A standing joke has it that once an American politician was asked what he had against euthanasia. The politician replied, “Nothing, I don’t have anything against youth anywhere.” However, euthanasia, or good death, is no laughing matter. It raises questions on a terminally ill or injured person’s right to die and along with it, all kinds of moral, religious and humanitarian implications. In the United States, Karen Ann Quinlan became a household name after she lapsed into a coma and her parents wanted to terminate her life support systems. The uproar that followed just goes to illustrate the raw emotions that are attached to such decisions. Does a mere mortal, whether doctor or parent, have the right to end another’s life? Some would even call it murder.
Now it is India’s turn to face and answer the question on the right to die.
Bina, 29, states vacantly at the ceiling of her room in South Delhi. It is Diwali. In stark contrast to the festivities outside, Bina doesn’t even flinch as loud crackers go off in the vicinity. She has been lying in the same position for eight years and chances are, she will die on this very same bed after being rendered a virtual vegetable. Her ailing mother Vasanti says plaintively, “a reckless scooter driver changed her life forever. She has to be looked after like a small child. How long can this go on?” Bina could conceivably live for another 30 years, but she will never be able to express whether she would choose death as an option.
Perhaps easier said than done. The issues that patients and their families face are not only legal or medical, but also financial, ethical and theological. Advances in medicine have also made the decision more difficult. In many cases, death can be postponed, indefinitely. But when looking for the final say, who should one listen to?
The doctor, the lawyer, the police or the priest?
At the forefront of this complex issue are the doctors who encounter terminally ill patients almost every other day in their lives. Says Dr Pragnya Pai, dean,Seth G.S. Medical College and KEM Hospital of Bombay, “Albert Schweitzer once stated that all lives are the same, but practically speaking, are they? Whom should I divert our scarce hospital resources to? A newborn who is in need of an operation and can be cured or should I allot those resources to a patient who has hardly any chance to live further?”
In India, passive euthanasia has been practiced covertly. Some doctors are afraid to admit that they have as much as thought of resorting to euthanasia. But there is degree of sympathy towards euthanasia by some in the medical profession. Passive euthanasia means allowing patients suffering from terminal illness to call upon their physicians to withdraw life-sustaining treatment. Dr Anandi Lal, a leading Delhi psychiatrist, believes,” Passive euthanasia should be allowed. However, a proper procedure has to followed, where the decision should be taken jointly by the doctor, the patient and the family together.”
Agrees Pai, ” When there is no hope of recovery, passive euthanasia should be considered. The decision need not to be a joint once. A person in his individual capacity can also take a decision provided he is in a fit state of mind. After all, well-known personalities like Vinoba Bhave and Sant Tukaram all willingly embraced death.” Opines Dr Pritam Pathare of KEM Hospital, “I see no harm in doctors practicing passive euthanasia provided the person who is taking the decision is of sound mind, and also provided his doctor thinks that there is no cure for him”.
A doctor’s decision to accept passive euthanasia depends on a number of circumstances. How far is the patient from death? How intense is the pain? How clear is the will of the patient to die? Finally, is the patient likely to revoke his opinion?
Doctors often find themselves in a quandary when the question arises of providing necessities like food and medicine to the patient. The case of Aruna Shanbag is one in point (see box). Can food, water and basic medical supplies be considered part of essential treatment? Says Pai, “Aruna is not braindead. She does respond to people. She is like small spastic child who cannot take care of herself.” This obviously raises more questions than it answers.
A solution, somewhat more drastic, could be provided by active euthanasia. Here, it is the doctor who actively helps the patient to die, often by means of pills or injections. Purely a judgment call on the part of the doctor and one that is also morally confusing for the medical practitioner. Pai sums the problem up in a nutshell when she says, “Active euthanasia is totally against the law and is tantamount to murder.” Contrast this view point with that of a KEM doctor who prefers anonymity, ” If it is a acceptable to allow a patient to die a slow and painful death without assistance, why not finish his agony by a swift act, by giving him a lethal dosage by injection ?”
As far as euthanasia is concerned, passive or active, those in the medical profession are either in favour of or against it. Like abortion, there can be no real fence – sitting on this issue. Says Dr Prem Lata Chawla, a leading Delhi psychiatrist, “Euthanasia means taking a life away. Besides violating the Hippocratic Oath (which commits a doctor to saving a patient’s life at any cost), it goes against the very grain of our ethics and of our religion.”
Those who favour the right to die claim that ending one’s life is not new to our civilization. The right to die has been sanctioned by Hinduism, Jainism and Buddhism under certain circumstances such as in the service of religion or country. Christianity, on the other hand, treats someone taking his or her own life as being the equivalent of murder. The Koran goes one-step further where, to paraphrase, taking one’s own life is “worse than homicide”. Hinduism has through out history accepted the right to live or, for that matter, dies.
Right -to-lifers will vehemently rattle off references and statistics favouring their stand. They argue that the right to live is sacred and God-given one. Says
Dr Chawla, ” What does the right -to-do advocate want? Do they want to go back to barbaric ages where one person killed another, where the rule of the jungle was the law?” Krishan Kalsi, a counselor at Sumaitri, a center for the mentally disturbed feels, “the right to die cannot be given to individuals because there is always a ray of hope. Who is going to decide it is the right time to die? Death would be natural. Besides, the law of land should be respected.”
Speaking of which, the law is a maze of contradictions. In a historic judgment the Bombay High Court,(on 24 and 25 September,1986), declared section 309 of the Indian Penal Code (IPC) as being ultra vires of the constitution. The section deals with suicide, which automatically includes the right to die. The judgment was a result of a writ petition field with the court by Maruti Dubbal, a constable with the Bombay police. Dubbal had been apprehended while attempting suicide. He challenged the validity of Section 309 on the grounds that it violated the fundamental rights guaranteed under Articles 14 and 21 of the Constitution. Justice J. Sawant ruled that section 309 is unreasonable and arbitrary and consequently struck it down as it went against the Indian Constitution. The police have now stopped prosecuting people who attempt suicide. Says Neural Kumar, DCP of Bombay (south), “We register a case of attempted suicide for people who try to take their lives as a mere formality. We do not prosecute individuals who try to end their
Eminent lawyer Ram Jethmalani says, “The right to die is a part of a wider concept of liberty. The whole nation of the state controlling your life and death is grotesque. You can practice passive euthanasia. The law cannot harm a person who practices it. A clever doctor can always tell his patient, Look here, I am warning you this medicine can be, fatal. I am also warning you it is against the law.” And then he can with draw and if the patient takes the medicine, the doctor is in the clear. Nobody can touch him. He never administered the medicine, the doctor just warned the patient.”
Equally radical is Dr Appa Ghatate, Supreme Court lawyer who agrees,” The right to die should be included in the Indian Constitution as a fundamental right. The very idea of the state controlling your life is absurd.”
The emotional aspect to it is also applicable to this country. The problem being that the issue is very much under publicized and India has enough problems as it is, without raising another one.
But for those who are terminally ill, their families and doctors, it is a problem that is close to the heart something they literally have to live with everyday. Until and unless the right to die or the right to live, however one chooses to look at
It, is addressed as a serious and immediate problem, the choice will always be a difficult one.
A case study
Is euthanasia the solution for Aruna Shanbag?
For the slightly-built, sallow skinned Aruna Shanbag, life begins and ends n a metal bed in ward no.4 of Bombay’s KEM Hospital. She has been confined to the bed for the last 18 years. And it appears as if the metal bed will be all she knows for some time to come.
Aruna should came to pieces on 27 November,1973. She worked as a nurse in this very hospital where she seems destined to die. On the fateful day, after seeing to the needs of a group of schoolchildren who had been admitted for treatment of food poisoning, she went to change before leaving for home.
She never did make it. For lying in wait, was a rapist who put a leather leash around her neck choking her and thereby cutting of the supply of oxygen to her brain. He brutally raped her.
Aruna was discovered the next morning by a ward boy in an unconscious state. The damage had been done and it would be of little consolation for Aruna to know that her assailant was arrested. Since then, Aruna lies in a coma at the KEM Hospital. Earlier, she used to have a constant stream of visitors. No longer, as people have stopped coming to see her altogether.
Does Aruna have right to die simply because she can no longer express herself? Explains Dr Pragnya Pai, ” Aruna is a person whom all of us love. She responds to people albeit in a limited manner. Though whenever she hears a male voice, she starts screaming.”
Aruna continues to remain curled up in her hospital bed in a fetal position, oblivious to what is going on around her. The future looks bleak, not least because she really has no hope of ever leading a normal life. Says Pai, “The Bombay Municipality bears her expenses as she was attached to them while on duty. If we do not care for her, who will?”
An honest question that needs some honest answers. Meanwhile, Aruna lies all but forgotten by her near and dear ones. However, is euthanasia the solution?
THE GREATFUL DEAD
An Indian Organisation helps provide the ultimate solutions
Founded by Minoo Masani, the Society for the Right to Die with diginity, was established in May 1981. The name is self-explanatory. The aims and objectives of the society are:
->To assert the right of every man and women of sound mind and freedom within limits laid down by the law, to choose to live or to die.
Ã° In case of persons who are terminally ill and who are not in a position to speak or think for themselves, to make it possible for persons duly authorised by them to arrange for the termination of the life of such persons after completing the necessary legal formalities and requirements enjoined by law, provided, such persons in a legally valid document gave the necessary authority to the persons mentioned above. Provided, of course, that the patient was of sound mind when making out the document.
->To create public awareness and opinion of the above.
->To work for suitable amendments of the law to enable implementation of the above.
Masani who retired from the chairmanship of the society, explains the rationale behind the objectives, “Veer Savarkar and Sant Tukaram took their own lives. I strongly believe that the right to die is a part of the right to live. A man should decide when he should die, and not the state.” The society has 300 members on its rolls and is currently headed by Dr B.N.Collabawalla. To be a member, one has to be above the age of 21 and agree with the aims of the society.
A ‘living will’ is given to society members which helps an invalid person who might choose death at some stage of his life. Recently, the society took an opinion poll of doctors on euthanasia and came up with some interesting answers.