The Supreme Court has once again opened up the interminable debate on euthanasia by asking for opinion from states and Union territories in a Public Interest Litigation pending before it. The Indian Society of Critical Care Medicine has supported mercy killing and has filed a petition to be impleaded as a party in the case. The apex court dwelt on the issue at length in Aruna Ramchandra Shanbaug v. Union of India (March 7, 2011), and allowed passive euthanasia (withdrawal of life support) with the permission of the high court concerned.
Permission can be given on request of the patient if s/he is in a position to give consent; if the patient is in a persistent vegetative state (PVS), the consent of the next of kin or friend is required. For each case the high court will appoint a committee of doctors to give its recommendation and grant permission after examining all facts. However, in the case of Aruna Ramchandra, who had been in PVS for over 37 years (now over 40 years), the Supreme Court declined to allow passive euthanasia as the staff members of the KEM Hospital, Mumbai, looking after her fondly, a rarity in the present world, opposed termination of her life. She slipped into PVS after being strangulated and sodomised by a cleaner of the KEM Hospital on November 27, 1973.
The issue is intractable, defying any acceptable solution as miracles do take place sometimes. In 2007, the recovery of Jan Grzebski after remaining in a coma for 19 years added a new dimension to the perennial debate. Jan, a railwayman who slipped into a coma following an accident in Poland in 1988, bounced back into consciousness 19 years later. It is difficult to guess what astounded him more — his resuscitation or the transition of his country from communism to democracy and capitalism. Similarly, in May 2005, Donald Herbert, a former fire-fighter, comatose for 10 long years in a US hospital, surprised everyone when he asked to speak to his wife.
In 2006, doctors had their first proof of a medical miracle when a man who was barely conscious for nearly 20 years regained speech and movement because his brain had rewired itself by growing tiny new nerve connections to replace the ones sheared apart in a car crash.
In 2005, two deaths in quick succession made world news. Terri Schiavo of Florida died on March 31, neither because of her PVS, nor because of her melted cerebral cortex, but because she was left starving for 13 days, not in a famine-stricken Third World country, but in the United States, the land of plenty. Fifteen years ago, a heart-wrenching tragedy left her brain dead. Her husband moved court to remove her feeding tube, which her parents vehemently opposed. The court accepted the husband’s prayer. The decision to remove the feeding tube triggered a fierce debate like never before on whether the Right to Life includes the right to a peaceful, dignified and voluntary death.
The second death was of Pope John Paul II on April 3, 2005. The two deaths had intimate similarities. The Pope’s refusal to return to hospital despite being “informed of the gravity of his situation” again threw up the debate whether critically ill patients have the right to spend their remaining lives on their own terms or should they be subjected to full-scale medical intervention. The Pontiff preferred to remain at the Vatican in his third-floor apartment overlooking St. Peter’s Square.
Surprisingly, the Pope encouraged research to “enhance and prolong human life” and told doctors it was a moral duty to maintain basic nutrition to patients even in a vegetative state — which brought him in direct conflict with those supporting the decision to remove Terri Schiavo’s feeding tubes. But the Pope clarified that patients could refuse drugs that cause unconsciousness or reject extraordinary medical treatment that would lead to a “precarious and burdensome prolongation of the life”.
In August 2009, Jeet Narain, a marginal farmer from the Mirzapur district of Uttar Pradesh, filed a mercy death plea for his four sons aged between 10 and 16, all suffering from muscular dystrophy. It sent shockwaves among similar patients struggling against odds to live a life of hope. Muscular dystrophy is a group of over 30 genetic conditions where skeletal muscles that control movement degenerate progressively. Estimates suggest that one in 3,500 people suffer from muscular dystrophy, but these patients hardly get any support from the government.
“Euthanasia” is a Greek term which means “good death”. But there is no unanimity over what is a good death. Many people do not find anything good about euthanasia except its name. The debate acquired a new dimension when the Netherlands became the first country in the world to enact a law in 1984 legalising physician-assisted suicide and voluntary active euthanasia. This move attracted severe criticism, with critics alleging that it has led to many dire consequences, including a breakdown of trust in the medical profession. Belgium was the next to legalise euthanasia, in 2002. Switzerland allows suicide assisted by doctors and those with medical training, though euthanasia is not legal. Many other countries have also provided for it.
Indian mythology espouses the belief that life and death are in the hands of God and man should not try to tinker with this divine scheme. In Hinduism, it is believed that the sufferings we undergo are prarabdha (destiny) which one cannot escape. Sufferings are meant to eliminate the baggage of samskaras or impressions (of feelings and actions both good and bad) that we have accumulated in our various births and we are doomed to be born repeatedly, till we are left with no samskaras when we breathe our last. It implies that each life is a chance to refine ourselves better to get “liberated”. Thus, there is a view that mercy killing may ruin one’s chance of liberation by cutting short a person’s sufferings, and forcing them to be reborn which would be most unmerciful. But, there is a catch. If life and death are predestined, so must be the mode of death. So the person hastening another’s death with noble intentions may be carrying out God’s wish.
However, Jainism has a different view with its concept of sallekhna, which is composed of two words, sat and lekhna. Sat is rationality in belief (samyak), while lekhna means weakening the strength of body and passion by taking a vow. Santhara is a process of fasting unto death that starts after a vow of sallekhna is taken. There are other instances when people have stopped eating before death. Vinoba Bhave died in this manner in 1982.
Before mercy killing is legalised, caution must be taken to address the uncomfortable question: What are the safeguards against mercy killing being misused?
The writer is a senior TV journalist and columnist and author of the book Justice, Judocracy and democracy in India
