Thursday, May 11, 2006

Euthanasia

I once wrote an essay for Manupatra Law Students Essay Competiton 2005. Here is that essay:

EUTHANASIA, SUICIDE AND THEOLOGY
Diyya Jyoti Jaipuriar*

Introduction
Voluntary ending of one’s own life is the common thread running through the concepts of euthanasia and suicide. On suicide, the society has always had a strong opinion. But the debate on euthanasia is of a recent origin. The moral bases of the two are quite distinct and so are their estimations. While suicide is often considered a “dishonourable exit” (exception notwithstanding), euthanasia retains certain degree of honour for the dead.
Religion, which has always a significant role in moulding the thought process of the societies around the world, has taken a stand on euthanasia by generally condemning it, by calling it interference in God’s ways of the world. But the debate goes on from Karen Aim Quinlan to “Diane to K. Venkatesh to Terri Schindler Schiavo, spreading across time and spatial dimensions.

What is Euthanasia?
The term euthanasia has its origin in the Greek term “en thanetos” which means “good or easy death”
The declaration on euthanasia “lura at bona”[i] issued by the Congregation for the Doctrine of Faith on may, 05th 1980, define euthanasia as “an action or omission which in itself or by intention causes death in order that all suffering may in this way be eliminated”.
Distinctions are often made based on patient’s consent to euthanasia (voluntary/ involuntary), or between euthanasia by action and by omission. Physician - assisted is the case where a physician provides information, guidance and means to a person to take his/ her own life.
Euthanasia: options divided
There have been several attempts to legalise euthanasia. Few have succeeded. In 1906, the bill for voluntary euthanasia was defeated in the state of Ohio[ii] (USA) legislature by a vote of twenty three to seventy one. In 1936, “Voluntary Euthanasia Bill” could not be passed after been introduced in House of the Lords in England. Similar bill was rejected in the New York in 1939. In 1994, Oregon voters approved by a 51-49 percent vote the Death with Dignity Act. In 2002, Netherlands and Belgium passed similar laws to allow voluntary euthanasia and physician-assisted euthanasia. The shrill over euthanasia has kept on rising. Opinions stand sharply divided.

Euthanasia and personal liberty
The supporters of euthanasia often consider a question of one’s right to die. They believe that euthanasia aim at reducing suffering and ensure honourable exit rather than helpless degeneration. But, those who oppose euthanasia argue that human dignity involves the heroic acceptance or going to a higher purpose of existence
Mahatma Gandhi considered Euthanasia as an act of non violence and insisted that the critics of euthanasia was wrong in assuming that death was always worse than life. He believed that if life was painful and unbearable, not to kill was an act of Himsa (Violence).
Similarly Acharya Vinoba Bhave[iii], one of the greatest visionaries in the twentieth century India preferred an end when life’s mission could not be carried any further. But the critics feel that the perceived “right to die” increasingly matures into a “duty to die” when euthanasia is offered as a remedy to undignified living. The old in Netherlands reportedly fear being admitted to a hospital for their age related ailments lest they would be sanctioned to die in a country where euthanasia is in vogue for quite some time now.

Euthanasia and Medical Ethics
The Hippocratic Oath prohibits a doctor from offering death to his patients and this is often offered as an argument against physician- assisted euthanasia. However the House of Lords in Airedale NHS Trust verses Bland (1993) 2 WLR 316, held that scantily of life was not infringed by ceasing to give invasive treatment which conferred no benefit on the patient and there was no duty on the part of the doctors to continue such a treatment when the patient has no further interest in being kept alive.
In the American case of Jack Kevorkean (Dr. Death), the juries repeatedly declined to convict the doctor of homicide as his actions seemed to have satisfied the morality of a significant proportion of an American society, the criminality of his techniques, notwithstanding.

Euthanasia and pain control
Proponents of euthanasia argue that in cases of terminally ill patients, euthanasia is a method to relieve them and their loved ones, of the agony of extreme pain bound to occur as and when end comes nearer.
Dr. V J Anand[iv] comments on the suffering of cancer patients with malignant ulcers on the body which fungate and emit foul smell because of bacterial infection. Not only is it agonising for the relatives to watch the suffering of he patient, but also inhumanly intolerable for such a patient to live within the family because of the foul smell. Such patients are often shifted to hospitals or hospices (health facilities providing palliative care to the terminally ill patients. “It is … natural for the patients suffering from terminal cancer and their relatives to think of relief from this situation by way of hastening the terminal events”.
But opponents of euthanasia find the idea of mercy killing to relieve pain revolting. They point out the technological advances in the medical science such as “Patient Controlled Anaesthesia (PCA) [a pump which can deliver a continuous infusion of a drug such as morphine as well as allow patient activated doses for breakthrough pain] should be resorted to relieve pain and not the lethal injection.
A whole new field of health care in the form of palliative care evolved to address to the needs of pain control in terminally ill patients wherein no substantial effort is made to cure the patient, but the focus is on relieving their pain. Hospices are a product of this approach to the health care.

Euthanasia and organ donation
P Venkatesh, a bubbly child of tender age, who was diagnosed with muscular dystrophy, a rare disorder which would make his end painful and inevitable. In next few months his muscles would refuse to function one by one before his vital organs ultimately fail bringing his life to an end. The child was distraught and so were his parents and those who loved him. The child and his parents wanted to make an informed decision. They wanted euthanasia for Venkatesh, not only would it relief Venkatesh of his pain, it would facilitate organ transplant to several needy patients. Loss of Venkatesh’s life could thus, be somewhat compensated by giving this rare gift of life to such others for whom death was possible to avoid if timely intervention was made. But the Honourable Andhra Pradesh High Court found itself on an infirm ground while dealing with legal aspect of euthanasia in a country where the debate is still in its nascent stage. P Venkatesh was made to die a slow and agonising death and in the process his vital organs lost their utility for transplantation.

Euthanasia for the political man
Almost all modern ideological streams give individual a pride of place in its settings. The rights of an individual are of paramount importance. Individual is at the Centre. He is the poster boy. Still, the individual is more of a political person than a private person and the control over his life is not of his alone. His life belongs to the polity, which offers him the environment of personal liberty and free will. He ought not to exercise this to the detriment of his very existence. Therefore euthanasia hits at the very bottom of the reasoning of free will: the basis of individuals political existence.

Suicide
Suicide or taking one’s life for wants of a better life for a better life has long been a social taboo. Civil society has looked down upon suicide. Though, a few socio-religious practice of Hindus and Jains have held suicide in high estimation., even these practices are not for those seeking refuse in death from the drudgery of life.
An attempt to commit suicide is a panel offence in India under section 309 of the Indian Panel Code. Certain judicial pronouncements have debated the constitutionality of the section 309 of the IPC. In P Rathinam v. Union of India (AIR 1994 SC 1844) a two judge bench of the Honourable Supreme Court of India took cognisance to relationship/contradiction between section 309 of the IPC and article 21 of the Constitution of India. The court ruled that the right to life embodied in article 21 also embodies in it a “right not to live”. A person cannot, the court ruled, be forced to enjoy right to life to his detriment, disadvantage or disliking. Article 21 of the constitution, the court further said, brings in its trial the right not to live a forced life. The bench held the section 309 of the IPC violative of article 21.
This question was again debated in Gian Kaur v. State of Punjab (AIR 1996 SC 946). The full bench reviewed the Rathinam judgement and held that the protection of life and personal liberty, guaranteed in article 21, nowhere includes extinction of life by a stretch of imagination. The court held, “… Right to life is a natural right embodied in article 21, but suicide is an unnatural termination or extinction of life, and therefore, incompatible and inconsistent with the concept of right to life…” The court validated section 309.
In this case, the Honourable Supreme Court distinguished between euthanasia and attempt to commit suicide in a passing reference. The court defined euthanasia as termination of life of a person who is terminally ill or in a persistent state. Death, in such a case, due to termination of natural life is certain and imminent. The process of natural death has commenced and the in euthanasia, the period if suffering the process of natural death is reduced. The process of natural death, which has already begun, is only accelerated in euthanasia.
The Honourable Supreme Court further maintained that euthanasia may fall within the concept of right to live with human dignity upto the end of natural life. This may include the right of a dying man to die with dignity when the life is ebbing out. But this cannot be equated with the right to die an unnatural death curtailing the natural span of life. But these assertions of the Honourable Supreme Court are more in the manner of obiter dicta and do not carry the force of law.

Right to die: a right to die for!
The question whether the Right to Life includes Right to Life is a tricky one in a country like India where the state has failed in its duty to ensure a dignified life to each of its individuals. In countries like USA and UK, suicide has already been decriminalised. In India too, the Forty Second Report of the Law Commission of India in early seventies had recommended deletion of section 309 of the IPC. This provision has been found to be outdated, irrational and cruel. It was in this light that the Honourable Supreme Court has decriminalised section 309 of the IPC in Rathinam case. “the most desirable fall out of such a finding would be that the frustrated and psychologically traumatised suicide-seekers would not only be spared of most unkind social stigma, but would also be in a better position to freely and fearlessly seek medical and psychiatric treatment.[v]

Theology at the crossroad
Hindu and Jain religions approve the practice of taking one’s own life for the “higher goal” of attaining salvation for the soul. But the practice of committing suicide for escaping life is not acceptable. Dharma Shastra condemns the killing of a person by his own art. Parasara states that if a person hangs and dies, he/she fell in the hell for sixty thousand years. Manu says no water is to be offered for the benefit of those who kill themselves.
Islam does not approve of suicide. The Prophet (Peace Be Upon Him) is reported to have said “La rahabaniah fi al-islam” i.e. Islam does not recognise renunciation of the world to be legitimate. The shari’ah creates a kind of trusteeship of life where the human being is to take care of his body and keep it safe.[vi]
Christianity also condemns taking one’s own life. Although it is not mentioned anywhere either in the New Testament or Old Testament, the church issued religious decree in the Council or Arles against the person committing suicide, and they were denied burial in the church graveyard, and their goods and properties were confiscated by civil authorities in the middle ages.[vii]
As regards euthanasia the theological position on it is of recent origin. There has been a tendency to club euthanasia with suicide and therefore, it has been generally condemned by religious authorities.
The Roman Catholic Church is one of the most vocal critics of thr concept of euthanasia. The reaction of Pope John Paul II on Terri Schindler Schiavo is an unambiguous pointer to it.
When George W Bush, the US president urged the US society to show a “prejudice for life when faced with an ethical question like that raised by euthanasia, critics were quick to point out the biblical tone of his appeal, so in line with his “neo con” ideology.

Concluding Lines
The ethical, moral, sociological and legal aspects of the debate surrounding euthanasia have to be discussed together if one plans to conclude on its desirability. But certain fundamental premises must be borne in the mind. Suicide and euthanasia are not to be confused with each others. The two are different issues and raise different questions, though the questions may be overlapping in few instances. Any move to decriminalise suicide must also accompany steps to prevent legitimising it. Suicide is a scar on any civilised society and its chances must be removed by positive actions on the part of the State and the civil society.
Euthanasia is an issue which raises more ethical questions than legal. Theology is yet to come to terms with it. It is still to get popular recognition. But its importance cannot be entirely brushed aside in a world where techenology has still not been able to remove the causes of pain and suffering of mankink. Theology stands on the crossroads and so does the civil society. For the time being, one may ask the poet to re-write his lines:
Death, Be Not Proud.
* The author is the final year student of LLB programme at the Law Centre-I, Faculty of Law, University of Delhi, Delhi. He can be contacted at jaipuriar@gmail.com. This essay was written by the author for the Manupatra-Westlaw-Surana & Surana All India Essay Competition 2005.
[i] Cantoni, Lorenzo: Euthanasia http://www.alleanzacallolica.org/
[ii] www.finalexit.org
[iii] Desai, Justice Ashok A.; Predicament of Euthanasia
[iv] Anand, Dr V J; Health care needs of the terminally ill cancer patients
[v] Pande, B B; Right to Life or Death: for Bharat both cannot be “right” (1994) 4 SCC (J).
[vi] Saqlain, Masoodi G. & Dhar, Lalita; Euthanasia at Western and Islamic Legal Systems: Trends and Developments, XV-XVI ICLR [1995-96]
[vii] Mustafa, Faizal; Should section 309 IPC continue on the statute book, 1993.




© Divya Jyoti Jaipuriar, 2005

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