Being Humane

With the Union Ministry of Health and Family Welfare deciding to ask the public for feedback on a Bill on passive euthanasia that it will introduce in Parliament, the question whether passive euthanasia should be legalised in India has come to the fore.

Passive euthanasia involves the cutting off or ceasing medical treatment for a patient — who chooses not to receive any — if it can be proved that he or she will not recover.

Inhuman though it may sound, experts say that passive euthanasia is actually often a better and more dignified choice a patient can make.

Writing’s on the wall “There are a lot of neurological issues that some patients face, and when we reach an end-stage where we are sure that there is no reversibility and the chances of treatment of the disease isn’t there — there are neurological degenerative diseases where the patient becomes bed ridden, dependent on external sources and even on ventilator support. These are the cases where we feel that the patient and the patient’s family members need to take into consideration the humiliation of staying alive,” says Apollo Hospital’s Dr Deepika Sirineni, a consultant neurologist.

“As an oncologist, I’ve seen so many situations where we know that the writing is on the wall. We know that people are prolonging not just the patient’s life but their misery as well. There needs to be a mechanism in place that’s fool proof. Passive euthanasia in many countries is ratified and legal,” adds Dr Hemanth Vudayaraju, senior surgical oncologist with the Yashoda Cancer Institute.

Dying with dignity Senior advocate Rachana Reddy invokes late nurse Aruna Shanbaug’s case as an example of why a Bill on passive euthanasia is required.

Shanbaug was sexually assaulted in 1973 by a staff member of the hospital she worked in, in Mumbai, and had been in a vegetative state ever since. While a plea for euthanasia was denied in 2011, the Supreme Court allowed passive euthanasia and Shanbaug finally passed away after suffering from pneumonia and being in a vegetative state for almost 42 years.

“Aruna Shaunbaug’s case is an example of how a human, for tragic reasons, had to live the life of a vegetable for over 40 years. I hope that kind of destiny isn’t written for anyone,” says Rachana, and adds, “I do believe that even with all its negative effects and probably short-sightedness too, every human being has the right to his or her own life and also the right to die with dignity. If they are terminally ill, they should be given the right to choose their own end.”

However, the Bill must be comprehensive and cover the many possibilities of misuse, say experts. Dr Deepika says, “The patient’s family sometimes gives you a wrong medical history saying that the patient has been suffering from a long time. Sometimes hospitals can indulge in malpractices and opt for passive euthanasia for monetary gain, say if there are issues with the patient’s financial position, or even if there are disputes with regard to the patient’s assets.”

Dr Hemanth adds that the very concept of passive euthanasia must be understood before a Bill can be passed.

“There needs to be a conviction from all the parties involved, including the patient, patient’s family and doctors. Just because a patient suffers from cancer or has a brain injury, you can’t decide to pull the plug. When you know that the road is ending and you have nothing much to offer, that’s when this can be an option,” he says.

Proper mechanisms Rachana points out that passive euthanasia can be made a possibility only if proper mechanisms are put in place to ensure that every case is properly scrutinised by those with authority vested in them to do so.

She says, “It has to be introduced with plenty of preliminary investigation by authorised personnel, such as qualified doctors and their bonafides. There are chances of it being misused, but we have to take adequate precautions against it.”

“The problem with our country is the safeguard mechanism — who will monitor these safeguards We need to have a multi-level foolproof mechanism before we actually spell out the criteria about which patient can be offered passive euthanasia. It is a very grey zone, because you’re actually taking away a patient’s life,” adds Dr Hemanth.