By Sumitra Padmanabhan
The writer, the General Secretary of Humanists' Association raises the valid question of why very sick and suffering people beyond recovery should not have the right to choose death. Venkatesh and his mother Euthanasia is a Greek word that means ‘good-death’ (eu = good, thanatos = death). In other words – a death that is preferable to life. When life becomes unbearable for whatever be the reason, a person or his/her near ones may wish for his or her death. It may be a conscious wish by the person’s relatives or guardians. In the latter case it may so happen that the person concerned suffers prolonged irrecoverable illness or is in an unconscious state. When we talk about ‘euthanasia’, we mean injecting lethal drug to bring about death of an ailing person, or withdrawal of life-saving drugs or implements, allowing the person to die. By ‘death-wish’ I mean the instances where the person concerned takes the decision to discontinue life. He or she asks for death in countries where active or passive euthanasia is permitted by law. In other countries such people commit suicide or wait for death in painful condition unable to move or carry out their wish without assistance. The original Greek word reminds us that the idea of mercy-killing existed centuries ago when our society was less complex and human corruption was less widespread and therefore legal aspects less stringent. We have heard of stories where a compassionate soldier shot his fatally wounded dearest friend to quicken his painful end. We put our disabled old pet dog or a favorite injured horse to sleep without any qualms. The act in these cases is simple and humane. The decision is taken by the owner of the animal and the doctor implements the act. Why then, this ‘humane’ act so difficult to carry out in case of human beings? We know active euthanasia is legal in two countries – Holland and the state of Oregon in USA. There, a person who is terminally ill can wish to end life with doctors’ assistance. To prevent legal complications over inheritance, lawyer’s help is also sought. A person, after complying with all the formalities can meet all friends and relatives before saying a final good-bye to life. Even then, the numbers of people who wish for death do not finally take the decision. Psychological and medical counseling make them change or postpone the decision. Such is the beauty of life. In many other states of USA passive euthanasia is common. That is, when a patient has no chance of recovery and is nominally living with medical assistance, he or she is allowed to die by discontinuing the medical care needed to keep the patient alive. In this case the will of the patient may not be taken into account, as in most cases such a patient is unconscious or in a vegetable state. If the patient is conscious and asks for a ‘physician-assisted suicide’, it becomes an illegal proposition in most countries including a majority of states in the USA. We are reminded of the Italian poet Pierre-Georgio Welby who suffered from muscular dystrophy for a decade until on his repeated requests his anesthetist friend ‘killed’ him with an overdose of sedative. The friend Mario Ricci is now facing trial for murder as euthanasia is illegal in Rome. The number of people who support Mario’s ‘act of kindness’ is on the rise. Most people would agree that to live just for the sake of living with elaborate and expensive life-support system is worse than death. A person who still has a will to voice his opinion and has the ability to realize the futility of his existence suffers even more. Therefore, it is all the more logical that his wish be fulfilled. Why then is human society still hesitant about legalizing physician-assisted suicide? If we go through the reasons for not encouraging euthanasia, we will find four basic arguments against legalizing mercy-killing. There are four common arguments.
One: “We cannot create life; can we willfully take away life?” This statement though sounds logical, is the silliest of the lot. It makes a pathetic attempt at sentimentalizing the issue, usually in the name of religion, by equating it with murder. If taking life was so very objectionable, those who hold this view should first stop warfare. Do we not train healthy, young human beings in the art or science of killing when we send them to the battlefield equipped to kill equally innocent and healthy youngsters of another country? So, this argument does not stand. Let us first stop manufacturing weapons before we pay heed to such foolish arguments.
Two: Religious restrictions. In Jain religion, committing suicide by willfully discontinuing the intake of food and water is allowed. In 2006 Kolkata witnessed the ‘public farewell’ of three elderly Jain women who embraced death in this method approved by ‘Jainism’. In Hindu religious texts and mythologies we find a number of instances of ‘Shwechha-mitryu’ (self-willed death). Roman Catholics opposed abortion for centuries equating it with homicide, but abortion is now legal in most countries. So, even if some religions consider suicide as sin, it does not affect people who wish to say good-bye to life. After all, there is no compulsion, legal or otherwise, to strictly adhere to all religious practices and beliefs.
Three: There is always a question of doubt before deciding on euthanasia for terminally ill persons. What if there is still a minuscule possibility of recovery? What if within a few days or months new drugs are discovered to treat the particular ailment? Since the decision is ultimate and irreversible, any possibility of regret at a later stage would be disastrous. It is true. In case of passive euthanasia or active mercy killing where the person concerned is not in a position to give his opinion, utmost efforts should be made to justify the decision. All legal and ethical aspects should be exhaustively explored and the opinions of the nearest members of the family who are the patient’s custodians should be taken into account. But waiting for the possibility of new drugs being invented has no logic. It does not justify prolonging a painful and futile life. Moreover in third world countries like India where health services for the poor is inadequate, euthanasia (with written request by near and dear ones and/or request by the patient) will have many positive effects. Firstly, when a patient occupies a bed for months without any chance of recovery, the patient’s relatives gradually become disinterested. They lose patience and become reluctant to spend further. Active euthanasia would --
a) Make a bed available to one of the numerous patients who are returned from hospital gates due to lack of vacancy. Many such accident or snake-bite victims die on the way traveling from hospital to hospital looking for admission. b) The patient’s relatives are saved from excessive and futile expenses and from the depressing duties of daily visits to the hospital; in cases of villagers it can mean a positive health hazard, waste of time and energy. c) The body of the ailing person can be utilized for other patients. In India, a brain-dead person’s body is legally used for transplantation of usable organs. In case of active euthanasia, arrangements can be made for transplantation, while in the hospital. The patient’s near ones only would have the pleasure of curing other patients from sure death by allowing the hospital to utilize organs of the terminally ill after consenting to mercy killing. So there are these three positive benefits if euthanasia is made legal possibly, all over the world.
We remember Venkatesh, a boy of twenty from Hyderabad who died in 2004. He knew he was terminally ill and his last wish was to donate his entire body after euthanasia by withdrawing life-support system. His mother wanted to honor his last wish and spent the last few days in hectic attempt knocking at all possible doors of the state asking for permission to put Venkatesh to sleep. He was in acute pain—breathing with difficulty. But to no avail. ‘Mercy-killing was illegal’, was the only answer she got. What was the result?
1. Venkatesh died anyway. 2. His last wish was not honored, causing deeper agony to his mother. 3. His body could not be fully utilized because of the delay. With prior arrangement, if transplantation is carried out properly as done in cases of the brain-dead, four or five patients can be revived from sure-death situation and at least 10–12 body parts can be used to treat various ailments or injuries from the donated body of a single patient.
Then for whom is this law after all? Is it for the benefit of man? Or is it just a kind of rigid superstition that forces you to suffer against your will? Whose life is it anyway? Once upon a time foeticide was illegal. It was also considered to be killing of a human life. Now abortion is legal and necessary in some cases in the interest of a healthy human society. It is shocking news that twenty cotton-farmers of Vidarbha in Maharashtra sought permission from the Prime Minister to commit suicide. They were totally immersed in debt. For them there was no way to repay the loans with the high interest accrued. The only other way was to starve to death. It is a known fact that during the last 3 years more that 9000 cotton farmers committed suicide in India by consuming pesticides. Could any one stop them? Could the government say – ‘No, suicide is illegal, we will somehow save you.’ No. The state was a silent spectator. People of Somalia, people of Amlashol or Kalahandi die of starvation in thousands. What have the respective states got to say? — ‘Yes, you live. You crawl and you creep your way to death watching your children die in front of you, helpless, ailing and starving.’ So, a state or law can have nothing justifiable to say regarding an individual’s wish to live or to die. [Ironically, India has recently changed the law – ‘attempt to suicide’ is not punishable any more. It was a clever decision. Poor survivors of attempted suicides would otherwise fill the jail hospitals. At least they would have got two meals there!] In fact state becomes instigators to suicide in the above-cited instances. We know in India bride burning is a common incident. The law is strict about it. Even if a young wife commits suicide, the husband and his parents are booked for instigating the suicide. So, in case of deaths in Amlashol and Bidarbha – should the state or its representatives not be punished for abetting suicide? Finally we must agree that a life should be worth-living. A painful life with prolonged old-age and illness cannot be better than a shorter healthy life. Medical science has made remarkable advancement. But man sometimes forgets that science and medicine should be utilized to make life healthy and happy. Just to make life longer by keeping the heart beating with the help of medical aids cannot be the answer. Fourth and the most terrible argument is that if euthanasia is made legal, it is bound to be misused. Even many legal professionals, when confronted with the topic express their apprehensions about abuse of law. Our question is – ‘Is there any law which has not been misused?’ We constantly hear about false charges being framed to get leaders of idealistic militant groups arrested. Wicked women to get divorce along with the husband’s money are framing false charges of torture. Hospitals get away even after ‘killing’ a patient with wrong treatment, female feticides in India is so rampant that it has resulted in gender imbalance in some states, but only a single doctor has so far been booked. Are these not examples of misuse, abuse and loopholes of law? So, the possibility of being misused cannot be a reason for not passing a law otherwise logical and ethical. Where there is corruption, misuse of law is a natural corollary. If the corruption is at an upper level among state officials and educated professionals, misuse of law becomes a practice. And, this logic becomes totally irrational when seen against the free will of a sane human being regarding his or her life and death. Man does everything for his own pleasure, for the happiness of his near and dear ones and for the well being of the society around him. Life is meaningful only when we enjoy life. So, when living is constant pain, life is futile and man ceases to be of any use to others, the only natural and rational answer is to accept and embrace death. So ‘euthanasia’, active or passive, if and when needed is the only logical and the most beautiful end we can think of. It has to be accepted sooner or later and be passed as a universal law. The sooner we realize it, the better it would be for millions of people around the world. At the end of an active and useful life – death is natural and beautiful. Man makes it ugly by trying to prolong it unnecessarily and with unnatural means. Many children are born with deformities and congenital incurable diseases. Their parents, knowing well that they cannot even survive their infancy, are forced to witness the agony. They and the siblings of the child suffer unspeakable pain. In such cases too the parents could take the ultimate decision and the doctor could only implement their wish and save all from further pain. In India, as probably everywhere else, old-age is a curse. Be it village or city, be it the upper class or the poverty-stricken – the infirm old women and the superannuated, old and disabled men face utter neglect in most cases. Their final years of life are spent in utmost loneliness. The younger family members hardly understand their mental state. There may be exceptions, but to ignore or disregard this fact would be utter hypocrisy. In the third world countries, we do not so far find any attempts – social or state-sponsored – to improve the quality of life of its debilitated senior citizens. They have neither anything to occupy or entertain themselves, nor do they have any place to complain to. It is a shame that an active and well-utilised life faces such a humiliating end in most cases. The ancient Indian had divided his life into four parts – Brahmacharya, Garhasthya, Vanaprastha and Sannyas. The last one ‘Sannyas’ was when the aged was ready to face the end. He would leave the house for a long walk to some pilgrimage in the woods or the mountains and spend the last few days in secluded meditation. The end would come naturally without much subsistance and without any artificial intervention. It was easier in the ancient, idyllic life-style and social set up. We can easily apply this basic concept to the modern world. During ‘Vanaprastha’, an elderly couple would leave the property and household duties to the younger generation who are earning members by then. They lived separately. After that came the time of choosing the final days of life. A time comes when an old person loses all interest in the pleasures of life and prefers to be left alone. The best way to treat them would be to allow then to have their own way, (which is hardly allowed by the modern, ‘know-all’ younger generation) and not to harass them with unwanted medical support. Once upon a time childbirth was uncontrolled and child mortality rate was high. Even during the end of the nineteenth century an average Indian woman used to bear 8 to 12 children of which on an average 3 or 4 would not survive beyond the age of five years. Other than congenital infections and accidents, diseases like typhoid, malaria, tuberculosis and cholera would take the annual toll. So, along with the advancement of medical science, control over the birth of children has positively improved the quality of life. Similarly, along with proper physical and psychological care of the elderly the disabled and the sick, if we learn to exercise control over death, we would definitely gain. We would have a better, healthier and happier society. Surely we do not wish to see a world filled with sick, old, prematurely old or disabled and unhappy men and women waiting for the end! Since legalization of Euthanasia would bestow utmost importance to the wish of the individual, misuse would be minimal. Making a will would be mandatory and that would further reduce the possibility of misuse of law. Life is beautiful. We would all love to enjoy it to the last bit. So ‘right to die’ would never become a ‘duty to die’ – whereby compelling a person or making a person feel unwanted. All such decisions would be taken in exceptional cases by committees made of near relatives, doctors and lawyers. Religious instructions and law go hand in hand. Once upon a time abortion was illegal, immoral and unethical following the religious order. Time has changed the concept. It is time that we realize the need to have control over death as well as over birth. In the interest of a better, happier society laws are beings changed. Hundreds of new laws are being made every year. The concept of ‘right to die’ would necessitate new laws being made all over the world. The idea that a peaceful, painless death awaits in the end would make life happier and the world healthier and a better place to live in.