The Union health ministry's draft bill on euthanasia put out last week marks a shift in the conversation about end-of-life care and the right to die with dignity. Well, a country that cannot ensure a decent life for its citizens should at least facilitate a peaceful death to those who, in addition to the congenital Indian conditions of scarcity and anxiety, also suffer from terminal physical and mental ills.
A few weeks earlier, I had argued in this column in favour of active euthanasia. The draft bill advocates passive euthanasia. Active euthanasia is where lethal substances are administered to cause death. Passive euthanasia, on the other hand, involves withdrawing or disconnecting a feeding tube, turning off a life-support machine, not performing a life-extending operation, and not giving life-extending drugs.
To be eligible for passive euthanasia as envisaged in the draft bill, patients must be suffering from terminal illnesses or conditions that cause unbearable physical suffering. Patients must express their will in writing and undergo rigorous mental health evaluations to ensure their decision is voluntary and well-informed. A series of checks are included to prevent abuse, such as mandatory review boards, family consultations, and the involvement of multiple medical professionals.
The main weakness of the draft bill is that it excludes patients beleaguered by mental problems. For some reason, India seems to think that the mind is not a real source of problems, though predominant Hindu traditions emphasise the mind over the body.
Active euthanasia and assisted suicide have been legalised in several countries, and the number of patients choosing these options is steadily rising.
For example, Belgium and the Netherlands, which have some of the most progressive euthanasia laws in the world, have seen a substantial increase in the number of euthanasia cases. In 2022, over 2,700 people opted for euthanasia in Belgium, a 10 percent increase from the previous year. Similarly, the Netherlands reported over 8,700 euthanasia cases, making up over 5 percent of all deaths. In Canada, where euthanasia has been legal only since 2016, the number of cases surged to over 13,500 in 2022.
A good number of patients opting for euthanasia are mentally shattered people. A notable recent case has been that of Shanti De Corte, a 23-year-old Flemish woman in Belgium, traumatised as a survivor of a terrorist attack.
Shanti’s death happened on May 7, 2022. Her parents were at her bedside when she closed her eyes for the last time. Though she had a troubled mind even before, the collapse of her inner world was triggered by the ISIS attack on the Brussels airport on March 22, 2016.
Shanti was with her schoolmates at the departure lounge when the bombs went off. Among the 32 killed were many of her friends. The injured were over 300. In her own words, Shanti became a 'ghost unable to feel anything anymore.’ Her medications included up to 11 antidepressants a day. And she lived in constant fear and anxiety.
Her case precipitated a massive public debate in Belgium as many doctors, health officials and members of the public were of the view that she could have had a better life had she chosen to live as medical possibilities were not exhausted and new-generation drugs were being invented.
The optimists failed to get the point. Faith and hope are not possible options for an acutely mentally troubled person. That is why they are in the spot in the first place.
In many countries, euthanasia is strongly resisted by pro-lifers, especially the Catholic Church and other institutional religions. Their view is that euthanasia violates the sanctity of life. That life was gifted by god and can be taken only by him/her.
This is not a reliable directive to go by as new science is overwhelmingly against the idea of a creator. Great minds like Stephen Hawking have argued that the universe can be explained without the need to rely on a creator.
A more viable argument of pro-lifers is that society should offer better palliative and psychiatric care and spiritual guidance instead of resorting to euthanasia. In practice, though, you never can have adequate palliative care for all patients.
In India, where Hinduism is dominant, practices like prayopavesh (fasting to death) anticipate the voluntary final exit, though it is recommended under specific circumstances, usually when a person’s life’s duties are fulfilled. So India does have a kind of tradition of euthanasia.
The draft bill on euthanasia marks an important step toward offering terminally ill patients a dignified exit from prolonged suffering. But to make this bill really work, it should also be advocating active euthanasia. Again, as I said, that the bill addresses the concerns only of patients suffering from physical illnesses is also a major drawback.
The draft bill is open to public feedback till October 24. It is a different matter whether these issues would be discussed in detail either by our elected representatives or by the public, given our national obsession is politics.
My interest in euthanasia is personal. My father, a well-known Malayalam writer , died some years ago of Alzheimer’s. The last eight years of his life were painful to watch. I had wondered if there was a legitimate way to end his life and grant him the grace he deserved. There was none. Often, we end up doing the cruellest things out of kindness. Mercy is a mellow manifestation of strength. The drafters of the bill should know.
CP Surendran
Poet, novelist, and screenplay writer. His latest novel is One Love and the Many Lives of Osip B
(Views are personal)