A time to live, a time to die

In the wake of the Supreme Court’s judgement in the Aruna Shanbaug case, the arguments have moved from the ‘potential to be misused’ argument to that of 'I have the right to choose when and how I wish to die’. So it’s no surprise that euthanasia is being viewed as a pre-emptive strike that will preve  nt the ‘loss of control’ or becoming a ‘burden’ on care-givers.

 

The World Health Organisation (WHO) maintains that “governments should not consider the legalisation of physician-assisted suicide and euthanasia until they have demonstrated the full availability and practice of palliative care for all citizens” (WHO Recommendations, Cancer Pain Relief and Palliative Care, 1990).

This is a position that has been reiterated by practitioners of palliative medicine worldwide. They have argued that countries that have legalised (or have sought to legalise) euthanasia and/or physician-assisted suicide have inferior palliative care services. The inference is that because of inadequate care, the suffering of the terminally ill is not relieved and, hence, the demand for assisted dying.

Published data also seems to support this position. A US study of physician-assisted suicides in Oregon suggests that 46% of patients who received substantive palliative care changed their minds as compared to the 15% who weren’t offered palliative care (New England Journal of Medicine 2000). This was also supported by evidence presented by other palliative care physicians from Britain, the Netherlands and Australia.

On the other side, economic factors — namely the cost of treatment and subtle coercion from carers — were recognised as parameters that can tip the balance in favour of opting for an assisted death.

But there are basic questions that beg to be answered:

Would offering euthanasia or physician-assisted suicide as a therapeutic option further add to the burden on patients as well as signify a deleterious shift in clinical practice currently focused on saving lives?

Who has the right to decide if and when a life-prolonging treatment be started or stopped or when suffering has become unbearable? The patient, the family, the physician, the lawmaker, or society at large?

Is it justified, in a situation where there is limited access to palliative care, to deny a person the right to end his suffering by euthanasia or physician-assisted suicide?

With people living longer and with diseases such as cancer, Alzheimer’s and  dementia on the rise, and with reduced family and community support, is it realistic to expect people to continue to live with dignity when no outside support is available?

Is it not better to legalise euthanasia, and thus bring it under closer control and scrutiny rather than allow it to operate clandestinely?

Do laws regulating living wills or advance directives that exist in only a few countries now have any place in this debate?

Does moral responsibility and personal beliefs count in a discussion on euthanasia and palliative care?

The debate shouldn’t be seen in an either/or paradigm but as a step-by-step approach with euthanasia offered only in the rarest of cases where it can be proved beyond any doubt that there is unrelieved suffering.

Harmala Gupta is founder-president, CanSupport

The views expressed by the author are personal