DC Debate: To allow terminally ill patients write a Medical Will seeking euthanasia
Need to make it legally valid
I am in favour of passive euthanasia. Keeping patients on ventilator support for too long without any chance of revival is not the right option.
An individual can choose between the right to live and the right to die honorably, and he or she must be allowed to exercise the option in the normal course. Many senior citizens in their complete consciousness are writing a Medical Will which states that they must not be subjected to ventilator support, catheters and aggressive use of medicine as and when they fall ill. This kind of a Will is fully justified and must be brought under the purview of the law. It must be made legally valid so that those who want to die peacefully are allowed the freedom to do so. That’s a service society can do.
As of now, we are finding a lot of patients in end stage of cancer, Parkinson’s and other debilitating diseases where there is no cure. The patient is in a vegetative state and suffers. When this occurs, the option of passive euthanasia can be exercised. In foreign countries, there are hospice centres that cater to patients with terminal stage illness, but there is no such facility in many cities in India.
The issue needs to be settled. The government may set up a committee of two eminent doctors along with a few social workers to decide whether or not passive euthanasia can be practised.
It may be advised that the age of the patient, his or her condition, the chances of recovery and also the activity of the brain are assessed before the option can be exercised. In many cases, we find that the cortical activity of the brain is gone and only the medullar function remained. In such a situation, there is no point in keeping the patient alive.
In one case, the AP government had asked me to decide on a patient suffering from muscular dystrophy, as to whether he can opt for organ donation and euthanasia. In the absence of legal back up, it had to be denied.
Hence, a proper framework of legal aspects is required even for patients who are conscious but are bed-ridden for life. They are suffering and have been put on support systems but there is no chance of them ever getting up and walking again. In the acute medical care unit in foreign countries, there are instructions like ‘Do not Resuscitate’, as the patient’s relatives end up spending too much even as there is no chance of a recovery. Such patients are not attended to and they are allowed to die a rightful, natural death.
Dr Pradeep Deshpande, The writer is president of the Indian Society of Nephrology.
Selectively and as last resort
If passive euthanasia is to be practised, caution is the byword. It must not be used as a tool to do away with end-stage care or not giving care at all.
“Treat the patient till the last minute” is the doctors’ motto. Patients who are conscious generally want to live and want be treated till the last minute. For such patients, passive euthanasia is not an option. A conscious patient of any age has the right to live in whatever state he is. What’s important for doctors and family members is to make him/her comfortable. If passive euthanasia is to be practised, caution is the byword. It must not be used as a tool to do away with end-stage care or not giving care at all.
The government would do well to come up with rules and regulations that define passive euthanasia. It must decide at which stage can passive euthanasia be allowed. It can’t be that a person is ‘living as he has hope to be treated by medicines and hope for recovery’, but due to the age-factors that care is denied to him in the name of passive euthanasia. The fine line between care and passive euthanasia is to be identified. Who, at what age and at which stage, is entitled to it? This must be made clear. It is not applicable to all; and if there is grievous injuries or debilitating diseases like cancer, muscular dystrophy, Par-kinson’s or Alzheimer’s, there must be guidelines on when end-stage care is to be stopped.
These definitions are important not only for the medical community but also for the people to understand the concept of passive euthanasia. Life support systems like ventilator are provided when the medical community sees hope for the patient to recover. Hence this can’t be denied to them. Despite ventilator support, if there is no improvement, the option of passive euthanasia can be looked into.
In conscious patients, we have seen the hope to live and the urge to fight the disease. Not even one per cent of them would opt for this kind of a treatment. Rather, they will be hurt due to their advanced age and may fall into depression or face psychological issues by a feeling that their near and dear ones and also the society itself do not want them.
At the same time, those who are unconscious, whose chances are zero, and each of whose family is spending lakhs to keep the patient on ventilator, must be allowed to take off the support systems which would mean death. It is not that they be given some poisonous substance to die, but simply to stop the supportive treatment and they be allowed to die peacefully.
Dr P. Vijay Anand Reddy, The writer is a senior clinical oncologist, Director of Apollo Cancer Hospital.
