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Euthanasia:A Moral Dilemma



What is Euthanasia?


Perhaps one of the most exhaustively covered topics in the morality discussion,euthanasia has stirred heated debate amongst ethicists. Alas,there is a dearth of awareness regarding this theme beyond the academic circle of intellectuals and scholars. Suicide is often considered synonymous with euthanasia. Whilst the ultimate objective of both suicide and euthanasia is self-destruction,it is paramount to comprehend the pain-alleviating significance of euthanasia. In other words, one can look to euthanasia as a ‘mercy killing’. Although deliberate,it is often a mechanism to cushion an individual from excruciating torment. The ethical,religious and legal implications of euthanasia are contentious issues indeed.


Euthanasia in India.



Active euthanasia is not permitted under any circumstances in India, by order of the judiciary. A permissive stance has been taken with respect to passive euthanasia, The right to an honourable death has been recognised by the Supreme Court for patients in a persistent vegetative state (PVS) and have no hope of recovery. Accordingly, under Article 21 of the Indian Constitution, passive euthanasia has been recognised in India as a component of the Right to Life.



Classification of Euthanasia


Voluntary euthanasia is often performed at the behest of the patient. It is an acceptable legal practice in certain countries such as the Netherlands,Colombia,Luxembourg and Belgium. It is undertaken with the purest of intentions to recognize an individual’s ‘right to die’. Although involuntary and non-voluntary euthanasia may seem similar at first glance,non-voluntary euthanasia is executed without a patient’s consent. The Groningen Protocol of the Netherlands is the only legal framework permitting child euthanasia in the world.



Arguments for Euthanasia


Right to die


Article 21 of the Indian Constitution states that ‘’No person shall be deprived of his life or personal liberty except according to procedure established by law’’. The Constitution recognizes every individual’s right to life as the fundamental basis on which the constitution rests upon. It is rudimentary as sans the right to live,every other legal entitlement would be meaningless.The right to life facilitates one to lead a healthy life,to enjoy all faculties of the human body in their prime conditions. A person is entitled to enjoy tradition, culture, heritage and every joie de vivre.


Although humans are granted the privilege to live,’the right to die’ is strictly restrained. No matter how much one attempts to break free of the clammy touch of death, death reigns supreme. It is the inevitable. It is yet another reminder about the sanctity of life. Just as one lives,one dies. Death is but a force of nature just as life is a bloom of flowers.To be denied death,is to be denied life. To place rigid laws that withhold the right to die is unjust as death is a natural process. It would suppress the right to freedom of choice as rather than an individual’s destiny would be shaped not by his choices but by the choices of society. An individual must be given the freedom to determine his own fate as he has a right to self-determination.


Proponents of euthanasia often suggest the ‘freeing up’ effect which is a consequence of euthanasia. No matter how well funded the public health system,scarcities of resources always persist. The limited medical resources affect public health immensely as some patients remain untreated. A considerable consignment of medical equipage is amassed as it is not drained by ‘irreparable medical cases’. Rather than die a slow,painful death and aimlessly consume medical resources,individuals choose to take the quicker way out.


Euthanasia is also a panacea for the sick who are battling the monsters of terminal illnesses. When concrete expectancy of death emerges,it is a monstrosity to prolong a patient’s agony when death is imminent. A vegetative state, or an unaware and unresponsive state, is a neurological diagnosis in which a person has a functioning brain stem but no consciousness or cognitive function. Such patients who alternate between sleep and wakefulness hang onto life by their fingernails.The utter damage caused to the cerebrum and cerebellum render voluntary functions impossible. Is it justifiable prolonging a vegetative state when there is no hope to regain consciousness? Is it not unjust to the patient to keep him waiting on the altar between life and death? Is he not a mere vegetable?

Euthanasia would thus liberate individuals from the harsh tribulations of life and enable them to die with dignity.


Arguments against Euthanasia


Opponents of the effective practice of euthanasia argue that alternative approaches such as palliative care and implementation of painkillers as a means to soften the degree of pain is preferable as opposed to the ultimate and final nature of euthanasia. Palliative care seeks to improve the quality of life of individuals who face the arduous hurdles associated with life-threatening illness. Prevention and relief of suffering is achieved by means of early identification and impeccable assessment. Pain and other complaints that are physical, psychological and spiritual are treated impressively.Research proves the success of palliative care. Would it not be morally erroneous to push a patient off the cliff of life towards the sea of death when there is still a fighting chance of survival?

Is it not appalling to know that a majority of patients that request euthanasia are not terminally ill? Rather they suffer from poor mental health,low self esteem or worthlessness that is a result of societal rejection. Convinced of the forlornness of their situation,the human instinct of survival is squashed by mental anguish. Although recovery may be well within reach,patients are disheartened by the prospect of financial burden on the weary shoulders of immediate family relations.Often the heartless family coerces the patient into euthanasia by manipulation. Or deserted elderly folk see it as their only choice. Euthanasia causes much anguish not only to the victim but also his family whose rights are affected.


Euthanasia also poses a great threat to the principle of the sanctity of life. The process of fertilisation only demonstrates how fortunate an individual is to be born. Out of a billion sperm,only one will emerge victorious to fuse with the particular egg that is released that month. Such is the sanctity of life. Euthanasia also undermines the worth of an individual. Every human being must be valued;irrespective of age, sex, race, religion, social status or their potential for achievement or even state of health. Euthanasia suggests the inferiority of a certain strata of society;the infirm and the geriatric.It suggests that their lives are not worth living and that it would be better consumed by the youth and those more ‘worthy’ of living.


Difficulties in regulation


There is a very real danger of the emergence of involuntary euthanasia in the event of the legalisation of voluntary euthanasia. It would be the start of the slippery slope by permitting a harmless action that would give way to the rise of involuntary euthanasia that is tantamount to murder. Murderers would be shielded by the legal framework put in place for euthanasia as no advantageous evidence would be in place to make a case.

Doctors would be equipped with a lethal weapon that could alter the course of countless lives. Health care costs may influence doctors to euthanize patients against their will to save money or to free up hospital beds. Nurses and doctors would no longer prioritise the saving of lives if euthanasia is legalised. Research on possible cures for diseases would no longer concern scientists. The entire medical system would collapse as treatment would become lackadaisical. A 1998 study found that doctors who are cost-conscious and 'practice resource-conserving medicine' tend to write a lethal prescription for terminally-ill patients. This suggests that medical costs do take a priority over ethics in medicine.


Regulation


No matter how many restrictions imposed on the practice of euthanasia,it would still continue to be carried out behind closed doors. It would be in the nation’s interest to legalise euthanasia as it would protect the vulnerable. Regulation and legislation would prevent abuse of euthanasia.Patients who are pressured to decide in favour of euthanasia would turn to the law by initiating the formal procedures involved in regulated euthanasia.


Existing systems of legalised euthanasia.


The Oregon approach


Legalisation of euthanasia in the US state of Oregon occurred in 1998. The necessary parameters for consideration of euthanasia are thorough and analytical such as:


patient must be resident in Oregon

patient must be aged over 18

patient must make 2 oral and 1 written request for euthanasia

there must be at least 15 days between the first and the last request

patient must be terminally ill with a life expectancy of less than 6 months

this prognosis must be confirmed by a second consultant physician

both doctors must confirm that the patient is capable of making this decision

both doctors must confirm that the patient does not have medical condition that impairs their judgement

patient must self-administer the lethal medication

Thirty percent of the patients died before the procedure was completed in the three year time period. Nineteen patients, who were given access to lethal medication decided not to use it. A survey showed that forty five percent of patients who were given good palliative care changed their mind about euthanasia.



The 'Dutch' Approach

In the Netherlands voluntary euthanasia and assisted suicide are still criminal offences, but doctors are exempt from criminal liability in certain circumstances. The Netherlands Criminal Code Article 293, paragraph two, stipulates that the doctor:

must be convinced that the patient has made a voluntary and well-considered request to die

must be convinced that the patient is facing interminable and unendurable suffering

has informed the patient about his situation and his prospects

together with the patient, must be convinced that there is no other reasonable solution

has consulted at least one other independent doctor who has seen the patient

and given his written assessment of the due care requirements as referred to in the points above

has helped the patient to die with due medical care

Features of good regulation

Thorough investigations of the patient's pyschology, family dynamics and the financial implications of his death is vital to reach a mature and informed conclusion.Medical condition and the likely course of the disease must also be studied.In order to ensure that requests are properly considered, by the patient, the family and the authorities, regulations need to be built in a time-period for reconsideration. Palliative care must be provided before a request for euthanasia is accepted.Although such procedures are time-consuming and expensive,they are the need of the hour.



Conclusion

Euthanasia is certainly a moral dilemma,ethically,religiously and even considering its practical implications. Although legalisation may facilitate involuntary euthanasia,the positive effects of regulation cannot be emphasised enough. The vulnerable could always look to the law to avoid pressure by doctors and family members regarding euthanasia.



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