EUTHANASIA
Euthanasia in
Greek means “good death”. It is defined as the practice of
intentionally ending a life in order to relieve pain and suffering. Euthanasia, a
perplexing subject worldwide, is once again the centre of a debate in India
with the death of the woman who started it all – Aruna Shanbaug - the mercy
killing plea for whom was rejected by the Supreme Court in 2011. While the vast
majority of countries have no laws permitting active euthanasia or assisted
suicide, reports show that they are practised illegally by some doctors, nurses
and even by friends and family members of seriously ill patients.
Euthanasia is
controversial for many reasons: The most important reason is often religious.
Most religions oppose the idea because they see it as going against god’s will.
But then a rationalist will say that religion is never rational on this score. After
all god’s will can never be known and thus it makes no sense to pander to his
presumed will. It is human reasoning that must prevail.
The second
reason is that neither family nor doctors feel comfortable playing god
themselves. This is a real issue. The state clearly has to set foolproof
guidelines on who can take these decisions, and create panels that can
supervise passive or active euthanasia.
Euthanasia
raises a number of agonising moral dilemmas:
·
is it ever right to end the life of a
terminally ill patient who is undergoing severe pain and suffering?
·
under what circumstances can euthanasia be
justifiable, if at all?
·
is there a moral difference between killing
someone and letting them die?
If suffering
cannot be relieved, the question then becomes: what should the State do? Should
we all be forced to live on regardless of the quality of life that confronts
us? Or, should legislation be extended to ensure dignity and choice for all?
RELIGIOUS ASPECT
Hinduism
Euthanasia is not a new concept with respect
to Indian culture. This practice was prevalent in ancient times, and references
could be found in Mahabharat, wherein Bhishma has the blessing of “iccha
mrityu”. Sadhguru Jaggi Vasudev opines, “Death is not a sudden
happening, but an inevitable end. In this culture, we always planned- prepared
for a conscious exit. Four stages of life included this. Vanaprastha meant that
when one feels they are done with the purpose of life, they walked away into
the forest to let go of the body. One has the right to determine the course of
life; one has the right to determine one’s exit. The concept of Nirvana and
Samadhi, too, forms a part of it.”
The modern Hindus, who are morally bound to their religion or
culture, would strongly disapprove of euthanasia, which they consider a
suicide. Hindus believe that a person committing suicide does not attain Moksha
or salvation from the cycle of life and death. It is again looked at as an act
of violence, as a consequence of which the doctor and patient both will be
devoid of Moksha.
Islam
Muslims strongly condemn euthanasia as they believe life and death
of a person depends on Allah's will, and human beings are prohibited from going
against His will. They categorically forbids all forms of suicide and any
action that may help another to kill themselves. It is forbidden for
a Muslim to plan, or come to know through self-will, the
time of his own death in advance. The precedent for this comes from the Islamic Prophet Muhammad having refused to bless the body of a
person who had committed suicide
Sikhism
Holding a similar view
like that of Muslims, Sikhs believe that life is gift of God; hence one must
accept sufferings without complaint.
Christianity
Christianity also does not support euthanasia, as they too believe
life is a gift of God and one must respect it. The Roman Catholic Church
strongly opposes physician-assisted suicide and euthanasia. The church teaches
that life should not be prematurely shortened because it is a gift from God.
At the same time, the church recognizes that a dying person has
the moral option to refuse extraordinary treatments that only minimally prolong
life. The predominant distinction or criteria for legitimate refusal of
treatment is whether the treatment in question is considered proportionate or disproportionate.
This means patients can legitimately forgo treatment that doesn’t give a
reasonable hope of physical or spiritual benefit, such as resuscitating someone
who is at the very end of life.
Buddhism
Following similar belief
of karma as Hindus, Buddhists believe that their next life depends on their
deeds of past life. Also, they are against causing harm to any life.
According to Damien Keown, emeritus professor of Buddhist ethics
at Goldsmiths College, University of London, Buddhists generally oppose
assisted suicide and euthanasia. Buddhism teaches that it is morally wrong to
destroy human life, including one’s own, he says, even if the intention is to
end suffering. Buddhists are taught to have a great respect for life, Keown
says, even if that life is not being lived in optimal physical and mental
health. Although there is no direct mention of euthanasia in Buddhism, they too
do not seem to support it as both the giver and the taker of euthanasia would
commit harm.
However, he says, Buddhists also believe that life
need not be preserved at all costs and that one does not need to go to
extraordinary lengths to preserve a dying person’s life. This means, for
instance, that while a terminally ill person should not be denied basic care,
he or she could refuse treatment that might prove to be futile or unduly
burdensome. “The bottom line is that so long as there is no intention to take
life, no moral problem arises,” Keown says.
Jainism
Mahavira Varadhmana explicitly
allows a sharavak (follower of Jainism) full consent to put an end to
his or her life if the sharavak feels that such a stage is near that moksha can
be achieved this way. Liberation from the cycles of lives being the primary
objective in the religion. Sallekhana (also
Santhara, Samadhi-marana, Samnyasa-marana), is the Jain religious ritual of
suicide by fasting. It is not classed as suicide in the Jain religion. The
process is still controversial in parts of India. Jain websites recommend
finding a place where it is not actively opposed and there is an apparently
supportive community. Estimates for death by this means range from 100 to 240 a
year. Preventing santhara invites
social ostracism.
Thalaikoothal
Thalaikoothal (showering) is the
traditional practice of senicide / geronticide (killing of the elderly) or
involuntary euthanasia, by their own family members, observed in some parts of
southern districts of Tamil Nadu state of India.
Thalaikoothal works thus: an extensive oil bath
is given to an elderly person before the crack of dawn. The rest of the day, he
or she is given several glasses of cold tender coconut water. Ironically, this
is everything a mother would’ve told her child not do while taking an oil bath.
“Tender coconut water taken in excess causes renal failure,” says Dr Ashok
Kumar, a practicing physician in Madurai. By evening, the body temperature
falls sharply. In a day or two, the old man or woman dies of high fever. This
method is fail-proof “because the elderly often do not have the immunity to
survive the sudden fever,” says Dr Kumar.
OVER THE years, other methods have evolved
too. The most painful one is when mud dissolved in water is forced down; it
causes indigestion and an undignified death. Velayudham of Help age India says
the families often take the mud from their own land, if they have any. “It is
believed that this makes their souls happy,”
Yes
- Tremendous
pain and suffering of patients can be saved. Numerous
ailments such as certain types of cancer result in a slow, agonizing
death. Doctors have enough knowledge and experience to know when a
patient's days are numbered. What purpose would it serve to suffer
endlessly until the body finally gives out? Imagine what it would be like
to spend six months vomiting, coughing, enduring pain spasms, losing
control of excretory functions, etc. Then you must consider the
psychological suffering; i.e. the knowledge that a patient knows he's
definitely going to die and the pain is only going to get worse. Wouldn't
it be more humane to give the patient the option to say when he's had
enough?
- The right to
die should be a fundamental freedom of each person. Nowhere
in the constitution does it state or imply that the government has the
right to keep a person from committing suicide. After all, if the patient
and the family agree it's what they want to do, who's business is it
anyway? Who else is it going to hurt? In a country that's supposedly free,
this should be a fundamental right. But then Suicide or an attempt to
Suicide is a criminal offence under Indian Penal Code and the only offence
where you can not punish the offender if he/she succeeds in his/her act of
crime called suicide.
- Patients can
die with dignity rather than have the illness reduce them to a shell of
their former selves. Dying patients sometimes lose all
ability to take care of themselves. Vomit, drool, urine, faeces, and other
indignities must be attended to by nursing assistants. Alzheimer's
patients suffer from progressively worse dementia that causes memory loss
and incoherent rambling. Virtually all people want others' last memory of
them to be how they once were, not what they ended up being. For example,
Ronald Reagan died of Alzheimer's. He and his family would like people to
remember the brave man that stared down the Soviets, told Gorbachev to
"Tear down this wall", and as the "The Great
Communicator", provided historic leadership. Other patients and
families have the same wishes for themselves. We should let people die
with their dignity, pride, and self-worth intact.
- Pain and
anguish of the patient's family and friends can be lessened, and they can
say their final goodbyes. Friends and family of the patient often
suffer as much or more pain as the patient himself. It's difficult to see
a loved one in such anguish for so long. It's emotional and physically
draining to have the stress drawn out for so long. And when the patient
does eventually die, it's often sudden or it follows a period when the
patient has lost consciousness. Doctor-assisted suicide would give the
patient a chance to say his final goodbyes and end his life with dignity.
- Reasonable
laws can be constructed which prevent abuse and still protect the value of
human life. Opponents of a doctor-assisted suicide
law often cite the potential for doctor abuse. However, recent Oregon and
UK laws show that you can craft reasonable laws that prevent abuse and
still protect the value of human life. For example, you can require the
approval of two doctors plus a psychologist (who verifies
the patient has the capacity to make the right decision). You can
proscribe waiting periods, get the additional sign-off of family members,
and limit the procedures to certain illnesses. States should have the
rights to pass laws that take into account the values and wishes of the
people of that state.
- Vital organs
can be saved, allowing doctors to save the lives of others. We
have long waiting lists for hearts, kidneys, livers, and other organs that
are necessary to save the lives of people who can be
saved. Doctor-assisted suicide allows physicians to preserve vital organs
that can be donated to others (assuming the patients are organ donors).
However, if certain diseases are allowed to run their full course, the
organs may weaken or cease to function altogether. Once again, we have to
put the needs of the living ahead of the needs of the dying.
- It would
violate doctors' Hippocratic oath. Upon
receiving a medical degree, each doctor is required to take a Hippocratic
oath, which says among other thing, "First, do no harm".
Assisting in suicides would be a violation of that oath, and it would lead
to a weakening of doctor-patient trust. The oath was created in part so
patients could be reassured that doctors only wanted to help them, not
hurt them. A weakening of that oath may cause patients to wonder.
- It demeans the
value of human life. In this country, human life means
something. For each death, we have 1-2 days of ceremonies, elaborate
burials, and months of mourning. To stomp out a life because it's not
convenient or it's expensive demeans that value. Human life is much more
that just a cluster of biological cells.
- It could open
the floodgates to non-critical patient suicides and other abuses. Any
loosening of the assisted-suicide laws could eventually lead to abuses of
the privilege. For example, patients who want to die for psychological or
emotional reasons could convince doctors to help them end their lives.
Attitudes would loosen to the point that certain states may decide
that any person can commit suicide at any time. We can't
let our values shatter this way.
- Many religions
prohibit suicide and the intentional killing of others. The
most basic commandment is "Thou shall not kill". Virtually all
religions have a law against killing. We need to protect the morality of
not only the patients but the doctors that must extinguish their lives.
- Doctors and
families may be prompted to give up on recovery much too early. If
a patient is told that he has, for example, six months left to live with
progressively worse pain, he may decide to end things before things start
to get worse. This wipes out valuable time that can be spent with family
and friends; it also denies the slim chance of a recovery or the possibility
of discovering a doctor error.
- Government and
insurance companies may put undue pressure on doctors to avoid heroic
measures or recommend the assisted-suicide procedure. Health
insurance providers are under tremendous pressure to keep premiums down.
To do this, they must cut costs at every turn and make tough decisions.
Many doctors are already prevented from give patients certain tests or
performing certain operations despite what the doctor believes is truly
necessary. Legalizing assisted suicide would likely invite another set of
procedures as to when life-sustaining measures should be undertaken. We
shouldn't give the insurance companies any more power over human life.
- Miracle cures
or recoveries can occur. You can never underestimate the power of
the human spirit. A cheerful, never-give-up attitude can often overcome
the longest of odds and the worst of illnesses. You also have to consider
the constant medical and pharmaceutical advances that just might lead to a
miracle recovery. We should never get to a point where we spend more time
looking for a way out of life than for a way to sustain life.
- Doctors are
given too much power, and can be wrong or unethical. Patients
put their faith and trust in the opinions of their doctor. If doctors tell
a family there's absolutely no chance for a patient to survive, the family
is likely to believe them. This is a problem for two reasons. First of
all, doctors make mistakes just like any other people. A wrong diagnosis
could lead to the suicide of a savable person. Second, doctors have the
ability to play God and decide who they encourage or discourage on the
prospects of recovery. For example, imagine a doctor who believes there is
too much of a shortage in medical staff & resources to pour extra time
& money into elderly people. He may always lean
towards the side of "no hope" when the odds are sketchy.
Decision-making ability on matters of life and death should stay where it
belongs--with God, not doctors.
Voluntary euthanasia gives too much power to doctors
Legalisation of euthanasia is usually championed by
those who have witnessed a loved one die in unpleasant circumstances, often
without the benefits of optimal palliative care. This leads to demands for a
'right to die'. In reality the slogan is misleading. What we are considering is
not the right to die at all, but rather the right to be killed by a doctor;
more specifically we are talking of giving doctors a legal right to kill. This
has its own dangers which we shall consider shortly. Allowing difficult cases
to create a precedent for legalised killing is the wrong response. We need
rather to evaluate these difficult cases so that we can do better in the
future.
Calls for voluntary euthanasia have been encouraged
either by the failure of doctors to provide adequate symptom control, or by
their insistence on providing inappropriate and meddlesome interventions which
neither lengthen life nor improve its quality. This has understandably provoked
a distrust of doctors by patients who feel that they are being neglected or
exploited. The natural reaction is to seek to make doctors more accountable.
Ironically, voluntary euthanasia legislation makes
doctors less accountable, and gives them more power. Patients generally decide
in favour of euthanasia on the basis of information given to them by doctors:
information about their diagnosis, prognosis, treatments available and
anticipated degree of future suffering. If a doctor confidently suggests a
certain course of action it can be very difficult for a patient to resist.
However it can be very difficult to be certain in these areas. Diagnoses may be
mistaken. Prognoses may be wildly misjudged. New treatments which the doctor is
unaware of may have recently been developed or about to be developed. The
doctor may not be up-to-date in symptom control.
Doctors are human and subject to temptation.
Sometimes their own decision-making may be affected, consciously or
unconsciously, by their degree of tiredness or the way they feel about the
patient. Voluntary euthanasia gives the medical practitioner power which can be
too easily abused, and a level of responsibility he should not rightly be
entitled to have. Voluntary euthanasia makes the doctor the most dangerous man
in the state.
Traditional medical ethical codes
have never sanctioned euthanasia, even on request for compassionate motives.
Conclusion
The
discussion over human euthanasia evokes strong emotions on both sides of the
debate. Convincing justifications are found for both viewpoints. Doubtless, at
times a need exists for euthanasia, be that in active, passive, involuntary, or
voluntary form, and some forms of euthanasia do exist; however, society must
ask what the cost of life and death is: financially, physically, emotionally,
and mentally. One person or group should not determine how, when, and if
another person should die. Ending an individual's life, because someone decided
that person's life provides no value to the individual or to society is not
ethical and never will be. If the Netherlands is considered a test case, the
system of protections put in place can and will be abused. As the world
watches, the slippery slope of legalized euthanasia in the Netherlands begins
to model the genocide perpetrated by Hitler, and one must ask where the line is
drawn. Legalized euthanasia has become a tragic means-to-an-end for older,
poor, terminally ill, mentally disabled, suicidal, and other at risk
populations in the Netherlands. Is it realistic to believe the example set
forth in the Netherlands can have any different results elsewhere?
We need to recognise that requests for voluntary euthanasia are
extremely rare in situations where the physical, emotional and spiritual needs
of terminally ill patients are properly met. As the symptoms which prompt the
request for euthanasia can be almost always managed with therapies currently
available, our highest priority must be to ensure that top quality terminal
care is readily available.
While recognising the importance of individual patient autonomy,
history has clearly demonstrated that legalised euthanasia poses serious risks
to society as a whole. Patients can be coerced and exploited, the search for
better therapies is compromised and involuntary euthanasia inevitably follows.
Legislation allowing voluntary euthanasia should be firmly resisted on the
grounds that it sidesteps true compassionate care (because effective
alternatives exist) and ultimately undermines rather than protects patient
autonomy.
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