Insights into Editorial: Paralympian Marieke Vervoort considering euthanasia after Rio 2016
Belgian paralympian Marieke Vervoort recently declared that she is considering euthanasia after Rio 2016. During the 2012 Games in London, Vervoort won gold in the 100m wheelchair sprint and silver in the 200m. She has an incurable degenerative spinal disease, one that causes unimaginable pain.
What is euthanasia?
Euthanasia is a medical term meaning ‘easy death’. It is the act of deliberate or voluntary end of someone’s life to prevent any further suffering or pain to the person.
Active and Passive euthanasia:
- Active euthanasia: It involves a doctor injecting a lethal medicine to trigger a patient’s cardiac arrest.
- In passive euthanasia, doctors, with the consent of relatives, withdraw the life support system of a person being kept alive with the help of machines.
Euthanasia in India- Background:
The debate over this topic is more than 14 years old. Several draft Bills have been formulated in the last 14 years. The debate on legalising and regulating euthanasia began with a Lok Sabha private member’s Bill – The Euthanasia (Regulation) Bill, 2002 – which was examined by the Health Ministry.
- The debate kick-started again four years later, following the 196thLaw Commission Report on euthanasia and the drafting of the Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2006.
- But the Ministry’s experts under the Director General Health Services took a stand against euthanasia for reasons that it amounted to “intentional killing” and against the Hippocratic oath.
- The Government even viewed euthanasia as an act against progressive medical science’s objective to rehabilitate and treat patients. It observed that death may be a fleeting desire arising out of transient depression and doctors should not fall for the patient’s wish to escape suffering by embracing death.
- However, the Government’s perceptions about euthanasia changed in 2011 when the Supreme Court issued comprehensive guidelines allowing passive euthanasia in the tragic case of the bed-ridden former Mumbai nurse Aruna Shanbaug.
Bill in this regard:
Addressing the contentious issue of mercy killing, the government had come up with a draft Bill- ‘The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill’- on passive euthanasia which gave a patient the right to withhold from medical treatment in case they are terminally ill.
Highlights of the bill:
- According to the Bill, “every competent patient, including minors aged above 16 years, has a right to take a decision and express the desire to the medical practitioner attending on her or him.”
- The Bill goes on to say that such a decision will be binding on the medical practitioner. He or she has to inform the spouse, parents or any other close relative of the patient and desist from carrying out the decision for a period of three days after informing them.
- The Bill provides protection to patients and doctors from any liability for withholding or withdrawing medical treatment and states that palliative care (pain management) can continue.
- The Medical Council of India has been given the authority to formulate guidelines from time to time for the guidance of medical practitioners and might review and modify the guidelines periodically.
- In case any patient is not competent enough to take a decision then his or her next of kin, including spouse, parents or sibling, can approach the High Court, which will have to take a decision within a period of one month.
Issues associated with the bill:
Clause 9: In Clause 9, it says that relatives, medical personnel and the like can apply to the relevant high court for “witholding or withdrawing medical treatment of a competent patient who has not taken an informed decision”. This is dangerous. The bill defines informed decision in subjective terms pertaining to an individual’s understanding of the nature of their illness and the forms and consequences of treatment. As long as the individual is competent, it must not be left to anyone else to judge the merit of their understanding in something as fundamental as their life. This has the potential for misuse and is antithetical to an individual’s fundamental rights.
Living will: There is a general disappointment over the concept of ‘living will’. As per the idea, it is defined as an advance document in which a person states their desire to have or not to have extraordinary life-prolonging measures used when recovery is not possible from their terminal condition, putting the doctors in a fix.
Court’s faith misplaced: The Bill demonstrates that the Supreme Court’s faith is misplaced. The draft Bill negates the basic common law rights of a patient to autonomy over her own body and the determination of what treatment she is willing to undergo. The government has thus denied the patient’s fundamental right to life and liberty.
Distinction: The Bill creates an irrational distinction between patients who are competent at the time at which a decision has to be made about refusing or withdrawing life-sustaining treatment, and those who are incompetent at such time, even though they might have expressed their decision earlier in the form of an advance directive. Clause 3 of the Bill states that the decision of the former category of patients to refuse such treatment is binding on their medical practitioners. The time at which the decision was made to refuse or request the withdrawal of treatment cannot be a rationale for distinguishing between these categories of patients, so long as such decisions were taken freely, fully informed, and not altered fundamentally since. Apart from being an infringement of the right to life under Article 21, the classification stands the risk of being struck down as unreasonable and therefore a violation of the right to equality under Article 14.
Drafting errors: Other problems include drafting errors. The definition of “terminal illness” seems to include even mental health issues.
Choice of High Court: The choice of the High Court as a forum to obtain permission for the withdrawal of treatment from incompetent patients imposes an unrealistic burden on medical practitioners as well as relatives and does not take into account the fact that High Courts are unlikely to be able to deliver swift judgment in such cases.
Should Euthanasia be legal?
Arguments For Euthanasia:
- It provides a way to relieve extreme pain.
- It provides a way of relief when a person’s quality of life is low.
- Frees up medical funds to help other people.
- It is another case of freedom of choice.
Arguments Against Euthanasia:
- Euthanasia devalues human life.
- Euthanasia can become a means of health care cost containment.
- Physicians and other medical care people should not be involved in directly causing death.
- There is a “slippery slope” effect that has occurred where euthanasia has been first been legalized for only the terminally ill and later laws are changed to allow it for other people or to be done non-voluntarily.
The perception of ethicality of euthanasia varies in different countries and cultures. Laws and religious sentiments of people often play a major role in the way it is perceived.
- The deliberate act of taking away a person’s life is classified as a murder and thus a crime. Aiding and abetting someone in suicide too falls under crime. Owing to this, various countries have greatly varying legal stance towards euthanasia.
- Euthanasia has been criminalized by the likes of Philippines, Australia, New Zealand and the United Kingdom. These nations saw several failed attempts to legalize euthanasia.
- There are some nations which allow ending a terminally ill person’s life if the person or next of kin consents. However, several conditions govern the definition of the term ‘terminally ill’. Legalizing euthanasia in these nations aims at preventing any further distress and suffering to the person.
- Euthanasia is legal in Colombia, Luxembourg, Canada and Belgium.
Euthanasia is a topic which touches various aspects of our society. It requires a focused perspective considering all the pros and cons. The dilemmas regarding the legal issues surrounding euthanasia are often due to the ethical aspects which raises question about the rights of a person to take someone else’s life. The debate over the ethicality of euthanasia is a never-ending one. Hence, to resolve this conflict between pain and death, the sooner that a comprehensive law on the subject is enacted, the better it will be for society. Even if permitted, euthanasia should be used in deserving cases only, that too sincerely, honestly and consciously under strict control and supervision of a statutory body.