- Euthanasia May Be Necessary For the Fair Distribution of Health Resources:
“Over 53% children in India under five years- that is 67 million- live without basic health care facilities. The children who are future of our country are without basic health care facilities. Is it ethical to care half dead bodies for years without any hope?”
-Times of India, May 2008
“53% Indian kids under5 lakh health care”
This argument may seem baseless and a little too practical to accomplish. If for the equitable distribution of resources, it were necessary to kill people who could not contribute, the world would be a veritable war field. But there are instances where this argument may stand ground. In Oregon, a 64- year old woman, had lung cancer and it would likely kill her. Her last hope to live was a $4000-a month drug that her doctor prescribed for her, which the insurance company refused to pay (Donaldson, 2008). Her Euthanasia drug would cost about $50. Hence, instead of going thru the difficulty of incurring debts and trying to extend her life, the euthanasia drug seemed like an easier way out. It is the case with most of the euthanasia patients, the life ending drug would cost about $70 to $100 but taking care of these people would cost $40000. What is more, Oregon Medical aid program pays for assisted suicide for poor residents as a means of “comfort care”! (Smith)
In some of western countries, particularly the USA, health care is provided by the state in an organised and subsidized fashion (Grier, 2010). In these countries the insurance will cover almost all of your medical expenses. In countries like India or Oregon where third party responsibility is very less the entire family may go bankrupt in providing medical assistance to the ones who are leading the life of a vegetable.
ARGUMENTS AGAINST EUTHANASIA
Depression is a significant contributor to the thoughts about euthanasia. In one study, of the 24% of terminally ill patients who desired death, all had clinical depression. Depression is treatable. Many people who have been killed could have been spared simply be providing some kind of therapy for their illness. (Debating assisting suicide)
Emotional and psychological pressures could lead people to choose euthanasia. If choice of euthanasia is considered as a good decision, many people will feel guilty for not choosing death. Financial considerations, added to concern about “being burden,” could serve as powerful forces that would lead a person to “choose” euthanasia. But the question is how can one gauge the impact of emotional pressures? When can the doctor actually decide that the patient can no longer survive the shock? What level of suffering must the patient be going through at the time of opting for euthanasia? These are some questions that raise dilemmas in the minds of the power - wielders.
- Misuse of rights for vested interests:
This argument can be best understood by means of an example. An elderly person in nursing home, who can barely see and understand a breakfast menu, is asked to sign a form consenting to be killed. Is this voluntary or involuntary? If the relatives of the patients have some vested interest in his property and want to end his life much earlier than the normal course, then euthanasia will become a legal device in this crime. Something that was meant to serve the purpose of relieving patients of their pain and suffering may actually turn out to be a murder weapon.
In a similar case, say a woman is suffering from depression and wants to commit suicide. One doctor sets up a practice to help such people. He plays God and provides the easy way out for such patients – death! Anyone who wants to die knows he will approve any such request. He makes lacks of rupees a year for charging some thousands to each patient. If such practices become commonplace nobody will be able to guard against unscrupulous doctors.
- The Hippocratic Oath:
Hippocrates, the father of modern medicine, said in 400 B.C “I will give no deadly medicine to any one if asked, nor suggest any such counsel’. (History of Euthanasia) Physicians are expected to live by this Hippocratic Oath. This oath prohibits them against killing patients voluntarily. It stands as a promise to whole society that he will not give any lethal drug to anybody nor will he make suggestion in effect. Hippocratic physician rejects the view that patient’s choice of death can make killing him right.
LANDMARK CASES OF EUTHANASIA IN USA, AUSTRALIA AND INDIA:
Legal status of euthanasia in U.S.A: (Schiavo Case In appeals Court) (GOP Maneuver in Schiavo case stirs controversy)
Active euthanasia is illegal in most of the United States. Patients retain the rights to refuse medical treatment and to receive appropriate management of pain at their request (passive euthanasia) even if the patients' choices hasten their deaths. Additionally, futile or disproportionately burdensome treatments, such as life-support machines, may be withdrawn under specified circumstances and, under federal law and most state laws only with the informed consent of the patient or, in the event of the incompetence of the patient, with the informed consent of the legal surrogate. The Supreme Court of the United States has not dealt with "quality of life issues" or "futility issues" and appears to only condone active or passive "euthanasia" (not legally defined) when there is clear and convincing evidence that informed consent to the euthanasia, passive or active, has been obtained from the competent patient or the legal surrogate of the incompetent patient. While active euthanasia is illegal throughout the US, assisted suicide is legal in three states: Oregon, Washington and Montana.
Case in the United States of America: Case of Terri Schiavo
Terri Schiavo spent 13 years in a hospital bed as the tragic victim of massive cardiac arrest at age 26 with no hope of recovery. She was in a "persistent vegetative state" (i.e., a condition in which a person is technically alive but brain dead)
This case was brought before various state courts in Florida. In each instance, the court recognized the testimony of medical experts that Terri was in a persistent vegetative state and that there was no possibility of her improvement. They recognized that her husband, Michael Schiavo, had the authority to make end-of-life decisions for his wife. They authorized him to remove her feeding tube on three occasions.
Federal Court activities:
U.S. District Judge James Whittemore heard arguments for two hours on 21st March 2005 from attorneys for Terri Schiavo's parents and husband. David Gibbs, an attorney for the parents, said that allowing Terri Schiavo to die by starvation and dehydration would be "a mortal sin" under Terri's Roman Catholic beliefs and requested immediate re-insertion of the feeding tube. Gibbs said: "It is a complete violation to her rights and to her religious liberty, to force her in a position of refusing nutrition." But Judge Wittemore responded that forcing Terri to endure another re-insertion of the tube would violate her civil rights.
Judge Whittemore issued his ruling on the morning of 22nd March 2005. He denied the parent's request for an injunction.
Within hours, the parents had appealed the decision to a three-judge panel of the 11th Circuit Court of Appeals.
At about 3:30 PM on 23rd March 2005, the three-judge panel of the 11th Circuit Court of Appeals rejected the parents' request by a vote of 2 to 1. They ruled that Terri's parents "...failed to demonstrate a substantial case on the merits of any of their claims”. Terri Schiavo's parents immediately asked for an emergency rehearing of the case before the entire court. The court responded within hours, ruling 10 to 2 to not reinsert the tube. As is normal in appeals like this, the full court did not explain its decision.
1)"Schiavo Case In Appeals Court," CBS News, 2005-MAR-22, at: http://www.cbsnews.com/
2) Gail Gibson, "GOP maneuver in Schiavo case stirs controversy," The Baltimore Sun,
Legal status of euthanasia in Australia:(supremecourt.wa.gov.au)
Euthanasia is now illegal in Australia. It was once legal in the Northern Territory, by the Rights of the Terminally Ill Act 1995. In 1997, the Australian Federal Government overrode the Northern Territory legislation through the introduction of the Euthanasia Laws Act 1997. Unlike the United states, legislation in the Northern Territory is not guaranteed by the Australian constitution. Before this law was passed by the Australian Government, Dr. Philip Nitschke helped three people by them using his Deliverance machine. Organisations such as Exit International (founded by Nitschke himself), want the government to bring back euthanasia rights to Australia. Exit made TV commercials which were banned before they made it to air in September 2010.
Legal status of euthanasia in Australia:
Euthanasia is now illegal in Australia. It was once legal in the Northern Territory, by the Rights of the Terminally Ill Act 1995. In 1997, the Australian Federal Government overrode the Northern Territory legislation through the introduction of the Euthanasia Laws Act 1997. Legislation in the Northern Territory is not guaranteed by the Australian constitution. Before this law was passed by the Australian Government, Dr. Philip Nitschke helped three people by using his Deliverance machine. Organisations such as Exit International want the government to bring back euthanasia rights to Australia. Exit International made TV commercials which were banned before they made it to air in September 2010.
Case in Australia: Case of Christian Rossiter
A landmark decision in Western Australia's Supreme Court has given a Perth quadriplegic the right to refuse food from his care provider.
Christian Rossiter, 49, was given the approval on the condition he understands the consequences of his actions. Mr Rossiter, who developed spastic quadriplegia after being hit by a car, said he was relieved by the court's decision.
Mr Rossiter was fed via a tube in his stomach and his care provider, the Brightwater Nursing Home, had asked the court whether it could legally stop feeding him.
In submissions to the court, Mr Rossiter's lawyer John Hammond said there was no lawful basis upon which Brightwater could ignore such a request.
Court proceedings and judgement:
The presiding Judge Martin CJ’s verdict was as follows:-
“It is important I think to emphasise at the outset what this case is not about. It is not about physicians providing lethal treatments to patients who wish to die. Nor is it about the right to life or even the right to death. Nor is the court asked to determine which course of action is in the best interests of a medical patient. The only issue which arises for determination in this case concerns the legal obligations under Western Australian law of a medical service provider which has assumed responsibility for the care of a mentally-competent patient when that patient clearly and unequivocally stipulates that he does not wish to continue to receive medical services which, if discontinued, will inevitably lead to his death.”
Legal status of euthanasia in India:(asiancorrespondent)
Passive euthanasia is legal in India. On 7 March 2011 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state. The high court rejected active euthanasia by means of lethal injection. In the absence of a law regulating euthanasia in India, the court stated that its decision becomes the law of the land until the Indian parliament enacts a suitable law. Active euthanasia, including the administration of lethal compounds for the purpose of ending life, is still illegal in India, and in most countries.
Case in India: Case of Aruna Shanbaug
In a breakthrough ruling, India legalised “passive euthanasia”. The Supreme Court ruled for the first time that life support can be removed for some terminally-ill patients in “exceptional circumstances”. However, the woman who started it all will not be allowed a mercy killing.
Aruna Shanbaug, a former nurse, had been lying in a vegetative state for the last 37 years following a sexual attack by a sweeper. It was journalist Pinky Virani who appealed to stop Ms Shanbaug being force-fed to keep her alive. India’s top court ruled that the plea had been denied as Ms Shanbaug was unable to make the demand herself. Furthermore, Ms Shanbaug’s parents died several years ago and most of her family have disconnected ties with her.
She had been paralysed and considered “brain dead” since 1973 when she was attacked by a rapist. In December 2009, journalist Pinki Virani, who has written a book on Ms Shanbaug titled Aruna’s Story, appealed to the Supreme Court on behalf of Ms Shanbaug asking for her life to be ended by “forewith” ensuring “that no food is fed” to her.
In her petition she stated: “This continued vegetative existence devoid of human dignity is not life at all and putting mashed food in her mouth only amounts to violation of human dignity.”
Court proceedings: Quotes by the judge:
“Heard Mr. Shekhar Naphade, learned senior counsel for the petitioner, learned Attorney General for India for the Union of India Mr. Vahanvati, Mr. T. R. Andhyarujina, learned Senior Counsel, whom we had appointed as amicus curiae, Mr. Pallav Sisodia, learned senior counsel for the Dean, KEM Hospital, Mumbai, and Mr. Chinmay Khaldkar, learned counsel for the State of Maharashtra.
1. Euthanasia is one of the most perplexing issues which the courts and legislatures all over the world are facing today. This Court, in this case, is facing the same issue, and we feel like a ship in an uncharted sea, seeking some guidance by the light thrown by the legislations and judicial pronouncements of foreign countries, as well as the submissions of learned counsels before us. The case before us is a writ petition under Article 32 of the Constitution, and has been filed on behalf of the petitioner Aruna Ramachandra Shanbaug by one Ms. Pinki Virani of Mumbai, claiming to be a next friend.
2. Judged by any parameter, Aruna cannot be said to be a living person and it is only on account of mashed food which is put into her mouth that there is a facade of life which is totally devoid of any human element. It is alleged that there is not the slightest possibility of any improvement in her condition and her body lies on the bed in the KEM Hospital, Mumbai like a dead animal, and this has been the position for the last 36 years. The prayer of the petitioner is that the respondents be directed to stop feeding Aruna, and let her die peacefully.
3. We could have dismissed this petition on the short ground that under Article 32 of the Constitution of India (unlike Article 226) the petitioner has to prove violation of a fundamental right, and it has been held by the Constitution Bench decision of this Court in Gian Kaur vs. State of Punjab, 1996(2) SCC 648 (vide paragraphs 22 and 23) that the right to life guaranteed by Article 21 of the Constitution does not include the right to die. Hence the petitioner has not shown violation of any of her fundamental rights. However, in view of the importance of the issues involved we decided to go deeper into the merits of the case.
4. Notice had been issued by this Court on 16.12.2009 to all the respondents in this petition. A counter affidavit was earlier filed on behalf of the respondent nos.3 and 4, the Mumbai Municipal Corporation and the Dean, KEM Hospital by Dr. Amar Ramaji Pazare, Professor and Head in the said hospital, stating in paragraph 6 that Aruna accepts the food in normal course and responds by facial expressions. She responds to commands intermittently by making sounds. She makes sounds when she has to pass stool and urine which the nursing staff identifies and attends to by leading her to the toilet. Thus, there was some variance between the allegations in the writ petition and the counter affidavit of Dr. Pazare.
- With the advent of technological advances in medical research, several diseases are now curable. Taking an optimistic stand, we, as a group believe that an incurable illness may be treated in the future. So, a physician should heal his patient with an incurable illness.
- Particularly from a legal perspective, there has to be legal clarity around the withdrawal and/or withholding of potentially life-sustaining treatment without consent.
- If death is not imminent, the physician must request a consultation with a second physician, either a psychiatrist or a specialist of the patient’s pathology. In that case, a delay of at least one month between the request and the euthanasia has to be respected. To avoid prosecution, the physician – and the physician alone – must respond only to the voluntary, written, well-thought-out and reiterated request by an adult patient who is in a serious and incurable medical condition, and experiencing unbearable physical or mental suffering. The physician must also inform the patient of his state of health and life expectancy, and of the possible therapeutic measures and available palliative care. In Netherlands, the physician has to declare the act of euthanasia to a Federal Commission composed of 8 physicians, 4 jurists and 4 persons from environments entrusted with the problems of patients suffering from an incurable disease. This Commission has a second mission: to establish every other year a statistical and evaluative report, and to suggest recommendations. (Belgium's legalization of Euthanasia by jacquline herremans) A similar arrangement may be made in India. In addition to making a recommendation, the doctor's self-perceived role is to get the patient to go along with this recommendation if there is any hesitancy on the patient's part. This is done by some explanation about the need for the recommended treatment and the consequences of not heeding the recommendation. But in the doctor's view there is no decision for the patient to make, except whether to get proper medical care.
- Mobile euthanasia team to assist people to die at home have been given the go-ahead in Holland. The mobile teams of doctors were the first to carry out assisted suicides in borderline cases when family doctors refuse to administer patients with lethal drugs on ethical grounds. (huffingtonpost) Taking cue from all these, India must devise laws that would examine the cases on their merit and give the rulings accordingly.
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