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Live and let die?

india Updated: Mar 10, 2007 04:07 IST
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Somewhere between declaring that corrupt politicians should be “hanged from a lamp-post” and deciding whether third floor apartments are legal, India’s Supreme Court will soon tell us whether we should be allowed to choose how we die.
Last month, in an unusually low-key case, the court admitted a public interest petition that asks for the concept of a 'living will' to be institutionalised.

This was despite opposition from the government which argued that the petition should just be thrown out. A battery of government lawyers argued that India was not ready for mercy killing. The 16th Law Commission report has already concluded that in a country where access to public health is dismal, any form of euthanasia can be horribly misused.

I don’t know about you, but I’m really not sure which side of the divide I am on. At some point or the other, we have all felt the heartbreak that comes from watching people we love grow old. As we see them swing perilously close to life’s finishing line, even the sceptics among us turn to prayer. Give them another year, another month, another week, another day, we whisper to ourselves in the darkness of the night. And for every morning that they are still there when we wake up, we are grateful.

Death is invincible. But what if it were life itself that left us feeling even more powerless? Imagine someone you care about, spending the rest of their days strapped to tubes and pipes and artificial respirators. Think of one of your most effervescent and exuberant friends and then visualise her condemned to a lifeless coma for the foreseeable future. Can we possibly know how we would react when it happens to one of us? When passion turns to paralysis, when our bodies stop listening to our brains, when a fatal disease sucks our insides out, will we then decide that death may well be an act of kindness?

We wept in approval when Hillary Swank asked her instructor to pull the plug in the Oscar-winning film, Million Dollar Baby. She played a boxer who was so badly injured in a match that she would never be able to pursue the dream that had defined her entire life. In perhaps the world’s most famous euthanasia case, most of us supported Terri Schiavo’s husband when he wanted to take her off life support.

She had been in deep coma for 15 years, and when doctors finally conceded that there was no chance of her recovering, her husband, Michael, said his wife had never wanted to live like a robot programmed by a machine. But to enable his wife’s right to die with dignity, he had to first fight his in-laws and a slew of Republican conservatives who charged him with murder.

And back home in India, when the Andhra Pradesh High Court dismissed the euthanasia plea of 25-year-old Venkatesh — a man who was dying from muscular dystrophy and wanted to donate his organs while his body still worked — we wondered whether the decision had been thought through.

But the opponents of euthanasia — and there are many — would accuse us of mealy-mouthed sentimentalism. Mercy killing, they say, is pitched as the ultimate act of love, when it is, in fact, the ultimate act of selfishness.

We like to say we would never want anyone we care about to suffer. But is it because it’s we who cannot see them in pain? Is it our own lack of emotional width, our own inability to absorb sadness, our own impatience that makes us sympathetic to the idea of euthanasia? Are we really honouring our own wishes, or the wishes of those we love?

And then there are other concerns. Does a terminally ill patient have the emotional coherence or strength to make an intelligent choice between life and death? In a country like ours where the poor barely have the right to live, a legally recognised right to die would push them to the very margins of healthcare services. There is the real danger that medical negligence could hide behind the lofty notion of mercy killing.

Exactly, says Prashant Bhushan, the lawyer who is arguing in favour of a ‘living will’ before the Supreme Court. A ‘living will’ is not euthanasia, he argues. Instead, while you and me are still healthy, still in control of our minds, a ‘living will’ could allow us to decide what should happen to us, in case we are ever fatally ill. More specifically, we could consent to or reject various forms of life support. We could choose what is often called a ‘natural death’.

It’s a radical idea, but one already in place in many parts of the world. In America for example, euthanasia is illegal in all states except Oregon, but nearly 40 per cent of people now have a ‘living will’. Some states offer specific and detailed choices — would you want artificial nutrition, hydration, CPR, ventilators or would you just prefer to fade gently into the night? Living wills also allow people to choose ‘health care proxies’ — someone you trust with your life, someone who will take decisions for you, when you may not be well enough to tell doctors what you think.

Could this work in India? Anyone who has spent time battling illness in a hospital here knows that it’s a miracle to come out alive at all. We already think that doctors don’t always fight to keep us well. I suspect, to actually give them that option legally would terrify us.

A country like ours also throws up a complicated religious dimension to the debate. Local courts in Rajasthan are already in the middle of deciding whether the Jain custom of Santhara is legal. For the believers, Santhara is simply a centuries-old custom that involves starving to death as a means to salvation. For the activists who are petitioning against it, this is nothing more than suicide or euthanasia.

Then, there is the larger philosophical dilemma: would you fight to stay or would you fight to go? And at what point does courage lapse into cowardice? So what would you choose? We all have grand notions of how we would like to die. But the sad truth is that all this is probably the bluster that only the living can afford.

Barkha Dutt is Managing Editor, NDTV 24x7