Death by choice

In a historic judgment in Aruna Ramchandra Shanbaug vs Union, the supreme court rejected active euthanasia but legalised passive, non-voluntary euthanasia and laid down clear guidelines that only a high court bench of at least two judges can allow plea for passive euthanasia after bonafide consent of patient’s relatives and the opinion of an expert panel of ‘reputed doctors’ comprising a neurologist, a psychiatrist and a physician.

It means that life-sustaining drugs and/or life-support system can be withdrawn in case of patients who are brain dead or in a permanent vegetative state (PVS) and about whom doctors are convinced that their revival is impossible. The court, however, rejected the appeal for mercy killing of Aruna. By laying down guidelines, the court has invoked the ‘fill in the vacuum’ theory as it did in Lakshmi Kant Pandey vs Union (1987) laying down principles and norms to be followed in the adoption of Indian children by foreigners and Visakha vs Rajasthan (1997) giving elaborate guidelines to stop sexual harassment of women at work place.

In 2005, two deaths in quick succession made world news. Terri Schiavo of Florida died on March 31, neither because of her persistent vegetative state, nor because of her melted cerebral cortex, but because she was left starving for 13 days, not in a famine-stricken third world country but in the United States which abounds in plenty. Fifteen years ago, a heart-wrenching tragedy left her brain dead. Her husband moved the court to remove her feeding tube, which her parents vehemently opposed. The court accepted the husband’s prayer.

The decision to remove the feeding tube triggered a fierce debate, like never before in the whole world whether the right to life includes the right to a peaceful, willing and dignified death. The second death was that of Pope John Paul II on  April 3, 2005. The two deaths had intimate similarities.

The pope’s refusal to return to hospital despite being ‘informed of the gravity of his situation’ again threw up the debate whether critically ill patients have the right to spend their remaining lives on their own terms or they should be subjected to full-scale medical intervention. The pontiff preferred to remain at the Vatican in his third-floor apartment overlooking St Peter’s Square.

Surprisingly the pope encouraged research to ‘enhance and prolong human life’ and told doctors it was a moral duty to maintain basic nutrition to patients even in a vegetative state — which brought him in direct conflict with those supporting the decision to remove Terri Schiavo’s feeding tubes.

Patients choice

But the pope clarified that patients could refuse drugs that cause unconsciousness or reject extraordinary medical treatment that would lead to a ‘precarious and burdensome prolongation of the life.’ In fact, the Roman Catholic Church has maintained for long that there is no obligation to use ‘extraordinary’ or ‘disproportionate’ means to prolong life — a view that the Declaration on Euthanasia issued by the Sacred Congregation for the Doctrine of the Faith and approved by Pope John Paul II in 1980 reiterated.

In August 2009, Jeet Narain, a marginal farmer from Mirzapur, Uttar Pradesh, filed a mercy death: plea for his four sons aged between 10 and 16, all suffering from muscular dystrophy. It sent shockwaves among similar patients struggling against odds to live a life of hope. Muscular dystrophy is a group of over 30 genetic conditions where skeletal muscles that control movement, degenerate progressively. Estimates suggest that one in 3,500 people suffers from muscular dystrophy, but these patients hardly get any support from the government.

‘Euthanasia’ is a Greek term which means ‘good death.’ But there is no unanimity over what is a good death. Many people do not find anything good about euthanasia except its name. The debate acquired a new dimension when the Netherlands became the first country in the world to enact a law in 1984 legalising physician-assisted suicide and voluntary active euthanasia. Belgium was the next to legalise euthanasia, in 2002.
Indian mythology in general, espouses the belief that the life and death are in the hands of God and man should not try to tinker with this divine scheme. In Hinduism, it is believed that the sufferings we undergo are ‘prarabdha’ (destiny) which one cannot escape.

However, Jainism has a different view, with its concept of ‘sallekhna’ which means weakening the strength of body and passion by taking a vow. ‘Santhara’ is a process of fasting unto death that starts after a vow of ‘sallekhna’ is taken.

If mercy killing is legalised, it may open the floodgates of controversy as there are practical difficulties in its application. The possibility of its misuse is also tremendous. The crucial question is whether medical science has reached its apogee where a doctor can certify with certainty that the disease of a terminally-ill person is incurable.

Another question is who will bear the exorbitant cost of keeping alive a patient in a PVS. In Aruna’s case, the KEM Hospital filed a moving undertaking that it would take care of Aruna so long as she is alive. But what about others? Who will support poor patients in a PVS? This aspect should also be looked into.