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Business News/ News / Business Of Life/  The euthanasia debate: which side is your doctor on?
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The euthanasia debate: which side is your doctor on?

From concerns about the suffering endured by patients and families, to fear of misuse, opinion on this contentious issue remains divided

It’s an emotional issue for the patient and the family.Premium
It’s an emotional issue for the patient and the family.

OTHERS :

Euthanasia is a delicate matter, something on which there can be endless debate. Both sides—for and against—have compelling arguments to make and horror stories of misuse and hardships to tell.

Now that the Supreme Court has opened up the debate on euthanasia and the Union minister of health and family welfare, Harsh Vardhan, has propelled it into the public domain, the issue is being discussed at length. At the moment, both passive euthanasia (withdrawal of life support) and active euthanasia (assisting a terminally ill patient’s death through, say, a painless injection) as well as assisted suicide (a physician providing means to die but not administering it) are illegal. Those who are brain dead, however, can be taken off life support after the consent of family members.

Belgium, the Netherlands and Luxembourg are among the few countries where euthanasia is legal. In others, the law is less clear; some forms of assisted suicide and passive euthanasia may be legal but active euthanasia is not. For example, some types of assisted suicide and passive euthanasia are legal in Switzerland, Germany, Mexico and the American state of Oregon.

Those in favour

Ramakanta Panda, vice-chairman and managing director at Mumbai’s Asian Heart Institute, is in favour of legalizing active euthanasia, but in selected situations with strict guidelines. “It is inhuman to make a patient go through immense pain when you can’t cure or relieve his/her suffering and when there is no chance of recovery based on current knowledge of medicine," he says.

R.K. Mani, ex-president of the Indian Society of Critical Care Medicine and chairman of pulmonary and critical care medicine at the Saket City Hospital, New Delhi, agrees. “To force a person who has no will left to live and is undergoing unbearable pain, is in a vegetative state and has no treatment option available, is inhuman and cruel. They should have the right to die, if they so wish to. This dignity should not be denied to them," he says, adding that forcing a ventilator on a dying man is an assault.

According to Sumit Ray, senior consultant and vice-chairman, critical care medicine, at New Delhi’s Sir Ganga Ram Hospital, a discussion on active euthanasia is important. But he foresees a long, tough road ahead since it is a complex issue. Dr Ray believes the initial focus should be on legalizing passive euthanasia, which he refers to as “end of life care". “Every week we see at least three-four cases in the intensive care units (ICUs) where we know that efforts are futile, and prolonging the inevitable is only causing severe distress to the patient. Besides, we must consider the huge cost this builds up for the supporting family. Every day spent in a private hospital’s ICU costs upwards of 40,000, and in government hospitals the beds are always in short supply," he adds.

He cites the case of a 75-year-old patient suffering from terminal tongue cancer, who died of cardiac arrest after being on life support for 15 days. “One by one all his organs were packing up and due to his severely compromised immunity a bad fungal infection invaded his body and expanded into the brain. There was absolutely no chance of cure in his case, and unnecessarily due to the lack of law, he and his family had to suffer immense grief, pain and economic loss for so many days," he says.

“What sense does it make to just keep the heart ticking and continuing to blow air in and out of the lungs, when everything else is lost? How long will, or can, one do that? I don’t want such a death. Whether one is salvageable can be decided through well-established guidelines," says Dr Mani.

A note of caution

There are many who believe that deciding when to pull the plug or withdraw medical support is a dicey call. How can any doctor or family member decide that there is no hope?

Sushma Bhatnagar, additional professor and head of pain and palliative care at the All India Institute of Medical Sciences, New Delhi, puts in a word of caution. “I am not exactly against euthanasia and I agree that there should be a limit to aggressive treatment and that everyone deserves a dignified end. That said, the circumstances need to be really clearly defined when further treatment is decided as futile."

Samir Parikh, director, mental health and behavioural sciences, Fortis Healthcare, New Delhi, adds that lawmakers must look into the psychological aspect. “I am worried that the wish of the terminally-ill patient requesting euthanasia may be coloured by depression. Hence, a psychiatrist’s role becomes important for assessing depression in these patients. Plus, families in such cases must be given psychological support, and for that, grief counselling needs to become a part of healthcare in our country."

Fear of misuse

George D’Souza, chief of medical services, professor and head of the department of pulmonary medicine at St John’s Medical College, Bangalore, does not support euthanasia. He is, in fact, worried about misuse in cases when the person concerned cannot take a decision himself, as in the case of the elderly or those who are suffering from dementia.

Counters Dr Ray: “It is stupid to not make a law just because of the fear that it can be misused. People had similar apprehensions about the dowry law, but it is proving to be a boon for many people." Dr Mani adds, “Non-existence of an explicit law is only helping the unscrupulous."

Clearly, it’s an emotional issue for the patient and the family, and a serious one for society. All viewpoints will need to be considered before a law is put in place. “It (euthanasia) should be limited to select situations with very strict guidelines, like wherever possible the patient’s consent must be taken, a team of doctors who are not involved in the care of the patient should certify, etc.," says Dr Panda.

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Published: 28 Jul 2014, 07:29 PM IST
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