The foundational idea of the Indian struggle for independence and the resultant new nation, with a new government and a constitution, was to secure all Indian people a basic minimum standard of human dignity. This was not surprising. For the makers of the Constitution, the aspiration of being free citizens of a sovereign country was attractive for various reasons. Perhaps the most important of those was that the two centuries-long experience of colonial rule was defined by its harassment and subordination of the Indian people, their dignity, and worth as human beings. In a free country founded upon the ideals of justice, liberty, and equality, every individual could expect to have their freedoms and rights protected by the State, thus ensuring that regardless of social, religious, or economic status, every individual is guaranteed a recognition of their dignity. However, these dignitarian concerns were easier to incorporate into the written Constitution than to replicate in daily life. India had inherited a deeply stratified social order, evident most glaringly in the hierarchical and rigid caste system prohibiting social mobility and enforcing social status based on generational justifications. Manifest in the caste hierarchy is the treatment of certain groups of individuals as less than human, as undeserving of the freedoms and public facilities guaranteed to them by the State. This has proved difficult to eradicate and continues as the impugnments of human dignity. If these values are to be holistically integrated into the lives of citizens, the affirmation and awareness must begin at the level of society.
The purpose of this article is to analyse human dignity as an important issue in contemporary Indian society. It is divided into two parts. In the second part, it will specifically study developments in manual scavenging and euthanasia. It will first summarise the legal and judicial framework behind the prohibition of manual scavenging and its present performance. It will focus on its causes and effects as a crime against human dignity. It will also scrutinise the effects of the COVID-19 pandemic on the lives of manual scavengers. Second, it will analyse the right to die through various judicial pronouncements, focusing on the current legislations under deliberation. It will also consider the arguments for and against euthanasia.
On 24th March 2022, a parliamentary standing committee took cognisance of official data stating that 325 individuals had died while cleaning septic tanks and sewers in the last five years, asked the government to furnish answers as to why this was continuing to occur despite legislations to this effect, and emphasised the swift correction of loopholes in the policies for rehabilitation. The standing committee expressed its confusion as to how despite various schemes subsidy implemented by the Department of Social Justice and Empowerment, such as skill development programmes, loans at concessional rates, credit-linked upfront capital, the impact was negligible, and deaths continued to occur. In its report, the committee noted that the National Action Plan for Mechanized Ecosystem, in coordination with the line ministries, could prove useful if all municipal bodies were made aware of the necessity to implement mechanical cleaning. It also suggested that the concerned department institute mechanisms for periodic scrutiny to plug the existing loopholes, considering the delays accompanying cooperation from state governments and bureaucratic permissions required for the continuation of various schemes. Stressing that budgetary allocations meant for the implementation of these schemes must be increased, it expressed its disappointment that the department had spent only ₹ 2873.42 crore on various welfare schemes administered by them till 31st December 2021, out of the reduced ₹10180 crore during the year 2021-22. It expressed its hope that the department would streamline the system to provide maximum support to the beneficiaries and prevent the misuse of funds. On 3rd July 2021, the Socio-Economic Caste Census data revealed that 180657 households had at least one member engaged in manual scavenging, with Maharashtra topping the list at 63713 households followed by Madhya Pradesh, Uttar Pradesh, Tripura, and Karnataka. It also reiterated their claims must be verified by the local authorities under the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013, to be included in the list of identified manual scavengers eligible for rehabilitation. According to Bindeshwar Pathak, the founder of Sulabh International Social Service Organisation (that builds and manages hygienic public toilet systems), though present findings display a significant reduction in the number of individuals engaged in this practise (from 3.5 million manual scavenging households according to the 1961 census), the Ministry of Drinking Water and Sanitation has not increased the finances allotted to panchayats to build toilets – from ₹12000 to ₹15000. He emphasised that the UPA government’s construction of more than five crore toilets continue to be of poor quality and have rendered the modernising of rural sanitation practises difficult. He also stressed that the provisions of the law were not enough to eradicate the practise, which would be possible only if the flagship Swachh Bharat Abhiyan increases the allocation of money for the construction of functioning toilets and sustains a campaign of public awareness. In response, the Union Minister for Social Justice and Empowerment Thaawar Chand Gehlot informed the media that under the new 2013 law, 2500 manual scavenger families had been identified, ₹40000 was disbursed in aid money, skill training for alternative employment was provided, and credit was extended under the Safai Karmachari Vitt Vikas Nigam for permanent employment. He also claimed that intervention procedures had been initiated in Lucknow, Haridwar, and Varanasi and would soon be extended to other states.
The proscription of manual scavenging was initiated in the late 1950s, when the Gobichettipalayam Municipality became the first local body to do so, under the chairmanship of GS Lakshman Iyer. Sanitation is a State Subject in the Seventh Schedule of the Constitution. Delhi utilised this to proscribe manual scavenging in 2013, obligating that district magistrates ensure no manual scavengers are working in their district and necessitating those ruling municipalities, railways, and cantonments make sufficient sanitary latrines available. The central government utilised Article 252 – which allows the Parliament to legislate on a State Subject with the consent of two or more states and the adoption of the legislation by any other state – to enact various laws and schemes. At the behest of six states passing legislations imploring the central government to proscribe manual scavenging, the Ministry of Urban Development under the Narasimha Rao government drafted The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act, passed by the Parliament in 1993. The Act penalised the employment of manual scavengers or the construction of dry non-flus latrines with imprisonment for up to one year or a fine of ₹2000 or both, though no convictions were obtained in the two decades it was in force. The Self Employment Scheme for Rehabilitation of Manual Scavengers was initiated in 2007 to assist in the transition to other occupations. Hence, to mitigate the lacunae in the 1993 Act, The Prohibition of Employment as Manual Scavengers and their Rehabilitation Act and The Prohibition of Employment as Manual Scavengers and their Rehabilitation Rules were formulated and passed in 2013. The Act aimed to eliminate unhygienic latrines, ban the employment of manual scavengers and hazardous manual cleaning of sewer and septic tanks, and maintain a record of identified manual scavengers and their rehabilitation. It became evident, however, that the new law also encountered inefficiencies of implementation – in recognition, protection, and rehabilitation – and the Ministry of Social Justice and Empowerment drafted The Prohibition of Employment as Manual Scavengers and their Rehabilitation (Amendment) Bill, under its National Action Plan in 2020. The Plan aimed to modernise the existing sewage systems and coverage of non-sewered areas through the setting up of management systems for mechanised cleaning of septic tanks and transportation and treatment of faecal sludge and septage and equipping the municipalities with Sanitation Response Units and helplines. The Bill proposed that sewer cleaning be completely mechanised, better protection and compensation be provided in case of accidents, and funds to purchase machinery be provided directly to sanitation workers instead of municipalities or contractors to prevent misappropriation. It also rendered the law more stringent by imposing penalties on agencies or individuals employing manual scavengers, with imprisonment of up to five years or a fine of up to ₹5 lakh or both. The Safaimitra Suraksha Challenge, with a total prize of ₹52 crores, was launched on 19th November 2020 to incentivise state capitals, urban local bodies, and smart cities to completely mechanise sewer cleaning by April 2021 and provide proper gear and oxygen tanks to any individual entering the sewer line due to unavoidable emergencies. The government has also announced programmes like the Self-Employment Scheme for Rehabilitation of Manual Scavengers (SRMS), national-level policy initiatives and inter-ministerial plans for the elimination of the practise, and the Emergency Response Sanitation Unit (ERSU) under the Ministry of Urban and Housing Affairs. As the 2020 Bill awaited Cabinet approval, however, Minister of State for Social Justice and Empowerment Ramdas Athawale informed the Parliament in March 2021 that there was no proposal to amend the law at all. He reasoned that Section 33 of the existing law already made it ‘the duty of every local authority and other agency to use appropriate technology appliances for cleaning of sewers, septic tanks and other spaces within their control with a view to eliminating the need for the manual handling of excreta in the process of their cleaning.” Even as various media outlets reported that the Ministry had commenced the groundwork to identify municipalities across India with the capacity to mechanise sewer and septic tank cleaning, Athawale stated that there was no plan to redefine manual scavenging to include larger categories of sanitation workers under the benefit schemes or to implement a national 24×7 helpline number for reporting cases of manual scavenging. Instead, he focused on the Swachhta Abhiyan App launched by the Ministry to allow public uploading of data relating to unsanitary latrines and manual scavengers. The lack of clarity and bureaucratic apathy regarding the proper implementation of legislation and allocation of budgets for schemes has ensured that manual scavenging is still widely pervasive across India. The government continues to postpone the achievement of policy goals, and the stigma attached to the practise ensures that professionals working for the emancipation of manual scavengers are ostracised. The Supreme Court declared in 2014 that there were 96 lakh dry latrines manually emptied, though the exact number of manual scavengers was disputed. Estimates in 2018 by international non-governmental organisations concluded that there were 1-5 million sanitation workers in India, with 50% of them being women, though it was evident that not all sanitation workers could be defined as manual scavengers under existing legislations. The Indian Railways extensively flout existing laws, employing manual scavengers to clean the tracks where excreta are dropped from trains – a situation that has improved with the introduction of on-train toilet treatment systems in 2018.
Sanitation work as an occupation that has been intrinsically linked to caste in India, and individuals from the lowest rungs of the hierarchy – Dalits, especially Valmikis – are assigned the “lowly task” of garbage collection, drain cleaning, and manual scavenging. Socio-structural violence also accompanies caste-based discrimination, and dominant castes continue to harass, threaten, and intimidate any individual of the lower castes – especially women – if they do not continue working as manual scavengers. The transgenerational nature of the occupation and the stigma of untouchability associated with it, has ensured a paucity of social mobility to better employment, ostracization of children born to manual scavenging families from education, and alienation from housing and other community activities. Indeed, according to activist Bezwada Wilson, the continuation of the dehumanising practise is due to its casteist nature and the collective failures of the government, judiciary, the administration, and the Dalit movements to address the concerns of the most marginalized community. There is also a gendered division of labour in manual scavenging in India, where women generally clean private dry toilets and carry waste to disposal while men clean septic tanks and sewers. Because the municipality employs the latter, they are paid better, while the former are only referred to by the names of the tools they use to carry the waste. Though women belonging to Dalit caste groups like Bhangi, Valmiki, Mahar, and Mehtar may not encounter risks of imminent death like men, they face disproportionate rates of daily humiliation and sexual violence. This is exacerbated by the inadequacy of government statistics on the actual number of women manual scavengers (though reports display that 75% of those engaged in this occupation are women), which also results in their lack of representation in schemes and legislations providing support for basic necessities and alternative incomes. In fact, WaterAid India’s baseline survey in 2018 identified more than a thousand women manual scavengers in thirty-six urban locations across four states who had struggled for enrolment and benefits because local administrations were loath to recognise that manual scavenging existed in their districts, and instead falsified the survey results. The double burden of gender and caste-based discrimination experienced by them has been worsened by the pandemic, and the lack of dedicated institutional arrangements committed to their welfare has resulted in paucities of advocacy, awareness-building, and rehabilitation. For all manual scavengers, the lack of safety provisions while handling hazardous materials like excreta, the use of thin boards, buckets, or baskets lined with sacking, carried on the head, and exposure to pollutants has led to respiratory disorders, typhoid, cholera, and skin and blood infections like leptospirosis, dermatitis, and helicobacter pylori. Exposure to gases like hydrogen disulfide, carbon (IV) oxide, ammonia, and methane cause epileptiform convulsions, blindness, and asphyxiation. The strenuous lifting of heavy storage containers causes musculoskeletal disorders, and contact with hazardous chemicals combined with waste have resulted in severe burns. Safai Karamchari Andolan found in data obtained between 2017-2018 that the lifespans of manual scavengers had decreased to 32 years, with destitute families losing their primary earner unexpectedly early. The Supreme Court observed in Delhi Jal Board vs National Campaign for Dignity & Rights of Sewerage & Allied Workers (2011) and Rajesh and Another vs Delhi Jal Board and Others (2018) that manual scavengers suffer from high workplace mortality and morbidity – whether due to accidents in blocked sewer lines or manholes or due to exposure to hepatitis B and tetanus – and directed state governments to identify and compensate the families of deceased workers.
The provisions of the 1993 Act were not made mandatory upon any state, and the number of manual scavengers continued to increase. The most important verdict in this regard was the Safai Karmachari Andolan and Others vs Union of India and Others on 27th March 2014. The petitioners prayed to the Supreme Court that the continuation of the practise of manual scavenging and the existence of dry latrines was illegal and ultra vires to the Constitution – especially Part III and the Fundamental Rights guaranteed in Articles 14, 17, and 21 – and to the 1993 Act. Seeking the writ of continuing mandamus, they asked the Court to direct the government to implement the existing legislations and undertake all necessary measures to completely eradicate the degrading practises, including formulating detailed and swift plans for the rehabilitation, proscription of dry latrine construction, and penalising all those who employ manual scavengers. The respondents directed the Court to the new 2013 Act, which more precisely defined the terms’ manual scavenger’,’ unsanitary latrine’, and ‘hazardous cleaning’, and obligated local authorities to survey such prohibited dry toilets and replace them with community sanitary latrines. The Court emphasised that the practise of manual scavenging was detrimental to human dignity. Its eradication would need the 2013 Act to broaden its definition of manual scavengers entitled to rehabilitation, to include sewer deaths – rendering entry into sewers without safety gear a crime even in emergencies and providing 10 lakhs in compensation to the families of the deceased; and railway workers – necessitating that the Indian Railways eliminate manuals scavenging in a time-bound manner. Recognising the efforts of key organisations mobilising for the right of Dalits, like the Safai Karamchari Andolan, the Supreme Court directed the State to ensure that individuals emancipated from the practise should not encounter bureaucratic hurdles in receiving their due, and women manual scavengers should be provided support for dignified livelihoods. In All India Council of Trade Unions vs Union of India (2020), the Supreme Court observed that though the Preamble of the 2013 Act was structured “correct the historical injustice and indignity suffered by the manual scavengers, and to rehabilitate them to a life of dignity”, the implementation of its provisions has been gravely inadequate. It emphasised that the practise of manual scavenging is contrary to the constitutional trinity of equality, fraternity, and liberty and vandalises the fundamental right of dignity guaranteed to all individuals under Article 21. Underscoring further dignitarian concerns, the Court also specified that the State was obligated to endeavour to secure just and human conditions of work and improve the standards of living of citizens in Articles 42 and 47 of the Directive Principles of State Policy, respectively. It also directed the government to swiftly comply with Section 13 of the 2013 Act, where local bodies would have to identify and compile a list of manual scavengers in every State so that their children receive scholarships, photo identities are issued, residential plots and financial assistance are allotted for house construction, subsidy or concessional loans are provided for sustainable alternative employment, and the central or State governments provide other legal and programmatic assistance. Because the Court observed that no such list had been compiled, it directed state governments to submit a report on whether the identification and publication of the final lists have been undertaken, whether district-wise and consolidated state lists have been prepared, and whether District Level and State Level Survey Committees have been constituted. It also issued interim directions to mitigate the prevailing non-compliance with provisions of the Act, especially the low rate of convictions. It instructed the State to provide details about first information reports of cases resulting in convictions, record the data collected by local authorities under Section 2(c) of the 2013 Rules, demolish all unsanitary latrines and ascertain the number of community latrines required within local jurisdictions, and comply with the Safai Karamchari verdict.
The World Sanitation Workers’ Alliance, the South Asian Sanitation Labour Network (SASLN), and the Safai Karmachari Ekta Manch, West Bengal, conducted a joint research study entitled Toilet Stories of India on 21st March 2022 that revealed that 178 manual scavengers were employed as ‘bone-scavengers’ – illegally gathering human bones from graveyards in the Birbhum, Siliguri, and Cooch Behar districts, selling them to traders who supply raw materials to calcium manufacturing factories and small cosmetics-producing units or directly trading with these industries. The study found that the highest number of bone scavengers and traders were employed in Kolkata, earning ₹200 for every transaction. Though the practise had been prevalent in West Bengal for the last two decades, the COVID-19 pandemic and the successive lockdowns fomented a 90% increase in the numbers of bone scavengers who lost their work as manual scavengers, bore the brunt of extreme hunger, poverty, and lack of alternative employment, and began to gather bones from mass cremation and pre-dug burial sites to sell to traders. Though the lockdowns were lifted, the practise continued alongside a return to manual scavenging because the access to landfills and dumping grounds after dark allowed surer increases in income and the development of the illegal bone trading supply chain into “a network of underground and small-scale business models”, including supply to medical institutions requiring bones and tissues for dissection and research. Manual scavengers forced into bonded labour seem to find bone scavenging from landfills and butcher shops easier than entering septic tanks and losing their lives, and sometimes even scavenge carcasses from hotels and household waste to feed their families. It is gravely concerning that not only have existing legislations failed to eradicate manual scavenging, but systemic apathy has also allowed the practise to become so entrenched that individuals now must engage in increasingly undignified and humiliating occupations to survive. Where there are petitions to broaden the definition of manual scavengers in the 2013 Act to allow for better identification and rehabilitation, stronger efforts must be made to include bone scavengers into the categories too.
The development of the concept of passive euthanasia in India has been a jurisgenerative process. In 1994, after P Rathinam and Nagbhushan Patnaik filed petitions in the Supreme Court challenging the constitutional validity of Section 309 of the Indian Penal Code (IPC) – punishing any attempt to commit suicide with imprisonment of up to one year – the Court held the Section to be unconstitutional. It interpreted Article 19 parallel to Article 21 and commented that like the right to speak also contained the right not to speak, the right to live included the right not to live. Similar questions were raised in Gian Kaur vs State of Punjab (1996) when Kaur and her husband Harbans Singh were convicted by a trial court under Article 306 of the IPC and sentenced to six years imprisonment and a fine of ₹2000 for the abetment of the suicide of Kulwant Kaur. The five-judge constitutional bench overruled the P Rathinam verdict, stating that Article 21 could only be interpreted into securing a life with dignity, the right to die was “incompatible and inconsistent” to it, and assisted suicide or euthanasia was unlawful. In 2006, the Law Commission of India released its 196th Report recommending the formulation of a law to protect terminally ill patients refusing medical treatment, artificial nutrition, or hydration from Section 309 of the IPC and doctors obeying such orders or individuals making the decision in the best interest of the patient, from Sections 306 (abetment of suicide) and 299 (culpable homicide) of the IPC. The Report elucidated that the patient must be suffering from an illness, injury, or degeneration of a physical or mental condition that causes extreme pain and suffering and would, according to reasonable medical opinion, inevitably cause their untimely death. In 2008, the Law Commission released its 210th Report stressing that Section 309 was inhuman because any individual attempting to commit suicide suffered from a diseased condition of the mind and should receive treatment and care instead of additional punishment. It suggested the decriminalisation of the attempts to commit suicide and improvement of access to the medical care of patients. The most important verdict in this regard was Aruna Ramachandra Shanbaug vs Union of India (2011). In 1973, Shanbaug was horrifically strangled and raped at the King Edward Memorial Hospital in Mumbai, where she worked as a nurse, the deprivation of oxygen leaving her in a persistent vegetative state, only kept alive by a feeding tube. After decades of incessant suffering, her’ next friend’ Pinki Virani filed a petition in the Supreme Court arguing that the “continued existence of Aruna is in violation of her right to live in dignity,” asking for euthanasia to be allowed. The Supreme Court appointed a team of three doctors to examine Shanbaug and submit a report about her physical and mental condition but eventually rejected the plea on the grounds that the hospital staff treating her had not consented to discontinuation of life support. Shanbaug laid in coma for forty-two years, finally dying of pneumonia on 18th May 2015. Even so, the Court engaged in a lengthy discussion about passive euthanasia and defined guidelines for its legalisation. It formulated two irreversible conditions which would merit passive euthanasia for those who are brain dead where the ventilator may be switched off and those who are in a persistent vegetative state where the feed can be gradually reduced and pain-managing palliatives be added, according to established international specifications. The Court also suggested the removal of IPC Section 309, and the government announced its decision to do so in December 2004. On 25th February 2014, however, while hearing a PIL filed by the non-governmental organisation Common Cause, a three-judge bench of the Supreme Court held the Shanbaug verdict to be “inconsistent in itself” as it was based on an erroneous interpretation of the Gian Kaur judgement and laid down guidelines for euthanasia even though it also observed that only the Parliament could do so. The case was referred to a five-judge constitutional bench to ensure that questions regarding the right to die be considered from a cogent social, legal, medical, and constitutional perspective “for the benefit of humanity as a whole.” The five-judge bench was tasked with deciding whether Article 21 could be interpreted as including the right to die with dignity by means of executing a ‘living will’ or advance directive – where the patient may provide explicit direction about the discontinuation of medical treatment before they are rendered unable to express informed consent. On 23rd December 2014, the government endorsed and validated the passive euthanasia verdict in a press release after stating in the Rajya Sabha that the Shanbaug verdict laid down comprehensive guidelines to process cases related to passive euthanasia and after consultation with the Ministry of Law and Justice, these guidelines would be treated as law. On 9th March 2018, the five-judge constitutional bench discussed the issue of Common Cause vs Union of India and recognised the constitutionality of passive euthanasia by honouring living wills under strict guidelines. This formed the basis for the recognition of the right to die with dignity as interpretable under the right to life and permitted the development of laws related to euthanasia like The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill in 2017.
In 2019, amidst forty-four private members’ bills introduced in the Lok Sabha, Bhartruhari Mehtab (BJD) moved a bill to regulate the termination of life of a terminally ill individual facing unbearable suffering or in a persistent vegetative state. The Act is being termed the Euthanasia (Regulation) Act, 2019, and provided for the Constitution of an Evaluation and Review Board – consisting of the Director General of Health Services in the Union Ministry of Health and Family Welfare as the ex-officio Chairperson, two eminent physicians, a jurist of repute; and an eminent person having experience in ethics or social work – to examine applications of passive and active euthanasia, consult with a paediatrician if a child below eighteen is involved, and submit its opinion within three weeks. It immunises physicians performing the termination of life and individuals or their families applying for active or passive euthanasia from penalisation. Instead, it describes that such an application must be made to the Chief Medical Officer of a Government hospital, who would constitute a committee of three physicians to consider the request and examine the involved individual. If the committee agrees that the termination of life may occur through active or passive euthanasia, the application would be transferred to a Court of Session, which would appoint a team of lawyers to ensure that the decision has been taken freely and with full knowledge. If the report produced is satisfactory, the Court may permit the application for euthanasia with its seal and signature and allow the Civil Surgeon or Chief Medical Officer to set a date and eventually “put the life of the patient to a gentle and painless end in the presence of the members of the family of the patient and a representative of the Court of Session.” The law aimed to regulate and institutionalise the procedures for active and passive euthanasia, manage the related ethnical and legal concerns, and implement the advice of the Court in the Aruna Shanbaug verdict to frame a comprehensive law in the matter.
There are several critics of euthanasia who believe that the embracing of the right to death with dignity would lead to the elimination of individuals with incurable and debilitating illness from civilised society, though palliative care (or the active, compassionate, and creative care for the dying) does counter this view. The worry is that the movement from cure to care of incurable diseases due to the former being distant and unachievable, lack of knowledge about palliative alternatives, or destitution, would prompt disproportionate focus on a peaceful death rather than efforts to sustain life and rehabilitative care. The primary logic pursued by critics of euthanasia is its equalisation with attempted suicide. They also believe that the State’s duty to protect the lives of its citizens under Article 21 of the Constitution and the physician’s duty of care is inconsistent with the legalisation of suicide or “unnatural” termination or extinction of life, leading to possibilities that States may refuse to invest in health (essential to the right to life) and fail its welfare role. They believe that because attempted suicide (or suicide) is commonly thought to result from depression, schizophrenia, obsessive compulsive disorders, and substance dependency, arguments for euthanasia do not merit legislative consideration but psychiatric intervention. There are also concerns that family members or doctors with malafide intentions – inheriting property or amassing income – may misuse these provisions for their own benefit, leading to the brief discussion of euthanasia in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 to maintain oversight over medical professionals handling terminally-ill patients. In the Aruna Shanbaug verdict, the Supreme Court also signalled alarm over the possibility that the legalisation of euthanasia could exacerbate the exploitative commercialisation of healthcare and allow hospitals to allow a “death sentence to many disabled and elderly citizens of India for meagre amount of money.” The proponents of euthanasia base their counterarguments on several factors. Advocates of the right to die believe that individuals in incurable, degenerative, disabling, or debilitating conditions should be permitted a dignified death, especially when scores of petitions filed by families of individuals with such illnesses display that the caregivers’ financial, emotional, time, mental, social, and physical burdens in an environment of governmental inefficiency, apathy, and lack of investment in health, are extremely unmanageable. In these cases, a dignified death finds preference over continuous, disappointing, strenuous, and expensive palliative care. They argue that the right to refuse medical treatment, including that which sustains or prolong care – well-recognised in law – forms the legal basis for euthanasia and emphasise that its legalisation would bolster the advocacy of organ donation, benefiting patients with severe organ failure.
Therefore, discussions regarding euthanasia, like those regarding manual scavenging, are (or must be) based on dignitarian concerns. All actions taken by the State or civil society organisations must consider whether the right to die is contradictory or aligned to the right to life and which condition better protects human dignity, and must agree that manual scavenging is offensive to human dignity and merits holistic eradication.
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