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Frequently-Asked-Questions (FAQs) on Euthanasia

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

What is euthanasia?

Literally, euthanasia means ‘good death’ (Greek: eu = good, thanatos = death). Defined in a more legal fashion, euthanasia means the act or practice of painlessly putting to death persons suffering from an incurable and distressing disease as an act of mercy, not necessarily at the request of the patient. On the other hand mercy killing is defined as the felonious taking of life by a family member or friend out of intent to end suffering. Physician-aid-in-dying is a term commonly confused with euthanasia. Physician aid in dying is defined as the prescribing of medication by a physician for the purpose of enabling a patient to end his life. So while euthanasia means the doctor is putting a patient to death, physician aid in dying means that the patient ends his life himself with the aid of a doctor’s prescribed medicine.


What does the law say about euthanasia?

(See article on Indian Law). In effect, euthanasia is illegal in India but the issue has been quite confused with contradictory judgements being passed. However, if a case of euthanasia were to currently come up in the courts, the verdict will probably go against the doctor.
Euthanasia is legal only in two parts of the world viz.:

  1. Oregon (USA): November 1994
  2. Australia’s Northern Territory: May 1995
Unlike India, suicide is not punishable in the USA. Netherlands is one country where euthanasia is openly and extensively practiced, yet it is illegal. However, the Dutch Supreme Court recently passed a bill that under some safeguards physicians might be allowed to kill their terminally ill patients by lethal injections or oral administration of lethal drugs.


Why isn’t the euthanasia issue big in India?

Apart from lack of funds, India faces the crippling problems of overpopulation and illiteracy. What it all boils down to is a heath care system that is primitive compared to that of say, USA. So naturally, the issue of comatose patients or accident victims maintained on artificial perfusion and respiration is confined to big hospitals where such facilities are available. And even in these centres, the demand for use of these on healthier cases is too high to call for a debate on passive euthanasia. Western countries interpret this to mean that value of life is lesser in the developing nations. But the truth is that here death is accepted as a part of the life cycle. Although death of an individual may plunge the family into a financial or emotional crisis, people here find it easier to ‘let go’ as compared to the Westerners. Even our religious beliefs are such that we look for the soul to be reborn and consider only the body to be perishable. Also, for a predominantly poor populace, maintaining a patient on expensive machinery for an indefinite period is quite impossible. The situation is very different in USA, where the insurance company foots the bill for medical care.


Where does the support for euthanasia come from?

Majority of the support for euthanasia comes from veteran campaigners like Derek Humphry, Jack Kevorkian and from voluntary organizations like the “Right to Die” organizations across the globe. A lot of support is from the vast majority of terminally ill patients and their relatives. They insist that a patient in a persistent vegetative state, or one who has lost the will to live due to a terminal and painful disease, be allowed to die according to his own wishes, peacefully and with minimum pain in his last moments.


Why is there so much opposition to this presumably humane idea?

Opposition to euthanasia comes from organizations like the International Anti-Euthanasia Task Force, religious groups and people who foresee tremendous abuse, exploitation and erosion of care for the most vulnerable people. They believe doctors and governments would use euthanasia as an excuse to cut down on their effort and health care expenditure. The poor, minorities, handicapped, etc. would be coerced to use it. This coupled with the possibility that doctors can misdiagnose someone as being terminally ill can lead to a lot of unnecessary sacrifice of human life. Moreover they feel that doctors should not be given the power to kill because then the society would look upon them as killers and not as healers.


On whose request does a doctor agree to euthanasia?

One would expect that it is the patient’s request but it is not always so because most of the terminally ill patients are not competent enough to make such a request (Alzheimer’s disease, brain death, etc.) Here the relatives of the patient come into play. Sometimes if the doctor is a strong supporter of euthanasia, then he himself takes the initiative to make the patient and his relatives understand the futility of the patient’s survival and obtains consent for euthanasia. Rarely the doctor euthanizes the patient without consulting him or his relatives.


What are the various methods used to euthanize the terminally ill?

The most popular methods include-

  • Lethal injection - Injection of a lethal dose of a drug, such as a known poison, KCl, etc.
  • Asphyxiation - The most popular gas used is Carbon monoxide (CO). Nerve gases like sarin & tabun etc. are also added in small amounts to fully ensure death.
Dr. Jack Kevorkian’s death machine (mercitron, thanatron) - This is a very unique innovation indeed whereby a patient can end his life himself. It consists of an injection, which initially injects normal saline. After the patient trips a switch a solution of sedatives follows, which is automatically followed by a paralyzing agent and finally by KCl. A recent modification of this machine allows the patient to inhale CO through a mask via a rubber canister connected to a cylinder. Dr. Kevorkian has used this machine, with minor variations, to allow his patients to die painlessly at a time chosen by them.

In this regard it becomes necessary to distinguish between active and passive euthanasia. The above constitute methods of active euthanasia. Passive euthanasia on the other hand is constituted by methods like withdrawal of artificial life support machines like the ventilator, withdrawal of nutrition, hydration, etc. Another well-known method of passive euthanasia is the order “Do not resuscitate” written on the case sheets of many terminally ill patients.


Does euthanasia always ensure a painless, dignified death?

A lethal dose for one person may not be so for the other. Also there is the phenomenon of idiosyncrasy. Who knows: a drug that is lethal to one patient may be harmless to the other. Many of the lethal injections have been known to cause violent convulsions, and relatives have been asked to leave the room while the deed is done. Passive euthanasia is generally peaceful. But euthanasia activists believe that a quick end to the suffering in a painful disease, when there is no desire to live a hopeless life, is by far the better choice.


Is euthanasia unethical?

This question is obviously very difficult to answer because different people have different views depending on their stand on euthanasia. Some people deem it unethical thinking of the potential abuse, or its religious implications. On the other hand, prolonging life beyond a certain point seems as unethical as anything else. Pro-euthanasia activists claim that it is cruel to maintain the body ‘alive’ on machines when it cannot be termed living in anything but the legal sense. Hutchinson’s clinical methods mentions that resuscitation for a few hours or days of further pain and discomfort might be regarded as an unnecessary prolongation of terminal illness. However it also states that whether one human being can decide the quality of life of another is highly questionable. The decision of withholding resuscitation should be made after an informed consultation with the patient. The relatives should be consulted but their views should not put pressure on the physician. So as is fully evident there is no clear-cut view of medical ethics on euthanasia.

No physician or facility would have to comply with assisting a terminally ill person hasten dying. They could transfer the patient to another treatment source. If they objected to having to transfer care to another, obliging physician, they would need to explain their ethical concerns the patient who would retain the right to discontinue care. The responsibility of medical treatment rests mutually with the patient and physician, not with just the physician. If a Roman Catholic physician refused to prescribe birth control pills to his patient and refused to transfer her to someone who would, then there would still be a responsibility owed the patient to explain the ethical dilemma and then to accept the patient’s decision to stay or leave. Then it becomes the patient’s responsibility to either resolve the issue with the physician or seek alternative care even if not transferred. The refusing physician would not, however, have the right to withhold information from the next treating physician as long as the information was properly requested.


Is physician-aid-in-dying a violation of the Hippocratic Oath?

Strictly going by the Hippocratic Oath which clearly states that “I will neither give a deadly drug to anybody if asked for, nor will make a suggestion to this effect” then euthanasia is clearly a violation of the oath. This has been one of the main arguments of the opposition against euthanasia. However, the oath also expressly prohibits physicians from “using the knife” (performing any surgery) or teaching women the medical arts. So, if doctors are really that serious about following the Hippocratic Oath, they should consider not doing surgery and prohibiting females from medical training or practice. Also abortion which was considered a serious violation of the Hippocratic Oath 20 years ago is now legal: euthanasia may have the same fate. Apart from these considerations, Hippocrates in his book Epidemic has clearly stated that “If a doctor cannot do any good then he must be prevented from doing harm”, so in this regard Hippocrates does seem to be inclined towards supporting euthanasia.


Doesn’t modern medicine keep people alive who would have died in the past?

True. What was incurable some 20-30 years ago is now curable and I don’t need to elaborate more on that. But what we are talking about with respect to euthanasia are diseases like multiple sclerosis, Alzheimer’s disease, amyotrophic lateral sclerosis, terminal cancer, etc. for which modern medicine has no cure, and does little to alleviate suffering. The  supporters of euthanasia say that in these cases approaches like artificial respiration, nutrition, dialysis, etc. using state-of-the-art machines are only ways of prolonging the death of the terminally ill patient rather than prolonging his life. They argue that the quality of the patient’s life in these cases is so compromised that he is better dead than alive. But this of course, does not justify saying that a patient should have died of this disease. The question is how long should the lifesaving effort continue; how long is it before the quality of life is said to be worse than death?


When will the euthanasia controversy be settled?

Passive euthanasia has been practiced for quite some time now, and active euthanasia cases are also not uncommon. It is just the terminology of ‘euthanasia’ which reflects the entire debate. By and large, it is the fault of the doctors that issues like euthanasia have become blown out of proportion. Taking euthanasia deaths to court is not the answer, nor is legislation. There are just too many factors to consider. The solution is a solid doctor-patient relationship. If the doctor was to explain to his patient the course of his disease, his options and the alternatives, a simple “Do Not Resuscitate” order could put an end to pointless arguments in court. This of course, will not cover accidents and other unexpected complications, but will provide a amicable solution for most of the controversial cases today.


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