Twenty-five years ago, the northern territory of Canberra had ‘world-first’ laws on medically assisted dying. In the following year, a 66-year-old carpenter had a ham sandwich with his wife and a visiting doctor, watched soccer game and then died precisely when he had planned to, at 2 pm. Bob Dent, who was suffering from prostate cancer, was the first person in the world to take his own life under a legal voluntary euthanasia scheme and the doctor in question, Philip Nitschke, facilitated it, with his own custom-built machine. The doctor was later deregistered when he assisted the death of Nigel Brayley, a depressed but otherwise healthy man who took his own life.
The Indian Supreme Court (SC), on Friday legalised passive euthanasia and approved ‘living will’ to provide terminally ill patients or those in persistent and incurable vegetative state, a dignified exit by refusing medical treatment or life support. The decision flows out of interpreting a fundamental right, “Right to live as including the right to die”. Though pragmatic in a certain context, can have far reaching consequences when not monitored, which of course, is extremely fluid. Obviously, more regulation will follow in the hope that this will not be misused like Dr. Philip did. Is our country really ripe and mature enough to absorb the nuances of life and death with dignity, so to say?
The right to life is a moral principle based on the belief that a human being has the right to live and, in particular, should not be killed by another human being. The concept of a right to life arises in debates on issues of capital punishment, war, abortion, euthanasia and public health care.
“Right to Life” assumes significance, only when it is read in conjunction with right to equality, right to freedom, right against exploitation, right to freedom of religion, cultural and educational rights, right to constitutional remedies, and right to privacy: A state guarantees its citizens that, this indeed is the case. In a country as large as ours, as disparate as ours and with a population as diverse as ours, have the State and the Courts been as successful in ensuring that the fundamental rights are not infringed upon? Forget infringement: have they even been seen to be made applicable to everyone in the same measure? The crux of the problem is, have we succeeded in providing a quality life to everyone? Have we really implemented right to live with dignity to all our citizens before we even discuss right to die, with or without dignity?
“Living will” is where individuals express their wish at a prior point in time, when capable of making informed decisions, regarding their medical treatment in the future, when they may not be able to make an informed decision. In Australia, living wills must be signed in presence of two witnesses, with rules on who can be witness, not if he/she is a substitute decision-maker in the living will, and not if he/she stands to profit directly or indirectly, from the person’s death or not if he/she is a health practitioner for the person writing the living will. Applied here, all have massive implications if we understand the fine print.
We still find, almost as a rule, people who cannot care for themselves, people cast away in so called old age care homes whose only prayer to the almighty is deliverance from their hell, people with only a torso begging on the streets, children and women cast away like no one’s business and brave legal workers coming to the cities for work, packed like sardines in clusters that are living holes, trying to make something of their left-over lives. If they all, apparently with a cause to live a dignified life, when they set foot on this earth, now, feel cheated by the State, were to invoke “right to die” or even if someone else were to do this on their behalf, as a PIL, or if they were to sign their “living will”, would the courts entertain? Would the government be held responsible for having guaranteed a right to live, now is found wanting?
Euthanasia advocacy began in earnest, after World War I. In 1920, when two highly respected German academics, Karl Binding, a law professor, and Alfred Hoche, a physician, wrote permission to destroy life unworthy of life, which advocated euthanasia as a compassionate “healing treatment.” The authors argued that mercy killing should be permitted for three categories of patients upon request of competent patients or the families of the incompetent, the terminally ill or mortally wounded, people who were unconscious, and disabled people, particularly those with cognitive impairments. Reasons, noble as may seem, are fraught with dangers, if applied to an entire humanity as a law.
Euthanasia as is currently understood, occurs when one person ends the life of another person for the purpose of ending the killed person’s pain or suffering. Some people also use the term “passive euthanasia” to describe a death that occurs after undesired, life-sustaining medical treatment is withheld or withdrawn. This is a misnomer. Euthanasia, at least as the term is presently used, involves intentional killing. That being so, “passive euthanasia” is not euthanasia, since death, when it comes, not everyone who has life-sustaining treatment, dies as a result of withheld treatment, and is naturally caused by the underlying illness or injury. Assisted suicide is closely related to euthanasia. An assisted suicide occurs when one person gives another person the instructions, means, or capability to bring about their own demise. If a smart lawyer’s argument retrofits this definition to the plight of a hapless individual, or to the benefit of a crook, for a price, one can possibly get away with planned, so called perfect murder. Active euthanasia is a death caused by lethal injection or drugs, including physician-assisted suicide. What then separates, passive from active euthanasia? Would the oath of a doctor not be simply Hippocratic and the State supporting it?
Despite having one of the fastest-growing economies in the world, clocking a growth rate of 7.6% in 2015 and potential to reach thereabouts soon, and a sizable consumer economy, the World Bank report shows that India has 179.6 million people out of a total of 872.3 million, almost 20% of the World’s poor. Our constitution guarantees free healthcare for all citizens below the poverty line. All government hospitals are required to provide free of cost healthcare facilities to the patients. Be as it may on paper, the truth on the ground is anything but palatable both in terms of quality and availability. Children die by the dozens in Government hospitals, sometimes for lack of oxygen cylinders and sometimes for lack of appropriate medicines. Shouldn’t an affordable healthcare system, and a right to live with dignity be made available to everyone and the default on this be made punishable by-passing strictures against the State and the Government and even bring them down, before right to die be made legal?
We seem to find answers to all our ills within the unequal eco systems that we have created for ourselves in the hope that the system will correct itself. What is the difference between killing for vengeance, killing for power and authority, killing for justice or even passive assisted killing? The only difference lies in the expected outcome and the cause of these actions, which is not important, when compared to their similarity. It is indeed necessary to know who would pull the final trigger. Is it the patient himself or the doctor who assists? Is a “living will” enough to exonerate all perceived guilt?
Euthanasia is currently illegal and punishable as murder throughout the United States. Assisted suicide is a felony akin to manslaughter in most states, proscribed either by statute or court interpretation of the common law. Internationally too, both euthanasia and assisted suicide are almost universally outlawed. Poetic justice extols, “Zindagi zakhmonse bhari hain, waqt ko marham banaana seekh lo, Haarna to maut ke saamne hain, filhaal zindagi se jeena seekh lo” The entire subject of euthanasia is so inextricably linked with ethics, values, morals, respect, dignity, rights, religion, law and medicine, that it is at best good enough, to be implemented only on a case-to-case basis and not legalised as a law.