Contextualising Euthanasia & The Right To Life

The path to hell, when not paved with good intentions, is still generally wrapped in a great deal of moral sermonizing. This is above all true of the recently resurrected euthanasia debate on TV and in print media. Somehow, the preserve-life-at-any-cost argument has drowned out every other viewpoint in a deluge of righteous rhetoric. Lost in all this is one fundamental question: is the right to continue a life quite the same thing as securing a life worth living for those we force to continue to live?

To revisit the root of the controversy, India had no law on Euthanasia till Ms. Pinki Virani moved the Supreme Court asking that King Edward Memorial Hospital, Mumbai stop ‘force feeding’ Aruna Shanbag who had then been in coma for 36 years. Aruna Shanbag, a rape victim, had been strangled with a chain while being sodomized. The oxygen supply cut off, Aruna’s brain had shut down permanently. Virani asked that Aruna be allowed to die in peace and dignity. The Mumbai Municipal Corporation and the Dean of KEM Hospital both begged to differ.

Inevitably, the ball came to rest at the door of the Supreme Court.  In Aruna Shanbaug v Union of India [AIR2011SC1290], the Supreme Court recognised a clear distinction between ‘active’ and ‘passive’ euthanasia and proceeded on the basis that ‘active euthanasia’ was not on the table for debate at all. It looked at legislation across the globe and noted that passive euthanasia was legal in a whole host of countries, amongst them, Ireland, United States, United Kingdom, France, Netherlands, Luxemburg and Belgium. As a general proposition, it all came down to informed consent. If a patient asked that his life be ended, the law had to be certain that he understood the choice he was making. Accordingly, the Supreme Court tried to find a solution suitable to ‘Indian conditions’, whatever that means.

The Supreme Court therefore ruled that the decision must be taken by either the patient, or his or her spouse or close relative. If no close relative were to be found, a body of persons acting as next friend or a doctor attending the patient could take the decision so long as it was bona fide and in the best interest of the patient. Second, the Supreme Court ruled that a High Court order was mandatory. It held that when presented with such a petition, the High Court was required to appoint a team of doctors (comprising of a neurologist, a psychiatrist and a physician) to report to the court, issue notices to government as well as close relatives of the patients and hear them all before allowing the euthanasia plea to be implemented.

As far as I am concerned, this is very far from a satisfactory situation. On the very principle of it, I like a law that leaves citizens free to do or not do something based on clean legal principles, rules and guidelines. I didn’t like the license permit quota raj of approvals, of hiring lobbyists and making applications and incurring costs and fixing petty bureaucracy to process these applications. Similarly, I don’t think citizens should need court permission to die, if they want to, or lawyers to process their permissions. Our courts are overflowing with cases they have no hope of deciding for decades. The last thing we need is for courts to actually become administrators and perform the roles of supervisory boards of hospitals granting approval to medical decisions. That is not my only objection.

Second, the right to life must include the right to not live. I’ve had two aunts who declined all medical assistance after they learnt their situation was terminal. They withdrew from all society and then basically waited to die. Their deaths were not pretty, not by a long shot, and they were coherent to the very end. If they had been given a choice, I suspect both would have at some point chosen a quick exit over the prolonged painful lingering decline they suffered. Active euthanasia may be culturally alien to some of us but any debate premised on a sense of humanity must dwell on the inhumanity of asking a fellow human being to suffer just because a doctor, or a relative, is too squeamish to end a life when asked to do so.

Bear also in mind that there is something deeply problematic about the distinction between active and passive euthanasia.  If withdrawing life support or medication makes euthanasia passive, what about withdrawing food, or better still withdrawing water? A healthy person denied water may not live for much longer than 5 days. If you will forgive the insensitivity, there is always a passive euthanasia solution for every situation. If you think about it, this kind of euthanasia is not culturally alien to us either. Jain monks still starve themselves to death, and to no one’s disquiet.

The real difficulty here is that it is not merely the terminal who need help to secure an easy exit. Medical sciences are already at a point where life can be prolonged indefinitely, even though an acceptable quality of life can’t be secured. What you have then is a severely disabled person who barely functions, but is perfectly functional in the sense that the digestive system works, end to end, but maybe not so much else. I’ve had an uncle who lived more or less in a coma for some eight years after he had his stroke, severely stretching family resources. The ensuing budgetary constraints meant that the children could not get the education they deserved, bringing relations within the family to point break. He died without ever ‘regaining consciousness. Which cannon of humanity justified the price the family pays for the choice they were not allowed to make? The cynic would argue that for the law, the right to life includes the right to make those who love you miserable.

Which brings us to patients who find themselves in hospital, surviving only because the laws says the machines must not be switched off except by a court order. That may not be what the relatives are told. Still the fact remains that at the end of the day, for so long as there is someone to pay the bills, a hospital may add Rs. 50,000 to its top line for everyday a court takes to decide a euthanasia case. Courts take years to decide anything at all. The idea that our sense of humanity and our compassion should transform seamlessly into shareholders value is deeply disturbing.

Confronted with this reality, I ask myself what do I expect from the law? The first thing I don’t expect is elevated moral obscurantism. I ask for recognition that the right to life is thus transformed by the pressure of the marketplace into corporate bottom lines and ESOPs. I want recognition that continuing some lives is emotionally and financially unaffordable in some cases. I expect the law to be pragmatic. It comes down to common sense, the right to choice and the ubiquitous questions around informed consent. If I want to die, or I am too far gone to tell but rational well-wishers around me think I should, then hey, it was a great ride while it lasted! Why cling to the ephemeral?

Originally published on July 25, 2015 in Businessworld


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