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EditorialEditorial : To Die or Not To Die


No, this is not a discussion on Shakespearean rhetoric, neither is it a commentary on the mental state of Hamlet. This is a discussion on a deeper question, a question about the life and death of a human being, quite literally so. While we do not decide on our birth, do we have the right to decide on our death? That is the question, the burning question, which has been consuming endless hours of intellectual deliberations of countless people over the past few decades. How did this discussion begin? It all began with a choice that technology gave us. Paradoxically, the choice was to keep a human being alive even in a physical condition that would have previously been equated with death. An accident, a convulsion, a concussion, or any other damage to the brain, can break the brain and put the body into a vegetative state. Earlier, that was the time to fix the funeral date. Not anymore. Now it is the time to put that body on a contraption, variously called ventilator or respirator, make the heart and lungs work by force, and wait for the brain to magically recover and bring back life and action to that inactive body. One waits and hopes that the dying fluorescent bulb of the body in its last flickers may suddenly come to life and continue with a steady glow.


The innovation of the medical ventilator or a respirator is a very old one, as early as the 1920s. Initially used on patients with breathing problems, the medical ventilator was developed to sustain life of patients under anaesthesia during surgery. Advances in modern medicine are unimaginable without this invention. Today, complicated surgeries of the heart and brain are performed with ease, sometimes even by machines, because of this medical ventilation. So, the technology is not to be blamed. The problem lies in its application in some cases. Here we are discussing ‘euthanasia’, which etymologically means ‘good death’, and denotes the practice of willingly putting an end to one’s life to stop pain and suffering. Yet, this is precisely the problem. In the conditions that lead to a patient being put on the ventilator, almost always the patient is not conscious, and the decision to put an end to her or his life has to be taken by others. So, in such circumstances, euthanasia does not quite fulfil its definition.


However, euthanasia is not just about patients on ventilators. It is also about people who are very much conscious and in a lot of pain and suffering. For example, patients with terminal illnesses, which do not have any hope of a cure. That is why the question of euthanasia is a major one in palliative care, the care of the terminally ill. Discussions and debates on euthanasia are consequently broadly divided into two possibilities, one called voluntary euthanasia, where the patient is conscious and the other called involuntary euthanasia, where the patient is not conscious. Generally, involuntary euthanasia is equated with murder. Unlike the ventilator, the concept and practice of euthanasia dates back thousands of years. Instances of euthanasia can be found in historical records, literature, mythology, and even religious texts. Some religions like Hinduism permit their adherents to end their lives in case of unbearable physical suffering that prevents one from doing religious practices. Ancient Indian texts on medicine have references to euthanasia. However, modern medicine started using the term only in the seventeenth century.


The definition of euthanasia thus raises three critical questions in every instance where this practice may be considered an option: Whether the patient is conscious, whether the patient is free from suffering, and whether there is a cure? Any attempt by a person to end a patient’s life, without the patient’s consent when the answer to even one of these questions is a yes, will be considered as murder. The debate is primarily about: Whether someone other than the patient can put an end to the life of the patient when she or he is unconscious, is suffering, and there is no cure? Also, whether the patient, who is conscious and suffering, can end her or his life when there is no cure? Even if the patient is unconscious, another person could end the patient’s life as a ‘merciful’ act to relieve the patient of pain and suffering. If one thinks that these are simple yes or no questions, they are greatly mistaken. The problem is complex because these questions are qualitative and difficult to counter-check. And there arises the fourth question: Whether there is sufficient reason for taking the decision of euthanasia? If ever there was an issue where all the factors were arbitrary, euthanasia is the one. All the same, one should be clear as to what is not euthanasia. Abortion, suicide, murder, and denying treatment—not withdrawal of treatment— are not euthanasia.


The greatest danger with euthanasia is that it can easily become a euphemism for outright killing. It is difficult to decide whether or not one should consent to euthanasia. Interestingly, many people opt for withdrawal of treatment for terminally ill patients rather than choosing to end their lives. Though in effect, they are almost the same, no one wants to be held responsible for someone else’s death. Some people opine that a person’s right to live would also translate as one’s right to die. In the absence of an incurable ailment, such an argument could only lead to the justification of suicide. Since euthanasia is not legal in many places, doctors sometimes take advantage of this and keep a dead person on a ventilator to increase the medical bill! Conversely, the near and dear ones of the patient who is administered euthanasia, suffer an indescribable trauma and for the rest of their lives, have to carry the burden of having ended the life of their loved one. This decision is also traumatic for the doctor who had been treating the patient. After all, every doctor wants to heal patients, not put them to rest.


The issue of euthanasia is being much debated now. Lawmakers worldwide are trying to find out the pros and cons of legalizing euthanasia. Movements for and against it are being started. The media is filled with debates and discussions on it. A definite decision eludes us. And this makes one to ask: Is there a single criterion which would determine the validity or need for euthanasia? Yes, there is one, and that is love. If a person decides to end the life of a terminally ill patient, it should be because that patient is a loved one, and the suffering of a loved one is unbearable. If a doctor assists in the euthanasia of a conscious patient, it should be because of the love the doctor has for the patient and the love the patient’s family has for the patient. Love is unselfish and so all instances of euthanasia with even the remotest gain to the person who ends the patient’s life should be seen only as murder. Love can be the only litmus test of euthanasia. Arbitrary though it may be, it can be the only justification to decide on behalf of another, act on behalf of another, an act which would otherwise be called murder.


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