The will to die

Inherent in the idea of human dignity is the right to choose a dignified death. The ‘living will’ judgment makes that possible

Dr Nagraj G Huilgol | April 4, 2018


#Passive Euthanasia   #Euthanasia   #Supreme Court  
(Illustration: Ashish Asthana)
(Illustration: Ashish Asthana)

Death is an inevitable consequence of birth and evokes as much a sense of mystery as it inspires awe and fear. In the Kathopanishad, Nachiketa considers knowledge of death and the beyond as the only truth. The idea of invoking death by choice, or ichchhamaran, is unique to the Indian ethos. But it has taken decades of struggle to legalise the idea of a ‘living will’ (which sets out a person’s will that he or she be allowed to die under certain conditions). Medicine is no longer about administering placebos. A recent judgment of the supreme court of India on passive euthanasia and living wills has brought partial closure to the long campaign of the Society for the Right to Die with Dignity, an organisation started by Minoo Masani in the 1960s.

Active medical and surgical intervention, backed by technological innovation, can not only cure illness but also prolong life.
Hooked to expensive ventilators, dialysis machines and other supportive systems, a patient can be made to live for much longer than the normal life expectancy for someone with their complications. The cost of artificially prolonging life can be both emotionally and financially prohibitive while outcomes are not always positive. Human finitude, the indignity of pain, and  a sense of a lack of self make the situation a living hell. The futility of treatment often gets overlooked. There is also much emotional pressure from beloved ones and others. What the five-judge constitution bench of the supreme court has pronounced, after hearing a petition from the Society for the Right to Die with Dignity and Common Cause, both rights groups, is to legalise passive euthanasia and ‘living wills’, laying down caveats and strict guidelines.

Individual autonomy is at the core of modern, non-paternalistic medical practice. Every individual has the right to refuse any treatment. Administration of treatment without informed consent amounts to battery. This autonomy is as relevant when an individual is not aware of the self (or unconscious) as when he is fully aware and in his senses. Currently, the power of attorney is usurped by surrogates without any explicit consent.

Legalising a living will changes it all. The living will is a document executed by a competent person of sound mind, on his/her own volition and under no coercion, about the health care decisions to be followed in the event of the person becoming incompetent to make such decisions or give consent for such treatment. This may include detailed instructions regarding therapeutic decisions or may be in the nature of designating a power of attorney to a surrogate who understands the needs and aspirations of the individual. The individual is free to revoke the living will at any time. Unlike a suicide note, it lists dos and don’ts –guidelines to be followed so that life is not needlessly prolonged.

A detailed living will without much ambiguity assists the treating physician to take appropriate decisions. The living will may instruct a physician not to resuscitate if the heart has stopped functioning for a period which might cause brain damage; if the patient is afflicted with an irreversible or irrevertible disease process; or if he or she is downed by a neuro-cognitive or other condition leading to a vegetative existence. In such conditions, the endeavour to maintain life at any cost is demeaning, bereft of dignity, and comes with a huge economic burden. It is a good practice for physicians to be empathetic and respect the living will. The logic and the idea of living will itself needs to permeate the health care system. The fear of abuse is overblown. The current system of surrogate deciding the fate of a helpless individual will continue till the living will becomes a popular idea.

Euthanasia literally means good death. Interpreted differently, it is life of dignity and without pain till death. Euthanasia has to be voluntary, be it active or passive. The supreme court has now approved passive euthanasia. Active euthanasia is an act of commission like overdosing of sedatives with an explicit intention to end life whereas passive euthanasia results from omission, like withdrawal of life sustaining devices or treatment. The proponents of active euthanasia think it immoral to prolong the agony when it is possible to end the same. However, those who endorse passive euthanasia think that not saving a life, particularly when it cannot be saved, is morally and legally permissive.

Euthanasia is further grouped into involuntary euthanasia and non-voluntary euthanasia. Involuntary euthanasia refers to a situation in which the person has the capacity to consent but has not provided one and non-voluntary euthanasia is a situation in which person is unable to provide a consent for reasons such as dementia or coma. Involuntary euthanasia should be avoided at all costs so that one doesn’t take the slippery slope. Non-voluntary euthanasia or passive euthanasia in the absence of living will must to be performed according to the guidelines prescribed by the supreme court.

The ruling may not change the prevailing practice, where de-escalation of treatment or DNR (‘do not resuscitate’ order) is followed on the instructions of the family. It will definitely have an impact on non-voluntary euthanasia. The decision is significant for an entirely different reason. The supreme court says, “The right to privacy protects autonomy in making decisions related to the intimate domain of death as well as bodily integrity”!

In these turbulent times, it is the secular (non-religious) undertone of the decision that calls for a big applause.

Dr Huilgol, the chief radiation oncologist at Dr Balabhai Nanavati Hospital, Mumbai, is president of the Society for the Right to Die with Dignity.

(The column appears in the April 15, 2018 issue)

Comments

 

Other News

It`s time to Unlock now, with economic focus

With Lockdown 4 ending Sunday, the home ministry has issued new guidelines to fight COVID-19 and for phased re-opening of areas outside the Containment Zones. The guidelines, issued based on extensive consultations held with states and UTs, will be effective from June 1 till June 30. The first phase of reo

Small kitchen gardens turn saviours for Gujarat tribal families

When the whole world is fighting COVID-19, food and nutrition security has become a major issue. The pandemic has aggravated the existing food crisis in India, especially in rural and tribal regions. There has been less availability of fresh foods in most parts of the country, and the tribal community has

India will set example of post-Covid-19 economic revival: Modi

India is determined to “set an example” for the rest of the word in the post-pandemic economic revival, prime minister Narendra Modi has said, underling the need to become self-reliant. “There is also a widespread debate on how the economies of various countries, including

3,543 ‘Shramik Special’ trains transport 48 lakh people in 26 days

Close to 48 lakh migrant labourers have been able to reach home from the cities they were working in, as the Indian Railways have run a total of 3,543 “Sharmik Special” trains from May 1. Following the home ministry order regarding the movement by special trains of migrant worker

How Jeevan Raths have helped 52,000 migrants in Maharashtra

Before the novel coronavirus hit it, Mumbai about 10-12 lakh labourers from elsewhere had made it their home. The figure for the state of Maharashtra was another 18-20 lakh. As the pandemic spread and the Maximum City emerged as the worst-hit place in India, all economic activities came to an end, and with

China is practicing attack as the best form of defence

For the rest of the world, it is not easy to understand China when it comes to politics or economics. Under pressure from the international community, it has accepted to open the country for a “comprehensive” probe into the origin of the deadly coronavirus. But it is not clear whether the Asian



Archives

Current Issue

Opinion

Facebook    Twitter    Google Plus    Linkedin    Subscribe Newsletter

Twitter