Death be not proud

There are thousands of reasons to die but only a handful of ways to do so. The euthanasia debate is as much about morality as it is about logistics, writes Sayandeb Chowdhury

Death, be not proud, though some have called thee

Mighty and dreadful, for thou art not so;

For those whom thou think’st thou dost overthrow,

Die not, poor Death, nor yet canst thou kill me.

Poetry has this ability to transmigrate. They travel in space and assume meaning of their own. The above poem, John Donne’s famous metaphysical critique, was intended as an indictment of death in the insouciant style and person of a genuine Renaissance overreacher. But used as a poetic overture for a report on Euthanasia, it assumes a degree of power that is unmistakable.

Euthanasia! Not a dirty word anymore, neither a countercultural buzzword for rights geeks. ‘Mercy killing’, ‘assisted killing’, ‘passive euthanasia’, ‘death with dignity’ are now discussed openly, free from misplaced legal or moral obligations. They all point to an increasingly critical issue — to a condition where there are legal provisions for sanctions that would make killing of a terminally ill patient legal and assisting to the same not akin to manslaughter. But why are we discussing Euthanasia? It is because of Aruna. In the fight for her right to live or die, depending which side of the fence you are in, Aruna Shanbag, the permanent resident of Mumbai’s KEM hospital, who was brutally raped and left to vegetate 37 years ago by a hospital janitor and has since been taken care of by hospital staff, has triggered us back into thinking about Euthanasia. Aruna’s case was preceded by a Sanjay Leela Bhansali’s Guzaarish, which dwelt on the petition by magician Ethan Mascarenhas to allow him to die with dignity. Bhansali’s film is copy of Spanish film, The Sea Inside, which is based on the true story of Ramon Sampredo, a ship mechanic who was rendered quadriplegic after an accident and who campaigned for no less than 29 years for his right to end his life.

Incidentally Bhansali’s film, like the original, ended with the protagonist committing suicide after he had exhausted every other route to die with dignity. In Aruna’s case however, the patient herself is unable to decide her fate and her case has become a site of contestation between rights bodies who campaign for the freedom to choose death with dignity and the Indian State, which wants to take a cautious approach to this ethically controversial issue. That the Supreme Court has made allocations for passive euthanasia for Aruna, by which doctors will be allowed to come to a consensus on whether to discontinue with life support to Aruna and if they decide on the negative they will be within law to do so, is considered a step forward in the right direction.

But the two cases are separate as chalk and cheese and that is exactly why the debate over mercy killing is so complicated.

To start with, it would be just right to ask exactly where does the petition for euthanasia start? A single individual who has lost the wherewithal and hence the zeal to live, like Sampredo? Or is it about one who does not know whether he/she is dead or alive, like Aruna? Or is it something in between? What about the thousands of cases where life support gives the faux hope of a reversal while all the way the doctors know that it is just a tool to hold back death for a while? What about advanced cancer patients or patients of multiple organ failure who, aided by advanced medical technology manage to keep death at arm’s length but only at a huge personal and financial stake?

Death, we all know, can only be deferred, but never be denied. So why do so at all? The debate over Death is neither new nor morally ingenious. Since the dawn of time, the ways of termination are a potent area of conjecture and meditation. In Hinduism, Icchamaran or Willful Death finds epic dénouement in Bhishma, so does the Last Journey (Mahaprasthan) of the Pandavas after their Battle Royale with the Kauravas. Says philosophy professor Jyoti Roy, “In Hinduism, there is this streak that goes against the grain of the typically Anglo-Saxon legal framework which was what the Indian constitution follows”.

Even if you are not the religious type, renunciation of life after having completed life’s duties is a thought that passes many men at a ripe old age. They think that they have the right to exit with dignity once they have fulfilled the responsibilities that life had entrusted them with.” It is with such thought that two cases in Kerala courts were filed requesting to consider the right to die even while the individual is very much in control of his faculties.

Internationally, the last word on the debate is far from out. There are many advocacy groups like Exit International in Australia and Dignitas in Switzerland which actively counsel and aid in helping terminally ill patients in deciding in favour of euthanasia. In a published address to the London chapter of advocacy group Friends at the End (FATE) Ludwig A. Minelli, founder of Dignitas said: “My work within the Swiss association has exactly to do with the last Human Right: The ability to decide, how and when somebody would like to end one’s own life. For years, I have been persuaded that this is really the last Human right, and I have also been fighting for this goal for many years.”

Incidentally, Switzerland and Holland, have by law, made assisted suicide legal. While article 115 of Swiss penal code takes care of the debate, Holland was the first country to pass not just passive but active euthanasia by law through the famous Groningen Protocol in 2004. Some other countries have followed Holland in full or part, including two US states, Oregon and Washington, which facilitate enactment of assisted suicide cases under strict guidelines.

In the US, the major line of debate on the issue was between one Dr Kevorkian and the state of Michigan. In a statement the American Ethical Union(AEU) – a powerful humanitarian lobby – had said: “Whereas, the AEU supports the right of each individual to make the critical decisions about his/her own life, including the right to terminate it when it is no longer bearable and whereas Dr John Kevorkian has continued to provide assistance to terminally ill people who wished to die and who appealed to him for that assistance, and whereas Dr Kevorkian’s actions have been declared illegal by the State of Michigan under a law that is being challenged as unconstitutional, now therefore be it resolved that AEU deplores the action of the State of Michigan with respect to Dr Kevorkian and urges that he be set free pending the disposition of the case challenging the constitutionality of the law he has refused to obey.” This was way back in 1993 and the statement acted as a major boost to further activism on the issue.

While critics have accused countries empathic to euthanasia of promoting suicide tourism, the debate, say sociologists, extend to every country’s bearing upon the faith it may want to follow. In UK for example, bill on Euthanasia has been twice rejected in both floors of the Parliament. In Italy it awaits legal nod, while in Germany it is being hotly debated. In each of the cases above there are a thousand reasons to make euthanasia legal, especially if the medical fraternity comes to a consensus about the impossibility of the patient’s return to relative degree of normalcy.

Of course, what it means should be decided on a case-by-case basis. The medical fraternity is of course tight lipped. “It is a topic we best not take any call on. Personally I am in favour of limiting life support if not lethal injection to terminally ill patients but such a case if it became popular, would hurt the medical industry badly and not just its ethical foundations. So doctors would be hard-pressed to take sides”, says a well-known city doctor on conditions of anonymity. Most people avoid the issue as it is subjudice and also since the call is a difficult one. The legal fraternity is similarly divided. Says Sharmila Roy, a lawyer, “I will go by what the court says. It is a hugely ethical issue and not just an emotional one. After all, we are talking about taking one’s life. It’s better to wait till the state and the judiciary come to a conclusion.”

The Indian State remains non-committal. It can send to the gallows criminals in case of rare and indefensible cases of crime but not relief terminally people of pain. Only it can take a call if it wants to intervene in what is both a personal issue of a suffering family as well as monumental issue about the ultimate fate of humanity. But it’s time that looks at the issue with empathy, to spare thousands of the suffering, the debilitation and humiliation of being forced to live staring at the sunset forever.

Death may not be proud. But death is always on the prowl.