Death on demand

‘I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing.’ I was recently reminded of this extract from the Hippocratic Oath while reading an article about the ethical dilemmas haunting doctors in The Netherlands, where selective euthanasia has been legal for six years.

We often extol a sadhu’s quest for a ‘better life’ through slow starvation, but such is our law that even a terminally sick person can be prosecuted for attempted suicide under Section 309 of the Indian Penal Code, and the doctor for abetment under Section 306. In case of involuntary euthanasia, the charge is racked up to murder. Seen as contravening Article 21 of the Constitution (Right to life and personal liberty), mercy killing is a cognisable, non-bailable offence. The pro-choice lobby has turned this on its head by focusing on the liberty to choose dignity in death.

Though mercy killing is shrouded in legal ambiguity, there are ample cases of individuals approaching Indian courts for permission to end their lives for various reasons. Any legal assessment has to consider the merit of individual choice, difficult to quantify medico-legally, as also the dangers of moral and mortal overreach. Palliative care has reached new heights, but the fact remains that, faced with a severely debilitating or painful condition, people do not wish to prolong their lives artificially.

The Law Commission has recommended that mercy killing be legalised, but only if withdrawal of life support is in the ‘best interests’ of a patient, who is ‘competent’ to make the decision. As the euthanasia debate moves away from ‘terminally ill’ into the domain of the ‘Right to Die’, with ‘living wills’ gaining acceptance globally, we cannot continue brushing difficult legal issues under the carpet.

Central to any future debate is the religio-ethical question: are we qualified to destroy something that we have not created? Then there is the issue of proxy decision-makers, if the patient is ‘incompetent’ to decide. Who chooses, and who should be authorised to implement the decision of taking a life — the lawful guardians (often more than one) or the doctor? This is where both the scope for misuse and the medico-legal dilemma lie.

Switzerland legalised physician-assisted euthanasia, stipulating that the decision to pull the plug can only be taken by someone with nothing to gain. In countries like Belgium and The Netherlands, where euthanasia has been selectively legalised, there are provisions for peer review of the physician’s decision to assist a patient.

With the Indian health infrastructure already groaning under the demand for more beds, doctors and hospitals, most can ill-afford prolonged hospitalisation costs. If you’re really poor, chances are you can easily bypass the legal wrangle as doctors send you home with a prayer when “nothing more can be done”. Euthanasia means ‘good death’ in ancient Greek. When faced with the question of what I would want, if given a choice, I quote Shakespeare: ‘O, let him pass/ He hates him much/ That would upon the rack of this tough world/ Stretch him out longer.’