From the moment of birth, a person is clothed with a number of basic human rights, of which the Right to Life is the most important fundamental right without which the other rights cannot be enjoyed. But the question arises, if a person has a right to live, whether he has also a right to die when his life becomes unbearable because of terminal illness or chronic disease.
If you ask the question in another format - isn’t euthanasia a logical option for the person who goes on suffering when the prognosis looks extremely bleak?
Euthanasia
What exactly is euthanasia? The term has its origins in the Greek language. When loosely translated it means, “easy and happy death,” Dr. Muditha Vidanapathirana of the Department of Forensic Medicine, University of Sri Jayewardenepura said. He says: “According to the Department of Forensic Medicine in the Medico-Legal Journal of Sri Lanka (2017), “Euthanasia is the practice of intentionally ending the life of another person to relieve pain and suffering.
When the consent of the person is considered, it can be classified into voluntary, non-voluntary or involuntary, and based on the method of application, it is classified into active or passive euthanasia.
“Voluntary euthanasia can be performed at the time of the illness or in advance by way of ‘living wills.’ Involuntary euthanasia is performed against the will of the patient and the physician takes the decision on his own.
In non-voluntary euthanasia, the patient leaves the decision-making capacity with a physician or a relation by proxy. If there’s no prior proxy, a court order can be obtained.
“In ‘active euthanasia’, death is brought about by an act of commission and in ‘passive euthanasia’ death is brought about by an act of omission by the physician. However, none of these methods can be practised in Sri Lanka.”
Dr. Vidanapathirana continues: “Non-voluntary passive euthanasia’ should be legalized in Sri Lanka to uphold the rights of the terminally ill and allow them to die with dignity.
Otherwise, physicians can misuse euthanasia and perform illegal and unethical malpractices such as ‘Do not resuscitate’ (DNR) orders. (A DNR order, instructs health care providers not to do cardiopulmonary resuscitation or CPR if a patient’s breathing stops or if the patient’s heart stops beating. The doctor writes the order only after talking about it with the patient if possible, or with the proxy or the patient’s family).”
“However, in ‘non-voluntary passive euthanasia’ medical paternalism is minimal, because, ‘proxy’ is not directly related to the ending of life, it is to take relevant decisions if incapacitate.”
Lack of awareness
A devout Catholic Doctor when presented with the discussed option, recoiled in horror. “How can we kill? We have no right on the life of someone else or our own lives. We have not come into this world out of our own liking.
Life is a gift from God. We have to prepare our patients for death which we consider a normal event. One who has come into the world has to die. But one cannot kill. Euthanasia cannot be justified,” he said.
The key issue in the debate is the absolute lack of public awareness and clear-cut legal directions on end-of-life terminal care.
On March 9, 2018 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state. It was a landmark law which places the power of choice in the hands of the individual, over government, medical or religious control which sees all suffering as ‘destiny.’ The Supreme Court specified two irreversible conditions to permit Passive Euthanasia Law in its 2011 Law: (I) The brain-dead for whom the ventilator can be switched off (II) Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out and pain-managing palliatives be added, according to laid-down international specifications.
At the crossroads
In many western countries, the courts have permitted the terminally-ill to refuse life-sustaining treatment and have not held doctors or family members liable for this - if consent of the person was obtained. It is a very difficult situation in Sri Lanka because of our deep religious attachments. On the other hand, our Constitution also lays great emphasis on the right to dignity. And although we have not yet articulated a right-to-die as many other countries, we have strong articulations of what the right to dignity entails.
Euthanasia represents a huge ethical and moral dilemma. One of the reasons is that the advancement of science has created more ethical and moral issues in a society which has not advanced as rapidly as the science itself.
Most religions also support the view that life is sacred and must be protected whatever the situation. However, Right-to-die advocates argue that the individual should have a say over the time and manner of death.
They maintain that everyone has a right to minimum dignity and when the state of his existence falls below that he must be allowed to end his tortuous existence. Euthanasia, it is believed, allows one to die in dignity and not be kept alive by artificial means.
Caution
Many countries have legalised the practice of euthanasia: for example, India, Canada, Belgium, the Netherlands, Albania, Columbia, Japan, US (some states), Germany, Switzerland and Luxemburg, Therefore, shouldn’t we too consider the non-voluntary passive euthanasia for legalization in Sri Lanka?
A note of caution is needed before any legislation is passed in our country. We have to think deeply of how to preserve the interests of both, the patient and society before such a legislation is passed.
The process of giving permission for Euthanasia needs to be well defined, on a case-to-case basis, the criteria laid out without any ambiguity and the decision has to be a collective one.