Don’t Say Euthanasia
Supreme Court judgment is more about giving people the power to stop futile treatment
Harmala Gupta
TIMES OF INDIA 16.03.2018
There is a saying in Africa: “When death comes, may it find me alive.” Today, with advances in medical science, and with people living longer and longer, it has never been more pertinent. Now, more often than not, when death visits it will find a lifeless body in which the heart is beating and lungs are being deflated and inflated by a machine. It is to such a circumstance that the recent Supreme Court judgment speaks.
Professionals who work in palliative care, in critical medicine and in neurology have welcomed this judgment as every day they have to assist patients and their families navigate tricky terrain without a route map to guide them. This is where an advanced medical directive, or a living will, made by a patient who is now unable to take decisions for him or herself has a role to play. It will help decide which fork in the road to take: one that seeks to beat death at any cost or one that seeks to preserve life so that it can meet death with dignity.
Words also matter. “Euthanasia” is a troubling word for many of us as it has become associated with a wilful act, albeit in the name of mercy, with intent to kill while the person is still in control of vital functions but fears a bleak future due to an irreversible disease process. This is a typical case of “active” euthanasia.
But the legal judgment is on the subject of “passive” euthanasia, and not “active” euthanasia. “Passive” euthanasia applies to those who are being kept alive with artificial means or those who fear such a future. Even so, the act of taking such a life is conditional on the person unambiguously stating, when in full consciousness, that he or she would like his or her life terminated if ever in a vegetative condition.
However, listening to discussions in the media, the use of the word euthanasia seems to have muddled public perceptions. People are talking about how good it is to have the option to take your life if you have a terminal illness or have become a burden on your family or are plain fed up with living. This is “active” euthanasia and it is not being endorsed by this Supreme Court judgment.
The Supreme Court has cited right to a life of dignity as justification for the right to die with dignity. It is about ensuring a person’s quality of life right till the end. For this to happen, we must talk about the kind of death we would want so that when the time comes, and we are not capable of taking decisions, our family members will be able to do so on our behalf keeping our wishes in mind. We now also have the option of leaving behind a living will, though experience from the West shows that it is only a minority that exercises this option.
What is more likely to happen, that did not happen earlier, is that doctors will now be empowered to stop futile treatments and take people off life support systems. In other words, they will be able to live up to the Hippocratic oath that enjoins them to ensure that their actions benefit patients and cause no harm. Letting a patient continue in a persistent vegetative state or suggesting treatments that will compromise personal dignity at the end of life are a clear violation of this oath. The Supreme Court judgment in this sense is reminding doctors of the ethics of their profession.
One cannot exaggerate the relief this judgment will bring to patients and their families. I recall the anguish of a son, a doctor settled in the US, when his mother was dying and admitted to a hospital in Delhi. Unfortunately, he heard about our home based palliative care service too late to use it. Instead, against his instructions, his mother was put on life support. His questions were pointed: Why did the doctors not follow my instructions? Why did they never respond to my many calls? And his final reflection: If they could do this to me, a doctor, what must it be like for ordinary people in India?
Unfortunately, doctors are not taught communication skills as part of medical training in our country. If they did, they would listen carefully to what the patient and family want. This becomes even more imperative at the end of life.
Recognising this, Atul Gawande – the doctor whose book ‘Being Mortal’ drew international acclaim – has created communication modules to help doctors break bad news to their patients as well as continue to guide them so that they can make the best choices for themselves. This requires an empathetic attitude, the use of simple language as well as frequent checks to ascertain whether what you have said has been correctly understood. Involving the main caregiver or the substitute decision maker in these conversations is a must.
To conclude, the Supreme Court judgment has ratified the principles of good medical practice: that the treating team should be sensitive to the needs of patients and should ensure their quality of life at all times, especially at the end of life. We can never cheat death. All we end up doing is depriving ourselves of the opportunity to make the best of the life we still have.
The writer is Founder President, CanSupport
Supreme Court judgment is more about giving people the power to stop futile treatment
Harmala Gupta
TIMES OF INDIA 16.03.2018
There is a saying in Africa: “When death comes, may it find me alive.” Today, with advances in medical science, and with people living longer and longer, it has never been more pertinent. Now, more often than not, when death visits it will find a lifeless body in which the heart is beating and lungs are being deflated and inflated by a machine. It is to such a circumstance that the recent Supreme Court judgment speaks.
Professionals who work in palliative care, in critical medicine and in neurology have welcomed this judgment as every day they have to assist patients and their families navigate tricky terrain without a route map to guide them. This is where an advanced medical directive, or a living will, made by a patient who is now unable to take decisions for him or herself has a role to play. It will help decide which fork in the road to take: one that seeks to beat death at any cost or one that seeks to preserve life so that it can meet death with dignity.
Words also matter. “Euthanasia” is a troubling word for many of us as it has become associated with a wilful act, albeit in the name of mercy, with intent to kill while the person is still in control of vital functions but fears a bleak future due to an irreversible disease process. This is a typical case of “active” euthanasia.
But the legal judgment is on the subject of “passive” euthanasia, and not “active” euthanasia. “Passive” euthanasia applies to those who are being kept alive with artificial means or those who fear such a future. Even so, the act of taking such a life is conditional on the person unambiguously stating, when in full consciousness, that he or she would like his or her life terminated if ever in a vegetative condition.
However, listening to discussions in the media, the use of the word euthanasia seems to have muddled public perceptions. People are talking about how good it is to have the option to take your life if you have a terminal illness or have become a burden on your family or are plain fed up with living. This is “active” euthanasia and it is not being endorsed by this Supreme Court judgment.
The Supreme Court has cited right to a life of dignity as justification for the right to die with dignity. It is about ensuring a person’s quality of life right till the end. For this to happen, we must talk about the kind of death we would want so that when the time comes, and we are not capable of taking decisions, our family members will be able to do so on our behalf keeping our wishes in mind. We now also have the option of leaving behind a living will, though experience from the West shows that it is only a minority that exercises this option.
What is more likely to happen, that did not happen earlier, is that doctors will now be empowered to stop futile treatments and take people off life support systems. In other words, they will be able to live up to the Hippocratic oath that enjoins them to ensure that their actions benefit patients and cause no harm. Letting a patient continue in a persistent vegetative state or suggesting treatments that will compromise personal dignity at the end of life are a clear violation of this oath. The Supreme Court judgment in this sense is reminding doctors of the ethics of their profession.
One cannot exaggerate the relief this judgment will bring to patients and their families. I recall the anguish of a son, a doctor settled in the US, when his mother was dying and admitted to a hospital in Delhi. Unfortunately, he heard about our home based palliative care service too late to use it. Instead, against his instructions, his mother was put on life support. His questions were pointed: Why did the doctors not follow my instructions? Why did they never respond to my many calls? And his final reflection: If they could do this to me, a doctor, what must it be like for ordinary people in India?
Unfortunately, doctors are not taught communication skills as part of medical training in our country. If they did, they would listen carefully to what the patient and family want. This becomes even more imperative at the end of life.
Recognising this, Atul Gawande – the doctor whose book ‘Being Mortal’ drew international acclaim – has created communication modules to help doctors break bad news to their patients as well as continue to guide them so that they can make the best choices for themselves. This requires an empathetic attitude, the use of simple language as well as frequent checks to ascertain whether what you have said has been correctly understood. Involving the main caregiver or the substitute decision maker in these conversations is a must.
To conclude, the Supreme Court judgment has ratified the principles of good medical practice: that the treating team should be sensitive to the needs of patients and should ensure their quality of life at all times, especially at the end of life. We can never cheat death. All we end up doing is depriving ourselves of the opportunity to make the best of the life we still have.
The writer is Founder President, CanSupport
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