Tuesday, August 17, 2010

Euthanasia by Default

The word “Euthanasia” got added to my vocabulary as I read the masterpiece, “Doctors”, by Erich Segal, about 22 years back. Though I must admit the deeper meaning and the bigger picture projected/incubated by the word, in the canvas of life, I could grasp only with the ‘passage of time’—which when translated to its effect implies ‘experience’.

The true essence of a word goes well beyond its literal meaning. It rather depends on its interpretation, distortion, manipulation, assimilation, extrapolation and integration. These operators at times work in tandem—some, if not all. While at other times they are mutually exclusive in their operation. And Euthanasia too is not immune to this norm—as is normal. We have a tendency to lynch a word, try its elasticity—synonymous to versatility and wide ranged applicability—till it reaches plasticity.

Thus when I gradually began to grasp the gravity of the implications of the word I started to gravitate towards either end of the fulcrum—pros and con of the effect imparted by what Euthanasia does. But before dealing with the pendulum of my analytical mind, I need to delve a bit on Euthanasia. Although I am sure almost everybody knows what is Euthanasia—especially my friends from the medical fraternity and legal field, but the teacher in me refuses to proceed further without a proper groundwork!

Euthanasia, as per Wikipedia (our fastest and most commonly used tool for accessing information), has its root in Greek: ‘eu’ meaning ‘good/well’ and ‘thanotos’ meaning ‘death’. The word was first used to signify a peaceful death, devoid of suffering, but was later on modified, by extrapolation by none other than Francis Bacon. He said that Euthanasia is definitely a peaceful death sans suffering but brought about by a physician who helps the patient suffering from an incurable disease and unbearable pain, to get rid of it. The physician at the behest of the patient helps alleviate the pain in the only possible way—by helping him/her to end the life.

Later on, it started being referred to as the practice of ending a life in a manner, which relieves pain, and suffering. According to the House of Lords Select Committee on Medical Ethics, the precise definition of Euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering”. Well there are many camouflaged, heavily loaded words used as preconditions for a process to be qualified as Euthanasia.
I do not want to enter into an ongoing raging debate all over the world over Euthanasia. But I need to put forth my views in order to validate my purpose behind this piece.

The first word that comes to mind on learning of an unnatural death—of a person, inflicted by another person—is ‘homicide’. Even ‘suicide’ is an act of ‘homicide inflicted by the self on the self’. ‘What led to it’ always comes as an after thought. So Euthanasia too apparently would likely come under it. Maybe this is the reason why it has not been legalized. It is deemed legal in not even a handful of countries, Netherlands being one of them, but then the Euthanasia has to of the “Voluntary” variety and needs to fulfill the conditions (laid down by deciding authority) to qualify for the procedure. And as I write this piece, Germany has made Euthanasia legal.

Euthanasia—ethical or unethical, notwithstanding—has been categorized as:
(i) Voluntary: - The patient unable to bear the pain—caused both by the illness as well the treatment that it necessitates—gives his/her consent….in fact urges with the attending doctor to bring an end to the suffering.

(ii) Non-voluntary: - The consent is unavailable from the patient, one of the example being that of child euthanasia.

(iii) Involuntary: - The consent of the patient is not taken and hence is equivalent to murder.

And even after these categorizations the true Euthanasia is considered to be the first one, Voluntary Euthanasia.

But what about the doctors? What do they do? Irrespective of the “Rights of the Terminally Ill Patient”, they are bound by the Hippocratic Oath. Though I am not the right person to comment upon it, but still there is one point in that oath that I find ‘double-edged’. The proclamation, “I shall not harm my patients”. What is actually harmful depends entirely upon the situation. Aspirin is great for some people while it is devastating on the ‘system’ of others. Likewise, if the situation of a patient is irreparable, the pain irreducible and the necessary drugs to fight the (lost cause) illness aggravate the suffering as an undesirable contra-effect, then is the continuance of the medication healthy or harmful? But then their hands are tied in the tug-of war between ethics of oath, supported by their conscience and contradicted by rational mind. ‘I can’t play God’, that is their overwhelming thought.

In fact, Euthanasia has also been aptly described as “Assisted Suicide”.

Thus is an act of homicide, at its face value. In spite of knowing that ending a life or aiding in culminating the pain, by terminating the working of the heart, would alleviate the pain, release and relieve the soul from the entrapment of the physical sufferings, at least I can’t actively participate in such an act and am happy that am not a doctor! Though of course I can passively play my part…..by doing what I can, legally, with the backing of the conscience. That is pray for the “Mukti” (release), but don’t inflict it—directly or indirectly by assisting in its execution. And this is all what we do normally. Not because of the “Oath of Hypocrisy” that we seem to have taken by default by dint of being born as humans. But because of our belief in the Supreme Being—as we live in a God ‘fearing’, if not ‘abiding’, society. We accept that the rights to ‘create or terminate’ life resides with God and not with us. As also to bestow the grace of (being) ‘Mercifully Killed’, to terminally ill patients.

But as it happens with various issues, there comes a time when the onus of decision-making cannot be passed on as a buck. We are forced to become ‘active’ from ‘passive’ participants. This is encountered when complications arise during childbirth. Till today various deaths are reported during childbirths—sometimes of both the mother and the child and at times either of the two. These occurrences befall unexpectedly most of the time. But when complications are pre-indicated and the death of one of them is imminent, both the Hippocratic Oath, as well as Oath of Hypocrisy, are tested. The doctor envisaging the improbability of saving both the mother and the child and unable to ignore the Oath that takes cognizance of even an unborn child, wants the decision made by the family members, thereby absolving the conscience (doctor’s) of any guilt. While the family members faced with such a difficult situation are afraid to come up with an immediate answer lest they end up being supporters of Oath of Hypocrisy. Whom do they choose, mother or the child—none has committed any crime to be discriminated against? Yet they have to decide and normally the decision is in favour of (saving) the mother and against the child. Then is it not an enforced Euthanasia by default with respect to the child and that too non-voluntary?

Not only this, but there is another instance—and quite prevalent in India where financial conditions of the majority of the population is very bad, the projected economic growth notwithstanding —where the financial constraints doesn’t allow the treatment to be continued, the patient dies and the family members are rendered mute spectators. I know it is Destiny but is not this Destiny reached via a form of Euthanasia, albeit by default. Because that is what it is, allowing a loved one to die, having no other option—that is what has been said of Euthanasia—to assist in dying; in hopeless and unbearable circumstances.

The countries which do not support Euthanasia legally, what do they have to say about these “Euthanasia(s) by Default”?