauses, before it returns the draft to parliament for an ultimate sanction.
- Ongoing process: Therefore, there is still some way to go.
Milestone and Victory for the Right to Die
- Historical significance: But seeing how previous efforts to bring about a law to allow assisted dying have floundered, the bill’s passing represents a milestone, a victory for those who consider the right to die, when faced with an intolerable ailment, as intrinsic to human liberty.
Divergent Views and Complexities of the Issue
- Complexity of the debate: The sharply divergent views expressed amongst lawmakers in britain also shows just how complex an issue this is.
- Global lessons: The debates contain lessons that the rest of the world can take, in deciding how best to allow people to both lead, and end, their lives, with dignity and compassion.
Opposition to the Law
- Slippery slope argument: The opposition to the law primarily rests on two planks: Opponents argue that the law is premised on a "slippery slope" — that it would be practically impossible to draw boundaries limiting the right to assisted death, and that the old and the disabled might be pressured into choosing to end their lives out of fear of becoming a burden on their loved ones.
- Concerns over the canadian model: Critics claim that a similar law employed in canada has produced worrying results. Originally, following a 2015 judgment of the country’s supreme court, the government opened up avenues to allow assisted dying for those whose death was “reasonably foreseeable”.
- But the law has since been expanded through judicial interpretation to make it applicable even to those facing a “grievous and irremediable medical condition”.
- In so doing, the bright lines of the rule, the bill’s detractors say, have been dimmed.
‘There are legitimate cases’
- Slippery slope argument countered: Proponents of the law counter the criticism by pointing to how the very invocation of a slippery slope suggests that those making the argument are offering a concession: that there are legitimate cases where it might be justifiable to help someone die.
- Carefully tailored provisions: The law, as drafted, they say, is carefully tailored: it only includes adults competent to make decisions, who are ailing from a terminal diagnosis and who have less than six months to live, to seek assistance in ending their lives.
- Independent assessment and safeguards: Additionally, the person making the claim will be independently assessed by two doctors, with a 14-day reflection time afforded to them, and no decision will be sanctioned without the High Court’s approval.
- Lord David Neuberger’s defense: Lord David Neuberger, the former President of the U.K. Supreme Court, argues that the Bill’s clauses are tightly worded enough to ensure that the law respects people’s right of personal autonomy, and that there really is no chance of its scope being enlarged through judicial challenge.
Traditional and Philosophical Opposition
- Objections based on religion and faith: The second cause for opposition stems from rather more traditional, philosophical grounds, sometimes resting on considerations of religion and faith. The proposed law, these critics claim, is simply deceit disguised as compassion, and offends the inviolability of the right to life.
- Bill’s supporters’ response: In response, the Bill’s supporters concede that in most cases, there ought to be serious objections to the taking of one’s life, and to avoidably allowing people to die. In ordinary circumstances, objections founded on a person’s right to life would prevail.
- Reconciling the conflict: But the conflict here, as they demonstrate, is not especially irreconcilable. For, as Ms. Leadbeater and others have shown, the moral background in which the debate resides cannot permit a wholesale embargo on physician-assisted deaths.
- Personal autonomy and decision-making: After all, every adult, we generally recognize, has the right to make significant decisions on how best to lead their respective lives. This freedom, grounded in the sovereignty of our bodies, may stem from religious faith or simply from conscience, but, regardless, it is something that is embedded in each of us as human beings.
The State's Duty and Freedom of Choice
- Dworkin’s perspective: The state, no doubt, owes to us a duty to ensure that we do not indulge in what Ronald Dworkin described as “irrevocable acts of self-destruction”.
- Limitation of state intervention: But, equally, the exercise of this duty can under no circumstances “justify forcing a competent dying patient to live in agony a few weeks longer”.
- Freedom of life and body: To do so would impinge squarely on the freedom that each of us enjoys over our livesand bodies.
On choice and dignity
- Relevance to India: In many ways, the debates in Britain assume universal value. In India, the Supreme Courthas previously recognised a limited freedom to die, a right both to passive euthanasia and a right to make an "advance medical directive" — that is a liberty to stipulate one’s preferences for medical treatment, or the withdrawal thereof, should one become incapacitated in the future.
- Common Cause case (2018): In its judgment in Common Cause (A Regd. Society) vs Union of India (2018), the Court found this right as essential to liberty, as “an element of the privacy of the being”.
Long Road to Assisted Dying
- Challenges ahead: The road from here to assisted dying is clearly a long one. But the reasons which compel one to hold in favour of individual dignity surely apply just as vigorously to how one might want to go about dealing with a terminal illness in their last days.
- Personal choice and dignity: The latter choice is as critical to one’s dignity and independence as it is to any other decision that a person makes over her body and life.
Complications of Legislation and the Slippery Slope Argument
- Lessons from Britain: Deliberations made in Britain’s Parliament have shown us that making laws to govern assisted dying is a complicated affair.
- Human dignity at stake: But the mere prospect of a slippery slope, or the possibility of abuse, cannot detract from the fact that at stake here is something central to human dignity — that is, the ability to allow people to make conscious choices to alleviate the most crushing forms of pain and suffering.
Conclusion
One can argue over the fine print of what a law that allows for assisted dying must contain. But there can be no doubt that the rudimentary principle on which such a legislation will inevitably rest is founded on ideas that are central to our existence, to our freedom to lead meaningful lives, and to the rights to privacy, dignity, and autonomy.
Context
The Vaikom Struggle was a landmark socio-political moment like no other.
Introduction
A little over a 100 years ago was a landmark socio-political moment like no other. The Vaikom Struggle, which culminated in the lifting of the barriers to the entry of backward caste Hindus to the local temple in the erstwhile Travancore princely State, would be the first of many mass movements that brought political attention to religious reform.
- Since then, the Dravidian Movement founded by Periyar E.V. Ramasamy and its self-respect principles have enabled wider reforms within the Hindu religion and paved the way for a more egalitarian society.
- What is less understood is that this was made possible only due to the insertion of a key clause in the Constitution by Dr. B.R. Ambedkar.
- Celebrating the centenary of Vaikom is not just a tribute to Periyar’s persistence and B.R. Ambedkar’s acumen but also a re-assertion of the strong reformist tendencies that continue to pervade through modern-day politik in South India.
The evolution of a mass movement: The Vaikom Struggle
- The Vaikom Struggle was fought against the prohibition of backward caste Hindus from walking on the streets adjacent to the Vaikom Mahadeva temple.
- When leaders of Kerala State Congress Committee and other social activist leaders began agitating against the injustice, they faced a clamp down by the administration.
- With the entry of Periyar in 1924, it slowly became a mass movement, bringing people from all classes within its fold.
- In November 1925, when the restrictions to walk on the streets finally lifted, the long arc of political movement began tilting towards social justice.
- Other Movements for Social Justice: In the decade that followed, movements erupted in other parts of the country, with B.R. Ambedkar leading protests to enter the Ambadevi Temple and Kalaram Mandir, where Dalits were denied entry.
Faster Reform Progress in South India
- The trajectory of reform in South India was progressing at a faster pace with the Legislative Assemblyintroducing a Bill to allow temple entry in 1932, followed by the Travancore Temple Entry Proclamation in 1936, the Malabar Temple Entry Bill 1938.
- There was also the entry of backward castes in the Madurai Meenakshi Sundareswarar Temple and the Thanjavur Brihadeeswara Temple in 1939.
- The Madras Temple Entry Authorization Act 1947 enabled Hindus of all castes to enter and offer worship in all temples within the then Madras Presidency.
Constitutional Recognition of Religious Reforms
- Though many of these reforms took place prior to the adoption of the Constitution of India, the Constituent Assembly took great care in delimiting the right to freedom of religion.
- During discussions on December 7, 1948, B.R. Ambedkar included the prefix ‘subject to public order, moralityand health restricting the extent of the fundamental right and thereby enabling state intervention when necessary.
Constitutional Courts and Fundamental Rights
- These seven words went on to form the legal and legitimate basis for reforms within the fold of religion, thereby enabling constitutional courts to intercede when there was a contestation of fundamental rights, namely between those of equality and religion.
State and the issue of regulation
- The larger issue has always been whether temples, and religion at large, can be regulated by the state.
- If this is allowed, some argue, then the government will lose its secular character.
- There can be nothing further from the truth or logic. The intervention of the State to regulate temples, which are public spaces, is to ensure equality and access.
Historical Legislative Intent
- A long history, beginning with the enactment of the Madras Hindu Religious Endowments Act 1927 to the present-day Tamil Nadu Hindu Religious and Charitable Endowments Act 1959, would make it apparent the legislative intent to manage religious affairs in consonance with public order and morality.
- Legal Precedents: This position has been confirmed through various judgments beginning from The Commissioner, Hindu Religious Endowments, Madras vs Sri Lakshmindra Thirtha Swamiar of Sri Shirur Mutt 1954 (Shirur Mutt case), where the Supreme Court of India upheld the proposition that the state can manage the secular affairs of the temple and propounded the test of essential religious practice.
Government Actions and Court Upholding State Rights
- Since then, successive governments in Tamil Nadu, beginning in 1970, have enacted laws to enable backward caste Hindus to be appointed as archakas (priests), which some have regarded as a contentious act of interference in religious affairs.
- In such instances, the Court has upheld the right of the State to manage secular matters in temples while carving out a special category of ‘Agamic temples’.
Change and resistance
- Government actions in appointing non-brahmin priests: Over the last few years, Governments of Kerala and Tamil Nadu have appointed hundreds of trained archakas, Odhuvaars, and Bhattacharyas from non-Brahmin castes.
- These reforms have been met with resistance within and outside the courts of law.
- Challenging orthodox religious beliefs and social diktats: These reforms challenge orthodox religious beliefs and entrenched social diktats.
- Stronger push for reforms: Nevertheless, the push for reforms is stronger than before.
- Emerging moral consensus: One hundred years after Vaikom and over 75 years since the Constituent Assembly debate, there is a compelling moral consensus emerging.
Conclusion
While the Governments of Tamil Nadu and Kerala have collaborated to commemorate the centenary of the Vaikom Struggle on December 12, 2024, they are also celebrating a historic event that brought together two States. They are paying tribute to the start of a social reform trajectory that was made possible due to the coming together of two of the greatest leaders.