Saturday, 16 August 2014

India debating provision of Euthanasia

Devendra Kothari Ph.D.
Population and Development Analyst,
Forum for Population Action

 To force a person to be kept alive in a vegetative state when medical opinion is as certain as can be, that there is no chance of recovery, is cruel both on the person and on his or her family and friends”.

(This post is not about my normal topics related with population and development. It is a personal exposition about something that has occupied my thoughts over the last couple of weeks. Though euthanasia is a complex issue with legal, social and religious overtones, but it must be addressed.)

Few days ago my late elder brother’s wife died due to cardiac arrest after a prolonged period of illness at the age 83. She was very close to me; and I used to visit her two to three times in a year since I live in a distant town.  For last two-year she was bed-ridden and rarely ventured out of her two-bed room apartment. She was looked after by a full-time caregiver to help her with meals, cleaning and the growing number of other tasks she could no longer do herself. But there was one thing that she refused to relinquish to her illness: that she wanted to kill herself by ingesting or injecting some painless drugs. She was not an exception. There are many Indians who wish to opt for euthanasia or assisted suicide to end their suffering. Doctors and NGOs say it could be hundreds, possibly thousands — no one knows for sure. However, killing terminally ill patients directly, even if they request it, is illegal in India. Prescribing certain barbiturates used for euthanasia in other countries is also illegal in the country.

But, the number of persons who are opting for euthanasia is going to increase sharply in coming years due to changing demographic and health scenario.[1] India’s demographic contours suggest a steep rise in the elderly population in the coming decades as a result of declining fertility, increasing expectation of life at birth and (partly) at later ages. Although the proportion of the elderly population was low in 1990, India ranked second in the world in absolute numbers in 2010, as per UN population Division. There were about 100 million elderly people in India in 2010 or one out of every ten persons was aged 60 years or more in that year. The elderly population aged 80 and above which was only 1.3 million in 1990 rose to 5.5 million in 2005 and to 9.5 million in 2010. The growth rate among different cohorts of elderly such as 60 plus, 70 plus and 80 plus during the decade 2000-2010 was much higher than the general population growth rate of 2 per cent per annum during the corresponding period. This phenomenon, coupled with rapid social changes resulting in the gradual breakdown of the traditional joint family system, is likely to pose serious problems for the elderly, especially related to their health.

Decline in morbidity and mortality from communicable diseases have been accompanied by a gradual shift to aging, and accelerated rise in the prevalence of chronic non-communicable diseases such as cardiovascular disease (CVD), diabetes, chronic obstructive pulmonary disease (COPD), cancers, mental health disorders and injuries. The occurrence of physical disabilities is another important aspect of the aging process. There were about 25 million disabled elderly persons in India in 2011, half of whom are likely to be visually disabled. Cancer is the second leading cause of death globally, taking a heavy toll of human lives and destroying the families of the cancer patients due to mental agony and heavy costs of treatment. 2/3 patients are detected in the advanced stages when treatment is ineffective. India has recorded one of the highest incidences of cancer in the world. Recently, NCRP (ICMR), Bangalore, has published a report on Time Trends in Cancer Incidence Rates. The total cancer cases are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020. [2]

One can visit chronic cases at hospital or even at home and give them false hope and a lecture and come back home, but one  cannot experience what they go through for the next few years till they need to live in that condition. “To force a person to be kept alive in a vegetative state when medical opinion is as certain as can be, that there is no chance of recovery, is cruel both on the person and on his or her family and friends”, as argued by the Times of India in its campaign to generate support in favor of passive euthanasia and decriminalization of attempted suicide. [3]  Recently, the Supreme Court of India recommended (on July 16, 2014)   that the question of passive euthanasia or mercy killing needs a comprehensive examination as there was no authoritative judicial pronouncement on the issue; and issued a notice to all states seeking their views on a petition on legalizing passive euthanasia or withdrawal of medical treatment with the intention of causing a patient's death.

Why only “passive euthanasia”? Why shouldn’t “active euthanasia” be permitted under law? While passive euthanasia is limited to withdrawing life support, active euthanasia goes a step further by assisting in a terminally ill patient's death (through, say, a painless injection). It is very difficult to comprehend the suffering of a person asking for death, a person lying in bed not being able to do anything himself or herself. Imagine the plight of a quadriplegic (a central character in Sanjay Leela Bhansali's film Guzaarish who cannot move anything below his neck and has his whole body paralyzed). The film concludes that he should be “granted active euthanasia on the premise that he has the right to a dignified death”. The law must, therefore, clearly allow for euthanasia — both active and passive — in such situations.[4]

Many countries in the world has recognized that it is humane to allow people to choose to die in specific situations. Switzerland, for example, allows not only its own citizens but also foreigners in certain circumstances to come to the Alpine country and seek doctors' help in ending their lives.  India itself has a tradition that sanctifies various forms of 'ichhaa mrityu' or death by choice. For example, some followers of Jainism practice Santhara. (SANTHARA is a religious Jain fast. Under this, a person goes on infinite fast, till eventually death comes.)

If we accept that somebody can consciously choose to die, there is nothing wrong about an informed decision being made for that person in his best interests, when he is in a persistent vegetative state. In actual practice, many families have had to take the painful decision to withdraw life support systems, either because they wish to end the patient's suffering or simply because they can no longer afford it. The Supreme Court has in the past acknowledged that the right to dignity in life also extends to the right to a dignified death, though that ruling applied this principle only to 'natural death'. It is time now to extend it further and adjust the law to the reality and to a more modern moral sensibility by allowing people to choose to die peacefully. There must, however, be very strict safeguards to ensure that the provision is not misused by people, who may benefit from the death of the patient. Further, we must offer the patient seeking euthanasia a variety of alternatives, including palliative or hospice care, pain management through medication and other therapies. But if, after everything, they still choose help in killing themselves, then their wishes must be respected.

In short, the issue in question is very sensitive but extremely important to address at. Euthanasia is a much awaited legal option and does much good for the suffering millions without hope of a cure. It is already available in some other advanced nations which shows that it is the only logical conclusion in certain cases of human suffering. It is long pending issue in India. Further calling debate means pushing the issue back.

[1] Sandip Kumar and Amit Kaushik. Non-communicable Diseases: A Challenge, Indian Journal of Community Health, Vol. 24 (4), 2012; H.B. Chanana and P.P. Talwar. Aging in India: its Socioeconomic and Health Implications, Asia-Pacific Population Journal, Vol. 2 (3).

[2] Takiar R, Nadayil D, Nandakumar A. Projections of number of cancer cases in India (2010-2020) by cancer groups. , Asian Pac J Cancer Prev. 2010; 11(4), 2010.

[3] The Times of India, has in the past, campaigned in favor of passive euthanasia and decriminalization of attempted suicide.  For details, see at:

[4]For details, see at: