Suffering and pain are universal; human empathy and grief towards the trauma of a loved one are unbound and immeasurable. Emotional scars on the family members of a patient are for life. And in such situations, euthanasia is an easy option that can give everyone involved a clean closure.
There are two procedural classifications of euthanasia: passive and active euthanasia. Passive euthanasia is when life-sustaining treatments are withheld, while active euthanasia is when someone uses lethal substances or forces to end a patient’s life, whether by the patient or somebody else.
Active euthanasia is more controversial and is more likely to involve religious, moral, ethical and compassionate arguments. In many countries, including the US, a patient can refuse treatment that is recommended by a health professional as long as they have been properly informed and are “of sound mind”.
A patient who is suffering unbearable pain, and if their illness is incurable, then the demand of patient to let go is just.
Assessment of the mental state of the person consenting to euthanasia becomes mandatory and here, the role of the psychiatrist becomes pivotal. Euthanasia is legal in the Netherlands, Belgium and the American states of Oregon and Washington, and discussions on the legalisation of this act are ongoing in many countries around the globe.
In India, active euthanasia is a crime. Section 309 of the Indian Penal Code (IPC) deals with the attempt to commit suicide and Section 306 of the IPC deals with abetment of suicide – both actions are punishable. However, in March 2018, declaring the right to die with dignity as a fundamental right, the Indian Supreme Court, in a landmark judgment, passed an order allowing passive euthanasia in the country.
According to a study conducted in India, 76.9% of Muslims and 64.3% of Christians had unfavourable opinions regarding euthanasia, compared to 24.3% of those practising Hinduism. In Catholicism, conservative Protestantism and Islam, euthanasia is strictly prohibited. They believe the individual is “neither the author of his or her own life nor the arbiter of his or her own death.”
On the other hand, secular cultures support an individual’s right to make their own decisions regarding life and death as seen with Jains, Buddhists and Hindus. This has not been a political controversy yet, and before it does, our lawmakers must pass scientific and ethical legislation on euthanasia.
Hence, the burden to put non-biased guidelines lies solely on the parliament. Only progressive legislation, along with frequent dialogue within the community of doctors and organisations working with terminally ill patients, will allow physicians to function professionally.
The Hippocratic Oath taken by every doctor includes the following words:
“I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”
A study found that geriatricians and oncologists in several European countries were less supportive of euthanasia compared to other specialities. Similarly, palliative doctors in France had less favourable opinions towards euthanasia than general physicians and neurologists, suggesting that more frequent encounters with terminally ill patients may lead to greater resistance to euthanasia.
Another found that younger physicians had more favourable opinions than older physicians in favour of euthanasia administration. It is possible that younger physicians are generally in better health and therefore think that euthanasia is preferable to the long-term endurance of pain or disease. Another explanation is that younger physicians are perhaps more tolerant of unconventional ideas, including the varying approaches to end-of-life care such as euthanasia.
Additionally, another study determined that a larger percentage of males compared to females consistently supported euthanasia. One explanation for such a finding may be that women “are likely to make more ‘emotional’ and ‘principled’ decisions.” Another possible reason for the more conservative attitude among female doctors is that women probably make more measured decisions.
Thus, a special team of doctors consisting of psychiatrists and specialists of the pertaining illness with doctors of different generations with no gender bias must administer the active euthanasia and it must not be let to the decision of consulting doctor only. It is important to make sure patients feel like a burden on their families and hence choose euthanasia as an alternative to a prolonged hospital stay and suffering.
This must be dealt with by psychiatrists, guidelines with no loopholes should be devised with great care. The essence of human life is to live a dignified life and forcing the person to live in an undignified way is against humanity. The choice of a person expresses a fundamental principle.
Article 21 of the Indian Constitution clearly provides for living with dignity, letting a patient suffer is against the essence of this article. An unbiased jurist would clearly see the individual who has lost a dignified life must on moral principles be allowed a painless death and social views must be set aside when formulating a law. There is often an argument that if such a right is granted to terminally ill patients, then there would be chances of abusing it. Every right involves a risk of being abused but that doesn’t mean that the right itself should be denied to the people. We should rather look at the brighter side of it than think of it being abused.
Aruna Shanbaug, who was working as a nurse at KEM Hospital, was assaulted on the night of November 27, 1973, by a ward boy. He sodomised Aruna after strangling her with a dog chain. The attack left Aruna blind, paralysed and speechless; and she went into a coma from which she has never come out. She was cared for by the nurses and doctors of KEM Hospital. The woman did not want to live anymore. The doctors told her that there is no chance of any improvement in her state. Her next friend (a legal term used for a person speaking on behalf of someone who is incapacitated) once described Shanbaug:
“Her bones are brittle. Her skin is like ‘Paper Mache’ stretched over a skeleton. Her wrists are twisted inwards; her fingers are bent and fisted towards her palms, resulting in growing nails tearing into the flesh very often. Her teeth are decayed and giving her immense pain. Food is completely mashed and given to her in semisolid form. She chokes on liquids and is in a persistent vegetative state.”
So, through her ‘next friend’ Pinki Virani, she decided to move to the SC with a plea to direct the KEM Hospital not to force-feed her. The Supreme Court, in 2011, allowed passive euthanasia in India with its judgement. The Court laid out guidelines, according to which, passive euthanasia involves the withdrawal of treatment or food that would allow the patient to live.
Finally, a landmark judgment of 2018 legalised passive euthanasia. The five-judge Constitution Bench of the Supreme Court has held that the right to life and liberty, as per Article 21 of our Constitution, is meaningless unless it encompasses within its sphere individual dignity. The judgment had mentioned; “With the passage of time, this Court has expanded the spectrum of Article 21 to include within it the right to live with dignity as a component of the right to life and liberty”. The best interest of the patient shall override the State interest, the Court has said.