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INVITED EDITORIAL
Year : 2015  |  Volume : 11  |  Issue : 2  |  Page : 257-258

Living well till death


Research Scholar, Centre for Political Studies, Jawaharlal Nehru University, New Delhi, India

Date of Web Publication7-Jul-2015

Correspondence Address:
Minakshi Biswas
Research Scholar, Centre for Political Studies, JNU, New Delhi - 110 067
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.159982

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How to cite this article:
Biswas M. Living well till death. J Can Res Ther 2015;11:257-8

How to cite this URL:
Biswas M. Living well till death. J Can Res Ther [serial online] 2015 [cited 2019 Nov 12];11:257-8. Available from: http://www.cancerjournal.net/text.asp?2015/11/2/257/159982

The advancement of technology and medical sciences in the contemporary times has been accompanied by a thrust from the medical, legal and political community to examine the questions of life and death in general and end of life care and euthanasia in particular. The word Euthanasia comes from the Greek words "eu" meaning good or happy and "thanatos" meaning death - so euthanasia literally means "good or happy death." In other words, it implies a kind of death that provides relief from pain and suffering. Euthanasia unlike suicide, is an act which is committed by the assistance of others and in most of the cases, it is physician-assisted. It can be classified as either active, or passive. Active euthanasia involves injecting lethal drugs into the patient's body while passive euthanasia involves withdrawing of life support system, food, and drugs which are used to keep the patient alive when the patient is terminally ill or is in permanent vegetative state. Euthanasia may be voluntary, involuntary or nonvoluntary. Voluntary euthanasia implies obtaining the concerned patient's consent towards the act while involuntary euthanasia implies taking measures to end the life of a person without having obtained his consent. Nonvoluntary euthanasia, on the other hand, refers to a situation where the patient does not have the competence to make life-defining decisions or choices regarding life.


 > Euthanasia and medical ethics Top


The question of euthanasia has been a subject of contention across various countries of the globe; there have been advocates as well as opponents with regard to the legalization of euthanasia. Medical ethics regards four moral principles as significant for the healthcare delivery system, namely - "autonomy," "beneficence," "nonmaleficence, and distributive justice." [1] Autonomy implies that physicians must respect the decisions of the patients with regard to treatment delivered to them as the patients have right over their own bodies. The second principle, beneficence refers to the idea that the actions of the physicians must be such that they benefit the patients. Nonmaleficence means that the healthcare professionals must avoid causing any kind of harm to their patients in all kinds of situation. The last principle, distributive justice, states that the physicians must be just while offering treatment and fair in allocating resources that are not in plenty. These principles are free from any religious, communal, and cultural biases and can be commonly shared by all. In the medical discourse, the term euthanasia does not find any explicit mention.

However, there is the practice of "do not resuscitate (DNR)" which has not yet been documented in the legal corpus. The autonomy of the patient remains a feeble concept here. The right to have a dignified death has not been extensively discussed either. The practice of DNR runs opposite to the Hippocratic Oath that a physician delivers before entering his profession. The duty of the physician often comes in conflict with the patient's autonomy and right to die or withhold treatment, which may include food, drugs or ventilation. However, the physician's role as per the Hippocratic Oath is not only to heal and relieve suffering but also to protect the interests of the patients.


 > The euthanasia debate Top


What merits attention is the fact that there is no consensus even within different schools of thought regarding the issue of legalizing or criminalizing euthanasia. The proponents argue in its favor on grounds of autonomy, right to self-determination, freedom to make life-defining decisions, and also provide a secular meaning to the notion of sanctity of life. The opponents of euthanasia to make use of similar principles but in a different manner. They argue on grounds of principles of equality and the notion of sanctity of life. Despite manifold differences within the different schools of thought, the opponents of euthanasia argue similarly that all individuals should be valued and treated in an equal manner and by reducing or terminating an individual's life, the concept of euthanasia devalues it. The advocates of euthanasia look at the patient as an empowered and informed individual who is capable of making decisions, taking into account his own interests and the principles of dignity. They argue that the terminally ill patients must be allowed to make their own decisions regarding whether he wants to live or not. Therefore, voluntary euthanasia where an individual gives informed consent as an autonomous and rational being stands permissible within this framework.

The basic responsibility of a modern liberal democracy is to protect the interest of everyone, particularly the interests of those who cannot protect their own interests. Therefore, India which adheres to a liberal democratic framework where freedom and dignity are prime requisites should allow individuals to decide for themselves on profound questions relating to life and death.


 > The concept of living will Top


The principle of autonomy is exercised by the patient only when there is a presence of informed consent to such an act. This brings us to one of the biggest ethical concerns surrounding the euthanasia debates. Issues of autonomy and best interests feature prominently in the writings of those who favor euthanasia. However, the question that deserves significance is what about the autonomy and best interests of those who are no more in a conscious state? Who should decide for individuals who are demented or in ventilation? Can such individuals be treated as autonomous beings? This is where the concept of advanced directives in form of living wills merits attention. It is regarded as a source of consent and as evidence for patients who are terminally ill, in a permanent vegetative state, demented or in ventilation. An advanced directive in form of a living will, a document where an individual mentions the kind of healthcare he should be subjected to in future when he is no longer capable of making his life defining decisions. In many countries where euthanasia has already been legalized such advanced directives help reach solutions keeping the wishes of the patient intact in case he is no longer capable of deciding. It helps the physician act in accordance with the wishes of the patient whereby the patient's autonomy or best interests are not violated. The physician subjects the patient to the kind of healthcare he had predecided for himself taking care of the autonomy and the best interests of such patients who are no more competent of deciding the course of their lives.


 > Cancer patients and end of life issue Top


The cancer patients who suffer from excruciating pain, symptoms, fatigue, and isolation in the last stages of their lives should have the option of deciding the course of their lives. There lies an immense need for the state to respect the autonomy and best interests of such patients and allow them to live with dignity till their last breath. The question of violating the decisions of an individual who is no more competent shall also be ruled out if India, like many other countries of the west imbibes the notion of introducing living will.

The hospice care, which aims at providing end of life care has developed to some extent in India in the past two decades. This mode of care is believed to provide pain relieving medication mainly to cancer patients. However, one should take cognizance of the double-effect of the morphine that is administered to the terminally ill patients in hospices. The double-effect of such drugs not only serves to reduce pain but also brings the patient closer to his death. Implicitly speaking, passive euthanasia is practiced in such centers as active treatment of patients stands withheld and morphine with double-effect are administered to the patients.

The Indian state, therefore, must look into the mechanism of DNR which finds no legal documentation and the hospice care identified with centers that account for passive euthanasia prevalent in the country. The state must recognize such practices. It must thus develop suitable mechanisms that would respect the autonomy and dignity of terminally ill patients. The concept of living will would play an extremely significant role in this regard. Hence, this too needs to be considered and taken into account by the Indian state.

 
 > References Top

1.
James EL. The Withdrawal of Treatment. Working Papers in the Health Sciences 1:6 Winter, Institute of Life Sciences, University of Southampton. Available from: . [Last accessed on 2014 Mar 12].  Back to cited text no. 1
    




 

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