Should Indian Government Legalise Mercy Killing?

In Depth

Should Indian Government Legalise Mercy Killing?

Madabhushi Sridhar | September 2014

Whether a person can end his life for any reason? This is the moot question pertaining to life and liberty including right to death with dignity. Prof Madabhushi Sridhar analyses more…

Ending of life prematurely for relief from pain and suffering is called ‘euthanasia’. It is a paradox to explain it in self contradictory term – mercy killing. Voluntary euthanasia is nothing but a suicide, while involuntary euthanasia or a group of persons deciding to end the life of a suffering person is another. Interestingly, both are crimes – attempt to commit suicide is a crime and killing someone even with a good motive could be culpable homicide not amounting to murder.

DEATH WITH DIGNITY

Encyclopaedia of American Law considers mercy killing as a class of criminal homicide. Killing as punishment is ‘permissible homicide’ while other homicides are criminal. Voluntary euthanasia, which is conducted with a patient’s consent, is legal in the US states of Washington and Oregon. Similarly, it’s officially permitted in Belgium, Luxembourg, the Netherlands and Switzerland. In other countries like Germany, Mexico and Switzerland euthanasia is legal but only in its passive form. The Oregon Death with Dignity Act made it legal for residents to request a lethal injection from a doctor. Denial ofdrugs or withdrawal of ventilators is called passive euthanasia, which is legal in many jurisdictions. It’s an open secret that such withdrawal happens every day.

“There should be a healthy countrywide discussion on the topic involving medical professionals and society at large with an open mind. Since people’s emotions are deeply associated with it,” said Dr Harsh Vardhan, the union minister for health & family welfare. He said, “A consensus should be developed on whether to allow killing of terminally-ill people with no chances of revival. It is a complex issue. There should not be any hurry to decide onthis highly emotive subject.” When some other people decide to end the life of a person, there is a need to deeply examine issues of dishonesty and corruption behind that decision. In a high-density-corrupt society like India, euthanasia, if legally permitted, would be comean easy method of killing elders and weak parents to inherit the property or for some such selfish reason.

Physician isthe right person to decide the need for euthanasia only when honest and objective. Those who spend huge money to become physiciansare engaging in recovery of huge money, for which unhesitatingly involving in corrupt practices in hospitals exploiting lack of medical knowledge of patients.

In a US survey of 10 thousand doctors, 16 percent preferred stopping a lifemaintaining therapy at the recommendation of family or the patient. 55 percent said no. Study revealed that 46 per cent of doctors believe that physician assisted suicide should be allowed with conditions. However, it is difficult to believe today’s doctors. Like corrupt lawyers colluding with the other side for money more than their entitled fee, corrupt doctors join killers to ‘serve’ the needs of patients.

CONCEPT OF ‘LIVING WILL’

The Supreme Court five-judge-bench of Chief Justice R. M. Lodha and Justices J. S. Khehar, J. Chelameswar, A.K. Sikri and Rohinton F. Nariman is hearing a petition filed by an NGO Common Cause, who sought the right to refuse treatment and the right to die with dignity to be incorporated within the right to life. This is the concept of ‘living will’, which allows a person to transfer his/her decision-making power to another, in case he/she goes into avegetative state. A will of a person generally comes into operation only after death. Since this will had to operate during lifetime of will-maker, it’s called living will.

Author Pinky Virani explained: “Living will is where you are able to state how much medicine you want and how much treatment you want, and till what stage you want it, in the event of your being either in persistent vegetative state (PVS) or in brain death.” She added that in India, passive euthanasia can be given to those patients, who are suffering from brain stem death (essentially full brain death) and persistent vegetative state.

On March 7, 2011, the Supreme Court had ruled against ‘active euthanasia’ on a plea for mercy killing in Aruna Shanbaug case. She was a nurse in King Edward Medical College when she was brutally raped by a sweeper in the hospital in 1973 and sincethen has been in a permanent vegetative state. Her every need is being looked after by the hospital nurses even now. Pinki Virani as “next friend” sought that Aruna should no longer be force-fed. Aruna was then aged 60 who had been lying in a vegetative state for nearly 40 years. The court permitted passive euthanasia under certain circumstances. With the SC ruling, India joined a select league of nations, which legalised passive euthanasia under “exceptional circumstances”. The Supreme Court laid down detailed conditions for passive euthanasia or withdrawing life support for food and sustenance for terminally ill people in vegetative state.

“When it comes to passive euthanasia, or the right to refuse invasive treatment in the end stages, be it ventilator or other support system, I feel an individual needs to decide on this right for his or her self, and society needs to respect that. There is almost uniform acceptability of this around the world,” said Samir Parikh, Director, Mental Health and Behavioural Sciences at Fortis Hospital. He explained that the patient’s families need to be given psychological support and “for that, I feel bereavement and grief counselling needs to become a part of healthcare in our country.”

Like everyone, the five judges of Supreme Court have apprehensions about living will in the present Indian context. Chief Justice has rightly asked ‘how to make it foolproof?’ Senior lawyer PrashanthBhushan suggested that the living will could be in writing and be registered. Justice Nariman doubted that this could not be considered absolutely foolproof. On July 16, 2014, the Supreme Court issued notices to all states seeking their views on whether a terminally ill person can execute a living will that life support system be withdrawn, if he or she reaches a vegetative state with no hope of revival.

GOVERNMENT SAY NO TO PASSIVE ‘EUTHANASIA’

Attorney General Mukul Rohatgi told the Court that the issue entirely concerns the legislature and the judiciary should not take it up. The government also told the Court that passive euthanasia is a form of suicide, which cannot be allowed. The Court has appointed former Solicitor General TR Andhyarujina as amicus curiae to assist in the case.

Dr. R. K. Mani, ex-president of the IISCCM and chairman of pulmonary and critical care medicine at the Saket City Hospital, New Delhi, has rightly said that expression ‘euthanasia ’gives a wrong connotation and it could be explained as ‘end of life decisions’. He explained: “When patients have no hope for a cure, medical intervention becomes unduly burdensome or is against the wishes of the patient. His only way would then be to live on life support.” In such cases, it is not treatment but the imposition of treatment, which involves pain and mental trauma to patient and their family besides imposing a financial burden. Procedures that involve life support systems range from anywhere between 40,000 -50,000 INR (USD 660-825 approx) a day, expensive treatments not many families can afford.

“When it comes to passive euthanasia, or the right to refuse invasive treatment in the end stages, be it ventilator or other support system, I feel an individual needs to decide on this right for his or her self, and society needs to respect that. There is almost uniform acceptability of this around the world.” Dr.r. K. ManI ex-president of IISCCM and Chairman of Pulmonary and Critical Care Medicine at the Saket City Hospital, New Delhi

“We are nobody to impose such treatments on patient which are of no use. The patient should be made aware of how effective or ineffective the treatment is that he has the freedom of choice. Doctors are here to support the patient in a wise manner,” said Dr. Mani.

However, the aspect, which is rather more serious than deciding these jurisprudential nuances of euthanasia, is the ‘extortion attitude’ of private hospitals that frightens the patients and their families about possible immediate death and creates false hope of revival with huge expenditure, treats dead bodies for such a long time to extort huge amounts as daily rent and treatment, including consultation costs. It is perhaps opposite of euthanasia.

ISSUE OF INTERESTS

Besides the law, religion and society also have a role to play in discussing the issues like euthanasia. It is reported that Muslim religious leaders felt that it was against religion’s rules to take somebody’s life by artificially injecting lethal drugs. However, they favoured withdrawal of life support system, if recommended by a group of doctors. Hindu religious leaders are also of the same view, i.e., religion opposes the active euthanasia and accept the passive euthanasia with conditions.

The issue of ‘interests’ behind such recommendation to withdraw should be thoroughly examined before acting on. This means a review by the judiciary. Financial burden on the society or agony of the family of the patient can never bethe reasons for ending the life. Even if there is slight probability of survival, the medical doctors, hospitals, government and society have to help him to survive. Each case has to be examined by the court of law thoroughly.