As part of the course, Science and Health Journalism, I wrote a piece on the prevalence of Euthanasia and its dynamic nature. I touched upon India's Supreme Court's 2018 verdict, which allowed for passive euthanasia but the tedious bureaucracy involved and also on palliative care in India. I talked to two doctors in India, who are well versed in this field.
Embedded Files
The Fight Continues: Bureaucratic Implications on Euthanasia
Time and again, the debate around euthanasia gets reignited. With a tedious bureaucracy in place, euthanasia becomes more of a hassle. With a lack of knowledge regarding palliative care in India, it becomes difficult for the patients to get respite from their terminal illnesses.
I observed the deterioration of the quality of life of my grandmother, who suffered from stage four breast cancer. After excruciating cycles of radiotherapy and its side effects, by the end, she got paralysed and was unable to talk or comprehend anything around her. This made me realise why someone would prefer to take control over how to end their lives, giving themselves a dignified death.
According to National Health Service, euthanasia refers to the deliberate act of ending one's life to liberate themselves from suffering. The term euthanasia has its roots in the Greek terms' eu' meaning good and 'thanatos' meaning 'death'; together, they form 'good death.'
Dr. Roli Chaturvedi, MBBS, did her PG Diploma in Medical Law and Ethics from the National Law School of India University, Bangalore. Her thesis topic was Euthanasia. When asked about the motivation behind the choice of her subject, she said, "Euthanasia continues to be a volatile, pertinent, and dynamic subject. It touches nearly everyone at some point in their lives."
Types of Euthanasia
There are two types of euthanasia- active and passive. Active euthanasia refers to killing someone who is suffering from a painful terminal illness with no cure through a lethal dose of drugs.
In passive euthanasia, medical assistance to the patient is withheld. For example, the patient can refuse artificial life support like a feeding tube or a ventilator.
Barring a few nations, active euthanasia is illegal in most countries with stringent punishments, including life imprisonment.
Landmark Ruling in India
The Aruna Ramchandra Shanbaug vs Union Of India was a landmark case. It brought remarkable changes in the existing euthanasia laws. Aruna Ramchandra Shanbaug, a nurse at King Edward Memorial Hospital in Mumbai, was brutally raped and strangled by a ward boy in 1973. This assault left her paralysed and in a vegetative state for the next 42 years. She died in 2015 due to pneumonia.
In 2018, a bench of four judges came to the unanimous decision of allowing the existence of a living will to decide what to do in case a patient going through a terminal illness falls into an irreversible coma. If a patient is in a vegetative state or going through a terminal illness, they can refuse medical assistance through their living will or choose passive euthanasia.
Process and SoPs
Dr. Sonali Chatterjee, MBBS, is a pain and palliative care specialist in HOPE, a cancer care clinic in New Delhi. While talking about the standard operating procedures (SoPs) revolving around euthanasia, she said that once you put the patient on a ventilator, you cannot remove it. She explained that there are no guidelines, and it is considered as taking someone's life. "In terminal cases, we counsel the patient's family members beforehand to not put them on the ventilator because they won't be able to remove it," she said.
Talking about loopholes in the law regarding passive euthanasia, Dr. Chatterjee said, "How will a person in a vegetative state have a living will stating they do not want to continue living?"
"If the decision to withdraw life support has to be taken by family members or doctors, it needs to be taken in front of two witnesses. Thereafter, it needs to be countersigned by a first-class judicial magistrate. Subsequently, it has to be approved by a medical board set up by the hospital. This is a very complicated process," explained Dr Chatterjee.
Doctors on Euthanasia
When asked about the psyche of doctors who have to perform euthanasia after seeing death daily, Dr. Chaturvedi said, "I believe it is a routine for them. They (doctors) have this attitude that this procedure might just help someone, freeing them from pain and at the same time, letting the doctors direct their energy to patients who have a higher chance of surviving an illness."
Regarding passive euthanasia, Dr. Chaturvedi said, "There are limited beds in the ICU (intensive care unit). The hospitals aim to provide those beds to someone with better chances of survival."
When asked about her views on legalising active euthanasia, Dr. Chaturvedi was not in favour. Meanwhile, Dr. Chatterjee replied in the affirmative. "I think it should be allowed. So many people suffer, and in many cases, your brain is working, but your body is in a vegetative state. That is the most pitiable condition. In that condition, euthanasia (active) should be allowed."
Palliative Care and Concerns Regarding Euthanasia
There are several concerns regarding the legalisation of euthanasia. Activists argue that the healthcare system in India severely lacks basic services, with covid being proof of this. Furthermore, the government's healthcare budget is also inadequate. The socio-economic strata that cannot afford proper healthcare will be forced to opt for euthanasia.
Dr. Chatterjee argues against this opinion. "Palliative care has made leaps and bounds in India, especially in the southern Indian states. While working in Kerela, I saw both a robust primary healthcare system and a palliative care system. There are several terminal care centres too." She also mentioned how lack of governance is the main issue. "CanSupprt is an organisation providing on-ground palliative care, going door to door and helping out people from the lower socio-economic background," she said.
She also talked about the existence of numerous palliative care centres in North India but a lack of willpower prevents us from working together. "Palliative care is a lot about counselling about expectations and that prevents the patients from repeating unnecessary hospitalization and ICU is no no in terminal cases. When we get rid of satisfying self and work for the greater good, then only all these issues can be resolved," she added.
According to Dr. Chaturvedi, euthanasia can be misused to gain financially from the patient's demise. "There is a fear factor it (euthanasia) can be misused with a crooked doctor and a greedy relative getting in cahoots to pull the plug, which will essentially be murder," she said.
Conclusion
Doctors and activists alike have divided opinions on the legalisation of active euthanasia. With no system of checks and balances in place and loopholes abound, it will take years for active euthanasia to be a reality in India.
Page updated
Report abuse