Wednesday, 8 July 2015


Euthanasia in Greek means “good death”. It is defined as the practice of intentionally ending a life in order to relieve pain and suffering. Euthanasia, a perplexing subject worldwide, is once again the centre of a debate in India with the death of the woman who started it all – Aruna Shanbaug - the mercy killing plea for whom was rejected by the Supreme Court in 2011. While the vast majority of countries have no laws permitting active euthanasia or assisted suicide, reports show that they are practised illegally by some doctors, nurses and even by friends and family members of seriously ill patients.
Euthanasia is controversial for many reasons: The most important reason is often religious. Most religions oppose the idea because they see it as going against god’s will. But then a rationalist will say that religion is never rational on this score. After all god’s will can never be known and thus it makes no sense to pander to his presumed will. It is human reasoning that must prevail.
The second reason is that neither family nor doctors feel comfortable playing god themselves. This is a real issue. The state clearly has to set foolproof guidelines on who can take these decisions, and create panels that can supervise passive or active euthanasia.
Euthanasia raises a number of agonising moral dilemmas:
·                is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering?
·                under what circumstances can euthanasia be justifiable, if at all?
·                is there a moral difference between killing someone and letting them die?
If suffering cannot be relieved, the question then becomes: what should the State do? Should we all be forced to live on regardless of the quality of life that confronts us? Or, should legislation be extended to ensure dignity and choice for all?
Euthanasia is not a new concept with respect to Indian culture. This practice was prevalent in ancient times, and references could be found in Mahabharat, wherein Bhishma has the blessing of “iccha mrityu”. Sadhguru Jaggi Vasudev opines, “Death is not a sudden happening, but an inevitable end. In this culture, we always planned- prepared for a conscious exit. Four stages of life included this. Vanaprastha meant that when one feels they are done with the purpose of life, they walked away into the forest to let go of the body. One has the right to determine the course of life; one has the right to determine one’s exit. The concept of Nirvana and Samadhi, too, forms a part of it.”
The modern Hindus, who are morally bound to their religion or culture, would strongly disapprove of euthanasia, which they consider a suicide. Hindus believe that a person committing suicide does not attain Moksha or salvation from the cycle of life and death. It is again looked at as an act of violence, as a consequence of which the doctor and patient both will be devoid of Moksha.
Muslims strongly condemn euthanasia as they believe life and death of a person depends on Allah's will, and human beings are prohibited from going against His will. They categorically forbids all forms of suicide and any action that may help another to kill themselves. It is forbidden for a Muslim to plan, or come to know through self-will, the time of his own death in advance. The precedent for this comes from the Islamic Prophet Muhammad having refused to bless the body of a person who had committed suicide
Holding a similar view like that of Muslims, Sikhs believe that life is gift of God; hence one must accept sufferings without complaint.
Christianity also does not support euthanasia, as they too believe life is a gift of God and one must respect it. The Roman Catholic Church strongly opposes physician-assisted suicide and euthanasia. The church teaches that life should not be prematurely shortened because it is a gift from God.
At the same time, the church recognizes that a dying person has the moral option to refuse extraordinary treatments that only minimally prolong life. The predominant distinction or criteria for legitimate refusal of treatment is whether the treatment in question is considered proportionate or disproportionate. This means patients can legitimately forgo treatment that doesn’t give a reasonable hope of physical or spiritual benefit, such as resuscitating someone who is at the very end of life.
Following similar belief of karma as Hindus, Buddhists believe that their next life depends on their deeds of past life. Also, they are against causing harm to any life.
According to Damien Keown, emeritus professor of Buddhist ethics at Goldsmiths College, University of London, Buddhists generally oppose assisted suicide and euthanasia. Buddhism teaches that it is morally wrong to destroy human life, including one’s own, he says, even if the intention is to end suffering. Buddhists are taught to have a great respect for life, Keown says, even if that life is not being lived in optimal physical and mental health. Although there is no direct mention of euthanasia in Buddhism, they too do not seem to support it as both the giver and the taker of euthanasia would commit harm.
However, he says, Buddhists also believe that life need not be preserved at all costs and that one does not need to go to extraordinary lengths to preserve a dying person’s life. This means, for instance, that while a terminally ill person should not be denied basic care, he or she could refuse treatment that might prove to be futile or unduly burdensome. “The bottom line is that so long as there is no intention to take life, no moral problem arises,” Keown says.

Mahavira Varadhmana explicitly allows a sharavak (follower of Jainism) full consent to put an end to his or her life if the sharavak feels that such a stage is near that moksha can be achieved this way. Liberation from the cycles of lives being the primary objective in the religion. Sallekhana (also Santhara, Samadhi-marana, Samnyasa-marana), is the Jain religious ritual of suicide by fasting. It is not classed as suicide in the Jain religion. The process is still controversial in parts of India. Jain websites recommend finding a place where it is not actively opposed and there is an apparently supportive community. Estimates for death by this means range from 100 to 240 a year. Preventing santhara invites social ostracism.
Thalaikoothal (showering) is the traditional practice of senicide / geronticide (killing of the elderly) or involuntary euthanasia, by their own family members, observed in some parts of southern districts of Tamil Nadu state of India.
Thalaikoothal works thus: an extensive oil bath is given to an elderly person before the crack of dawn. The rest of the day, he or she is given several glasses of cold tender coconut water. Ironically, this is everything a mother would’ve told her child not do while taking an oil bath. “Tender coconut water taken in excess causes renal failure,” says Dr Ashok Kumar, a practicing physician in Madurai. By evening, the body temperature falls sharply. In a day or two, the old man or woman dies of high fever. This method is fail-proof “because the elderly often do not have the immunity to survive the sudden fever,” says Dr Kumar.
OVER THE years, other methods have evolved too. The most painful one is when mud dissolved in water is forced down; it causes indigestion and an undignified death. Velayudham of Help age India says the families often take the mud from their own land, if they have any. “It is believed that this makes their souls happy,” 
  1. Tremendous pain and suffering of patients can be saved. Numerous ailments such as certain types of cancer result in a slow, agonizing death. Doctors have enough knowledge and experience to know when a patient's days are numbered. What purpose would it serve to suffer endlessly until the body finally gives out? Imagine what it would be like to spend six months vomiting, coughing, enduring pain spasms, losing control of excretory functions, etc. Then you must consider the psychological suffering; i.e. the knowledge that a patient knows he's definitely going to die and the pain is only going to get worse. Wouldn't it be more humane to give the patient the option to say when he's had enough?
  2. The right to die should be a fundamental freedom of each person. Nowhere in the constitution does it state or imply that the government has the right to keep a person from committing suicide. After all, if the patient and the family agree it's what they want to do, who's business is it anyway? Who else is it going to hurt? In a country that's supposedly free, this should be a fundamental right. But then Suicide or an attempt to Suicide is a criminal offence under Indian Penal Code and the only offence where you can not punish the offender if he/she succeeds in his/her act of crime called suicide.
  3. Patients can die with dignity rather than have the illness reduce them to a shell of their former selves. Dying patients sometimes lose all ability to take care of themselves. Vomit, drool, urine, faeces, and other indignities must be attended to by nursing assistants. Alzheimer's patients suffer from progressively worse dementia that causes memory loss and incoherent rambling. Virtually all people want others' last memory of them to be how they once were, not what they ended up being. For example, Ronald Reagan died of Alzheimer's. He and his family would like people to remember the brave man that stared down the Soviets, told Gorbachev to "Tear down this wall", and as the "The Great Communicator", provided historic leadership. Other patients and families have the same wishes for themselves. We should let people die with their dignity, pride, and self-worth intact.
  4. Pain and anguish of the patient's family and friends can be lessened, and they can say their final goodbyes. Friends and family of the patient often suffer as much or more pain as the patient himself. It's difficult to see a loved one in such anguish for so long. It's emotional and physically draining to have the stress drawn out for so long. And when the patient does eventually die, it's often sudden or it follows a period when the patient has lost consciousness. Doctor-assisted suicide would give the patient a chance to say his final goodbyes and end his life with dignity.
  5. Reasonable laws can be constructed which prevent abuse and still protect the value of human life. Opponents of a doctor-assisted suicide law often cite the potential for doctor abuse. However, recent Oregon and UK laws show that you can craft reasonable laws that prevent abuse and still protect the value of human life. For example, you can require the approval of two doctors plus a psychologist (who verifies the patient has the capacity to make the right decision). You can proscribe waiting periods, get the additional sign-off of family members, and limit the procedures to certain illnesses. States should have the rights to pass laws that take into account the values and wishes of the people of that state.
  6. Vital organs can be saved, allowing doctors to save the lives of others. We have long waiting lists for hearts, kidneys, livers, and other organs that are necessary to save the lives of people who can be saved. Doctor-assisted suicide allows physicians to preserve vital organs that can be donated to others (assuming the patients are organ donors). However, if certain diseases are allowed to run their full course, the organs may weaken or cease to function altogether. Once again, we have to put the needs of the living ahead of the needs of the dying.
  1. It would violate doctors' Hippocratic oath. Upon receiving a medical degree, each doctor is required to take a Hippocratic oath, which says among other thing, "First, do no harm". Assisting in suicides would be a violation of that oath, and it would lead to a weakening of doctor-patient trust. The oath was created in part so patients could be reassured that doctors only wanted to help them, not hurt them. A weakening of that oath may cause patients to wonder.
  2. It demeans the value of human life. In this country, human life means something. For each death, we have 1-2 days of ceremonies, elaborate burials, and months of mourning. To stomp out a life because it's not convenient or it's expensive demeans that value. Human life is much more that just a cluster of biological cells.
  3. It could open the floodgates to non-critical patient suicides and other abuses. Any loosening of the assisted-suicide laws could eventually lead to abuses of the privilege. For example, patients who want to die for psychological or emotional reasons could convince doctors to help them end their lives. Attitudes would loosen to the point that certain states may decide that any person can commit suicide at any time. We can't let our values shatter this way.
  4. Many religions prohibit suicide and the intentional killing of others. The most basic commandment is "Thou shall not kill". Virtually all religions have a law against killing. We need to protect the morality of not only the patients but the doctors that must extinguish their lives.
  5. Doctors and families may be prompted to give up on recovery much too early. If a patient is told that he has, for example, six months left to live with progressively worse pain, he may decide to end things before things start to get worse. This wipes out valuable time that can be spent with family and friends; it also denies the slim chance of a recovery or the possibility of discovering a doctor error.
  6. Government and insurance companies may put undue pressure on doctors to avoid heroic measures or recommend the assisted-suicide procedure. Health insurance providers are under tremendous pressure to keep premiums down. To do this, they must cut costs at every turn and make tough decisions. Many doctors are already prevented from give patients certain tests or performing certain operations despite what the doctor believes is truly necessary. Legalizing assisted suicide would likely invite another set of procedures as to when life-sustaining measures should be undertaken. We shouldn't give the insurance companies any more power over human life.
  7. Miracle cures or recoveries can occur. You can never underestimate the power of the human spirit. A cheerful, never-give-up attitude can often overcome the longest of odds and the worst of illnesses. You also have to consider the constant medical and pharmaceutical advances that just might lead to a miracle recovery. We should never get to a point where we spend more time looking for a way out of life than for a way to sustain life.
  8. Doctors are given too much power, and can be wrong or unethical. Patients put their faith and trust in the opinions of their doctor. If doctors tell a family there's absolutely no chance for a patient to survive, the family is likely to believe them. This is a problem for two reasons. First of all, doctors make mistakes just like any other people. A wrong diagnosis could lead to the suicide of a savable person. Second, doctors have the ability to play God and decide who they encourage or discourage on the prospects of recovery. For example, imagine a doctor who believes there is too much of a shortage in medical staff & resources to pour extra time & money into elderly people. He may always lean towards the side of "no hope" when the odds are sketchy. Decision-making ability on matters of life and death should stay where it belongs--with God, not doctors.

Voluntary euthanasia gives too much power to doctors
Legalisation of euthanasia is usually championed by those who have witnessed a loved one die in unpleasant circumstances, often without the benefits of optimal palliative care. This leads to demands for a 'right to die'. In reality the slogan is misleading. What we are considering is not the right to die at all, but rather the right to be killed by a doctor; more specifically we are talking of giving doctors a legal right to kill. This has its own dangers which we shall consider shortly. Allowing difficult cases to create a precedent for legalised killing is the wrong response. We need rather to evaluate these difficult cases so that we can do better in the future. 
Calls for voluntary euthanasia have been encouraged either by the failure of doctors to provide adequate symptom control, or by their insistence on providing inappropriate and meddlesome interventions which neither lengthen life nor improve its quality. This has understandably provoked a distrust of doctors by patients who feel that they are being neglected or exploited. The natural reaction is to seek to make doctors more accountable.
Ironically, voluntary euthanasia legislation makes doctors less accountable, and gives them more power. Patients generally decide in favour of euthanasia on the basis of information given to them by doctors: information about their diagnosis, prognosis, treatments available and anticipated degree of future suffering. If a doctor confidently suggests a certain course of action it can be very difficult for a patient to resist. However it can be very difficult to be certain in these areas. Diagnoses may be mistaken. Prognoses may be wildly misjudged. New treatments which the doctor is unaware of may have recently been developed or about to be developed. The doctor may not be up-to-date in symptom control.
Doctors are human and subject to temptation. Sometimes their own decision-making may be affected, consciously or unconsciously, by their degree of tiredness or the way they feel about the patient. Voluntary euthanasia gives the medical practitioner power which can be too easily abused, and a level of responsibility he should not rightly be entitled to have. Voluntary euthanasia makes the doctor the most dangerous man in the state.
Traditional medical ethical codes have never sanctioned euthanasia, even on request for compassionate motives.
The discussion over human euthanasia evokes strong emotions on both sides of the debate. Convincing justifications are found for both viewpoints. Doubtless, at times a need exists for euthanasia, be that in active, passive, involuntary, or voluntary form, and some forms of euthanasia do exist; however, society must ask what the cost of life and death is: financially, physically, emotionally, and mentally. One person or group should not determine how, when, and if another person should die. Ending an individual's life, because someone decided that person's life provides no value to the individual or to society is not ethical and never will be. If the Netherlands is considered a test case, the system of protections put in place can and will be abused. As the world watches, the slippery slope of legalized euthanasia in the Netherlands begins to model the genocide perpetrated by Hitler, and one must ask where the line is drawn. Legalized euthanasia has become a tragic means-to-an-end for older, poor, terminally ill, mentally disabled, suicidal, and other at risk populations in the Netherlands. Is it realistic to believe the example set forth in the Netherlands can have any different results elsewhere?
We need to recognise that requests for voluntary euthanasia are extremely rare in situations where the physical, emotional and spiritual needs of terminally ill patients are properly met. As the symptoms which prompt the request for euthanasia can be almost always managed with therapies currently available, our highest priority must be to ensure that top quality terminal care is readily available.

While recognising the importance of individual patient autonomy, history has clearly demonstrated that legalised euthanasia poses serious risks to society as a whole. Patients can be coerced and exploited, the search for better therapies is compromised and involuntary euthanasia inevitably follows. Legislation allowing voluntary euthanasia should be firmly resisted on the grounds that it sidesteps true compassionate care (because effective alternatives exist) and ultimately undermines rather than protects patient autonomy.

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