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Nikhil Goyal and Raju Easwaran
from Spandan 1996-97 Cover Story on Euthanasia

One popular joke goes something like this:

Journalist to Election Candidate: "Sir, what are your views about Euthanasia?"

Candidate: "Young people should be free to enjoy their life fully - whether they are in Asia, for Africa or the US..."

Euthanasia is an issue which has a lot of misconceptions associated with it, one which people prefer to ignore and sidestep rather than tackle. We, as medical professionals, have no choice - the euthanasia question will continue to haunt us throughout our careers.

Can a doctor prescribe death as a cure? Must a terminal patient stifle the pain and wait for his death? Would a patient be better off dead than living on a machine? Many questions come to mind as one tries to make a decision on euthanasia. Lots of questions, but there are no answers. Just too many possibilities.

Euthanasia is a modern problem, which has arisen because of the great advances in life-preservation techniques. Ironically, lack of advancement in curative medicine is what causes the problem. It may be impossible to restore the normal life of a person in irreversible coma; but the patient could be maintained indefinitely on artificial perfusion and respiration. The patient is unresponsive, and for all observers, dead. But he's very much alive, according to the definition of death. Does that mean we must change the definition? One definition cannot hope to cover all the situations that might arise in the human body. Hence the problem of passive euthanasia. Can we consider the patient to be already dead when we remove life-support? Or would he have wanted to live on, despite everything?

Active euthanasia is even more complicated. Doctors have been trained to save lives. Can they... Should they be allowed to end their patient's life when they feel that nothing else can be done? Or should they just sit back and give painkillers, while the patient begs for death? What is the point after which the treatment, rather than the disease, becomes the problem? Can we as doctors give up hope on a patient saying that the current medical literature labels his condition as incurable?

The Swiss psychiatrist Elisabeth Kubler-Ross found that many dying patients are comforted if someone sits and listens to their openly expressed fears and thoughts. She also observed that many dying patients, after the shock of learning their condition, go through five psychological stages: denial, anger, bargaining, grieving, and acceptance. In the denial stage, the patient refuses to recognize reality and acts as if the disease did not exist. The patient may then become angry, resenting others who enjoy good health and blaming doctors and relatives for their inability to help. In the bargaining stage, the patient tries to "buy time," often in the form of prayers asking for "one more year," in return for being a better person. This psychological stage, which is usually brief, is followed by the first true recognition of reality, and the patient then enters the stage of grief or depression, mourning the loss of his or her own life. In the final stage of acceptance, the patient may still be fearful and angry but is now prepared to die with peace and dignity. Patients may be assisted in reaching acceptance by the hospital staff's and family's openly talking about death when the patient so desires.

A lot of people agree that a human being, despite his 'karma,' deserves a good death - a death with minimal pain, peace of mind and above all, minimal trouble to others. Think of a patient of terminal cancer, a patient for whom nothing can be done. Of what use is he of himself and to others? Can his death be more valuable that whatever is left of his life? The only job left for him is to stare aimlessly at the ceiling, console his relatives, stifle the pain, wait for his daily dose of painkillers and above all, pray - not for life, but for death. But alas! That's not to be. Death will be slow, painful and with each passing moment the pain builds up, because the patient himself realizes the uselessness of suffering for death.

On one hand, watching the patient shriek in agony and beg you for death makes you say yes to euthanasia, while on the other hand the over flowing guilt of letting your patient die from your own hands makes you back off. So the euthanasia debate continues, with the mind always pondering on the question: should I have...? Perhaps if we were to know more about euthanasia, it would make matters easier. The Spandan Cover Story on Euthanasia aims to give you the facts, arm you with the knowledge - to make your own decisions.

This cover story has been the concerted effort of a lot of people, and we've tried to bring out some important facts about euthanasia. There is a section on 'Frequently Asked Questions,' which will help you get a clean-cut picture of the current status of euthanasia. We have interviewed prominent pro- and anti- euthanasia activists to illustrate their viewpoints. Sidebars on Indian Law, Religious Aspects, etc. should help in giving some little known facts. Following this we have a survey conducted amongst our own doctors at LNJPN, GB Pant hospitals, results of which are quite remarkable. We hope this compilation will help you confront the euthanasia issue with confidence, armed with the knowledge that you made the right decision.

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Copyright (c) 2004, Nikhil Goyal. All rights reserved.