Rising numbers of aging and sick make euthanasia an option

The Karnataka government has taken a surprising stand on a medical cum moral issue by disapproving euthanasia for a school teacher who is seeking termination of life due to severe health problems. Whatever the merits of the case, it is a stand that rejects the verdict of the Supreme Court which legalised passive euthanasia last year.

The highest court in the land passed a judgment in the case of a nurse in a hospital in Mumbai who was in a vegetative state for 37 years. Passive euthanasia means the withdrawal of life support systems in cases where there is no hope of recovery for a patient.

It is still a debatable issue with doctors -- and patients who have been diagnosed with an incurable, terminal illness. While the latter may feel that they should be in control of their lives, the doctor has a moral responsibility to save a life rather than terminate it. He is bound by the Hippocratic oath. Then, there are the relatives or ‘care givers’ of such terminally ill patients who feel that they too have a voice in such decisions. It is altogether a difficult situation that can bring a lot of pain and heartbreak among all the persons concerned.

Maybe, that is the reason for the ‘living will’ which more and more elderly people resort to nowadays.The living will is an advance directive, signed by a patient, witnessed by a relative and notarised by a lawyer. This document instructs the attending doctor and the relatives to withdraw all medical interventions when he/she enters a vegetative state.

But, even in such cases, a physician may be unwilling to follow the instructions since he does not know whether the patient signed it voluntarily, or was pressurised by others to do so. Instances are not lacking where property disputes have forced elderly persons to sign a living will.

So, euthanasia continues to remain a gray area among physicians all over the world. Since doctors also are vulnerable and can be dragged to courts on these issues, their reluctance to end lives beyond repair is not at all surprising. Much depends on the care givers of a sick person. A spouse or child who sees the suffering endured by a partner or parent, for example, may find it easier to convince the doctor about the futility of such lives. Their desire to end the life of a loved one is driven by genuine concern to end the pain and suffering.

Some countries have made it easier for them by legalising what, in medical parlance, is called ‘assisted suicide’ which usually involves nothing more than detaching the life supporting systems like ventilators etc. But, even here, doctors have encountered problems when a single member of the family objected. It is very rare that every member stands by the patient who wishes to have his life ended. That calls for courage and conviction.

Philosophical view of life

Perhaps, these things are easier in countries like India where doctors tend to take a philosophical view of life and death rather than a sterile medical approach. Sometimes, they prefer not to treat terminal illnesses like cancer which is best left untreated rather than be subjected to expensive and useless treatment where the end result is the same.

Since the techniques of pain management have advanced by leaps and bounds, there need be no more fear that a loved one will suffer the agonies of painful diseases. It also gives a patient the options to choose life or death. It is only in extreme vegetative cases like that nurse in Mumbai where a patient may live on and on with no other sensibility than living and breathing – and that too with the help of a ventilator – that euthanasia may be the only answer.

Economists have argued that precious medical resources that would have helped others to survive are wasted on one who has no chances of survival. Once again, this is a question of ethics versus economics. Who is to decide which life is more important?
Countries like Switzerland have legalised assisted suicide where neither the physician nor the patient can be found guilty on these counts. A doctor can give a lethal injection to a patient who receives it in the full knowledge that it will terminate his life. Neither is guilty of a criminal act.

This unique law has actually promoted what is known as ‘suicide tourism’ to that country where even visitors can make use of it. In March 2012, at least 180 British nationals are said to have travelled to Switzerland simply to end their lives in the facility known as Dignitas where volunteers officially help terminally ill patients as well as those severely afflicted with incurable mental and physical ailments to end their lives peacefully at the hands of qualified doctors and nurses.

A handful of countries only have legalised an act which has baffled the medical profession and caused moral dilemmas to families. It is an act which is painful and soul searching that no legislation can compensate. Yet, with the growing numbers of an aging population that is susceptible to incurable diseases, this is a subject that cannot be swept under the carpet any more.

It is time that physicians and families shed their inhibitions to talk about it openly as a topic that needs to be discussed threadbare. The Hippocratic oath and deep religious beliefs notwithstanding, who has the right to decide whether to live a painful life deprived of dignity, or to end it graciously?