Euthanasia: Where human life is concerned, one can't be silent

Karibasamma is a 67-year-old retired schoolteacher from Davangere who has chronic back pain and wishes to have her life ended, as she is unable to obtain relief. She has petitioned the state and Central governments and submitted signatures supporting her campaign for euthanasia.

Shyamsunder is a victim of the 26/11 Mumbai terror attack, alive but incapacitated by a stroke and memory loss. His wife, now the sole breadwinner of a family of seven, is unable bear his helplessness or afford his care and has written to the chief minister to facilitate the mercy killing of her husband.

As long as euthanasia is illegal in India, such requests will be not be granted but the issue that re-surfaces is as disturbing as it is irreconcilable. Doctors play a pivotal role in this situation as they are expected to sympathise with the patient’s distress and have at their disposal the techniques to end life painlessly.

When a doctor administers or makes available to the patient the means to end his life, it is termed assisted suicide or active euthanasia. He may also be involved passively by withdrawing medication or life support to the patient resulting in death.

It is understandable that doctors worldwide are reluctant to participate in this activity, not only for fear of litigation, but mainly because the medical profession, by its nature is aimed at prolonging life and restoring health. Respecting the intrinsic value of human life and applying all efforts to save and protect it, is at the very heart of medical ethics. Every Code of Ethics right from the Hippocratic oath espouses the principles of Respect and Non-Malfeasance (Do no harm). Given the trust reposed in the doctor, by no stretch of the imagination should he be perceived as a purveyor of death.

It cannot be denied that there are unique cases where even death would seem to offer a compassionate solution, but the question is — to whom? In most appeals for euthanasia, as in the case of Shyamsunder, it is not the patient himself who asks for death, which is why the law prefers to adopt a cautious approach.

Even when the request is from the patient, it has to take into account the emotional and psychological pressure involved, with decision making faculties compromised by suffering and helplessness. Patients can begin to feel guilty for being such a burden and not choosing death.

If life unfolds within a society then dying too has a social context. Are we abrogating our responsibility as a society at a time when individuals need it most? 90 per cent of pain can be relieved by pain control methods and studies have shown that, in an environment of care, attention and affection, terminally ill patients are less likely to express a wish to end their lives.

When pain and depression are treated, just as in the case of a suicidal, non-dying person, the desire to end one’s life recedes. Geriatric medicine, Palliative Care and Hospice Care are expanding disciplines that endorse the value of human life in the dying or terminally ill person.

Right to live, die

The proponents of euthanasia allege that a person’s right to live itself implies an autonomy that extends to his right to die. The supreme court has struck down this interpretation of the right to life as inconsistent with the understanding of this human right. Allowing euthanasia would more likely imply a right to unnatural death or a right to be killed.

In most countries, active euthanasia is illegal. It is presently allowed only in Belgium, Netherlands and Oregon state, US in accordance with strict judicial protocol in specific situations. The voices against euthanasia stem from religious groups, legal and medical profession that is wary of awarding a mandate to kill. In our country, where there is large-scale illiteracy and the old and destitute are a burden with no social system to support them, euthanasia will put this vulnerable population at risk.

Laws can be expanded once something is declared legal. In India, where abuse of the law is common, devious relatives with an eye on possible heirlooms or escalating costs may seek to influence decisions in this area. Once allowed, the fear is that it may progressively lead to involuntary euthanasia.

The criteria for euthanasia could slowly expand to include all chronically ill, unproductive persons who may be seen to be using up limited resources available that could possibly save another life. Difficult cases do arise, but sanctioning the practice of euthanasia could lead to more harm than good.

In the case of Aruna Shanbag, victim of a grievous assault that rendered her semiconscious, it was a journalist who appealed for euthanasia and not the patient. The hospital and nurses, devotedly caring for this patient since 36 years, say she is responsive and do not agree that her life should be ended. Whatever meaning her life is allowed to have, does a ‘friend’ have the right to intervene?

Another poignant case that stopped the law in its tracks is that of Rom Houben, comatose for 23 years, who was recently discovered by a neurologist to have been conscious all along but unable to communicate. Recent brain scanning techniques made this possible and the case lead to a revaluation of the Coma Scale in medicine.

End of life dilemmas move and disturb us and we have a responsibility as a society to ensure that patients are as pain free and comfortable as possible until death. Currently, the debate is among jurists and social scientists lobbying for legal clarity in this area while the state bears the onus of protecting its most vulnerable citizens. There is urgent need for a wider view and national consensus on this profound issue that can impact us so personally.

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