Euthanasia, Yes or No…?

It was 27th November, 1973. For Aruna Shanbaug, in her mid-twenties and a junior nurse at KEM Hospital (KEMH), Mumbai, it was nearing the end of a tiring and extended day, stressed out of continuingly heavy workload from previous days, triggered by several cases of food poisoning in nearby locatons of the city; she traced her tired steps towards locker room at the basement, for change of clothes and collecting her personal belongings. Little did she know that it would be the last time she would be on her feet moving around, as a contract sweeper boy, who was lurking in the vicinity, pounces on her and sexually assaults her. Found by a ward attendant in a bleeding and unconscious state the next day morning, it was observed that she was sodomized, choked with a dog chain and robbed. Asphyxiation had cut off oxygen supply to her brain, putting her in vegetative coma for remainder of her life that dragged agonizingly on for another forty two years, nursed by her colleagues and later generations of nurses, in continuity and with loving care, as an in-patient at KEMH, till her deteriorated end came on the morning of 18th May 2015.

The case of Aruna would be recorded in medical history as the world’s longest survivor in a persistent vegetative state. A nursing college in Mumbai has since been named after her. Her story has also been incorporated into school text books as a glowing example of post trauma health care and compassion, that successfully pleaded for her dedicated care-taking, in spite of her family abandoning her and even against background of the highest court’s decision to permit passive euthanasia. The violence and human depravity in Aruna’s tragic story poignantly contrast with strong commitment and unstinting dedication of KEMH’s team of nurses in responding to the situation with extraordinary humaneness. It has set off a fresh debate within the country on the pros and cons of euthanasia, with the aye-sayers clamouring for a realistic approach to the issue, shorn off religious bindings and liberated from restraining legal complexities.

Euthanasia, or ‘good death’ from Greek éu’ for ‘well’ or ‘good’ and ‘thanatos, ‘death’, is the practice of intentionally terminating a life in order to relieve pain and suffering. The word was first used in a medical context by Francis Bacon in the seventeenth century to refer to an easy, painless, happy death, responsibly facilitated by a physician to alleviate physical suffering of the body, a deliberate intervention undertaken with the express intention of ending life, to relieve intractable suffering. The laws vary from country to country, with many countries prohibiting it and some allowing it under clearly defined categories and extenuating circumstances. Defined under various categories, Euthanasia is described as voluntary, non-voluntary and involuntary, active and passive, with rights and wrongs associated with each.

In active euthanasia, a person directly and deliberately causes the patient’s death, whereas in passive euthanasia, the patient is merely allowed to die. While the death, in active euthanasia, is effected by external action, like killing with an overdose of painkillers, it is brought about in passive euthanasia by anomission, that is, letting the patient die by withdrawing or withholding treatment. The distinction, however, is only technical; it does not make moral sense in that, whether active or passive, the intention of causing death is present in both. Voluntary euthanasia occurs at the request of the person seeking termination of life; non-voluntary euthanasia occurs when the person is unconscious or otherwise unable, as in the instance of an infant or a mentally challenged person, to make a decisive choice between living and dying, and a suitably placed external entity decides on their behalf. It is also inclusive of cases of normal children or legally minor teenagers where an external entity is involved in the decision making process. Involuntary euthanasia happens when the person, who is keenly opting to live, is done away with. Usually termed as murder, these are cases where the killing would be counted as beneficial for the victim. Yet another category is indirect euthanasia, where the well intended medical treatment, like administering anesthesia or pain-killers has the collateral effect of hastening the patient’s death. Called the doctrine of double effect in medical parlance, it is mostly seen to be morally acceptable, as the primary intention is to alleviate the patient’s suffering and not to cause harm.

Euthanasia is legally prohibited in India, and it is very unlikely if it will ever receive any consideration in the foreseeable future, given the sanctity accorded to preservation of life by various religions, belief systems and the myriad cultures that form the country’s social fabric. It is also prohibited in the United Kingdom. While non-voluntary euthanasia is illegal everywhere, voluntary euthanasia is legal in some countries, a few states in USA and provinces in Canada. Jurisdictions where euthanasia or assisted suicide is legal include the Netherlands, Colombia, Switzerland, Germany, Belgium, Luxembourg, Estonia, Albania, Japan, the states of Washington, Oregon, Montana and Vermont in USA, and, most recently, the Canadian province of Quebec.

With rapidly advancing technologies and, consequently, longer life spans, the question of euthanasia appears to pop up with increasing momentum and topicality. Even the mere consideration of it starts pricking society’s moral consciousness, like,  is it ever right to end the life of a terminally ill patient undergoing severe pain and suffering, under what circumstances can euthanasia be justified, if at all, is there any difference between killing a person and letting him die? At the heart of the answer to these questions is the meaning and value attached to human existence. Can human beings arrogate to themselves the right to decide on life and death? If so, what is the guarantee that euthanasia will not be abused and used as a cover for murder? Quite often, euthanasia is described as ‘mercy killing’, appropriate for a terminally ill person, suffering prolonged, unbearable pain. Some surveys in the Netherlands and USA, however, indicate that only a small fraction of the requests for euthanasia attributed the cause to severe pain. People who are terminally ill may have other exacerbating conditions, such as incontinence, suffocation, nausea, paralysis, advanced stages of cancer, Alzheimer’s, not to discount psychological factors weighing on mind like depression, loss of control or dignity at becoming dependent and a burden on others, causing them to veer towards going to permanent sleep. If euthanasia is accordingly justifiable, can it be controlled by legislation once it is allowed? Not quite so, as there will always be people and situations where it may be enforced on the sly to eliminate vulnerable patients for reasons as selfish as the desire to gain early hold of ancestral properties or simply getting rid of the aged and sick who are considered an inconvenience.

The other pro-euthanasia argument is that the right to die, is as equal as the right to live a qualitative life with dignity, that it is implied in the numerous other human rights, that death is a personal matter and if there is no harm to others in one’s act of dying, then the state and the law must not interfere; the belief that human beings have the right to die when and how they want to is further strengthened by the specious notion that human beings are free and independent biological entities with the right to take own decisions on matters concerning themselves based on the belief that death is the end, hence nothing bad about dying and it is kosher to bring it about in the manner and time of one’s choice; that euthanasia in some manner is already happening as a matter of course, and hence allowing aged and terminally ill people to die, or facilitating it, may free up health care and economic resources for more deserving cases in the younger and productive age group. These arguments do not hold against the ill effects that such a provision can have on the emotional state of families of persons who put an early end to their lives; it is also as fallacious as the view that violence and murder already in exist in societies so it may as well be legalized. It also fails to counter the fact that permitting euthanasia can result in dilution of the commitment of health care professionals to safeguard life under all circumstances, especially in the case of the aged; in turn it may also end up with the gravely ill patient coming under indirect pressure to opt for voluntary euthanasia. Euthanasia weakens society’s respect for the sanctity of life, as it engenders the notion that lives of the disabled and gravely ill are less valuable than others. Voluntary euthanasia cannot be properly regulated, and is the beginning of a slippery slope leading to involuntary euthanasia and doing away of people considered undesirable. It is neither in the best interest of the patient nor the rights of others. It will discourage the search for new cures and treatments for major illnesses, and leaves undesirable power in the hands of doctors. It undermines society’s commitment to provide good care for the elderly and institute effective palliative care for the suffering and terminally ill, putting them under inhuman pressure to end their lives, allow materialism to entrench itself to such levels in the minds of people as to force families to abandon the gravely sick and aged, leaving them in the lurch, to  inevitability of fate.

The observations of Immanuel Kant fit admirably into the context here. He maintained that rational human beings are to to be treated as an end in themselves, and not as a means to something else; the fact that we are human has value in itself. Our inherent value does not depend on anything else – it does not depend on whether we are having a good life that we enjoy, or whether we are making other people’s lives better. We exist, so we have value. We should not treat other people as a means to our own ends. Similarly, we must not treat ourselves as a means to our own ends, which means we should not end our lives just because it appears to be the most expedient way of putting an end to our suffering, as to do that is not to respect our inherent worth.

The compelling need is to look at the most acceptable option, accommodative and conservative, rather than destructive and extinguishing of life. The solution is to put in place the most advanced and regularly updated system of palliative care as a means of physical, emotional and spiritual support for the suffering and dying whose conditions are beyond cure. It includes compassion and support for family and friends, treating the patient as a human being and not as a cluster of ailments. Competent palliative care may well obviate any necessity for a patient to contemplate euthanasia. WHO points to the direction with their statement that palliative care affirms life and regards dying as a normal process, it neither hastens nor postpones death; it provides relief from pain and suffering; it integrates the psychological and spiritual aspects of the patient. The words of Dame Cicely Saunders, founder of the modern hospice movement, resonate meaningfully, “You matter because you are you. You matter to the last moment of your life and we will do all we can to help you die peacefully, but also to live until you die”.

There is no need to look into religions for sanction as all beliefs forbid taking away life. Even from a rational standpoint, all life forms are intrinsically valuable and, therefore, the order that sustains can only be upheld by preserving life to its fullest. Taking measures to relieve pain and suffering is desirable, nevertheless the other side is affirmative of concealed power in suffering, as it taps into one’s inner strength to bring out finest qualities of the spirit, which are transformative, not just of the individual, enabling his growth in wisdom, character and compassion, but of society at large. Integral to a person’s progress towards ultimate liberation, suffering is part of the moral force of the universe, urging the individual towards drawing upon all his faculties for elevating to the highest and noblest attributes. How else can there be the finest expressions of human spirit, like the sacrifice and dedicated struggle of a Nelson Mandela in undergoing a quarter century of incarceration in an island off Cape Town, or, as in given context, the saga of compassionate care taking of Aruna Shanbaug over a period of forty two long years by generations of nurses at KEMH, Mumbai?


60 thoughts on “Euthanasia, Yes or No…?

  1. The never ending debate on euthanasia can be summed up in just one sentence: if we wish to live with dignity, we should be allowed to die with dignity.
    Living in a vegetative state, to be left in the care of those who seem to show empathy or love or both does not serve any purpose. It just feeds the ego of those selfish human beings who claim to love! Love doesn’t demand anything, love can’t let you suffer and stare at your helplessness. Love is letting go when there is the need. All this talk of religion and spirituality and ‘to live until you die’ is meaningless for a person who is in a vegetative state.

    There surely will come a time in human history when euthanasia would be legalised just like love, which has begun to progress. Thanks for picking up the most humane topic and creating awareness to rethink.

      • Do you think others laws have not been abused? All legislation is open to interpretation and abuse but we can’t turn our face the other way from enacting one.

      • Your view is well taken, Balroop. My wife holds the same position, but I am sure she will support me till the very end of life if I move into a vegetative situation, and vice versa. If prevailing regulations are already abused, does it mean adding more legislation is the solution? Not at all. If human mindsets in the near or distant future trend towards accommodating euthanasia, so be it. My position here is on the side of preserving life no matter what. Thanks for your comments.

  2. I very difficult but well written and thought-provoking post, Raj. Financial issues often rise to the forefront (cloaked in other forms of best interests). It’s difficult to wade through each case through a court system as well. I have many conflicted feelings on the matter due my past experience as a director in a nursing home. I can say that no matter how cognitively impaired a person becomes, I would look at patients and treat them with the same respect I would hope others would have for me if I could not speak for myself. I would not want to end my life as a freak-show. Regardless of a decision to euthanize or not, I still believe a person should be cared for with dignity until the end.

    • Your view recognises that life is sacrosanct, no matter how difficult it gets. As a person associated with health care and nursing, Anne, it just could not have been otherwise. Thanks for coming in…

  3. Many thanks for this comprehensive and eloquent article on the most intractable of moral problems Raj.

    “The solution is to put in place the most advanced and regularly updated system of palliative care as a means of physical, emotional and spiritual support for the suffering and dying whose conditions are beyond cure.”

    Yes, that is indeed a solution that circumvents any need for others; the problem then remains of how to fund such a service when politicians see no votes in advocating the same due to the high and escalating costs entailed.

  4. Thanks Hariod. While much can be said on both sides, informed opinion will always veer round to supporting life under all circumstances. The issue of old age care will only assume bigger proportions in the years to come, going by increasing life spans enabled by better health care and advances in the field of medicine. Increasing cost of Medicare adds another dimension to the problem, making twilight years a burden for people with limited resources. It is here that the state and NGOs (Non Governmental Organisations) must step in to fill the breach with assured social security structures. It is the bounden duty of society to care for the aged with proper support systems till the end of their lives.

  5. Oh Raj, what a heated debate you’ve mentioned here. Life is like a spinning top which keeps us spinning and revolving around issues which involve spiritual matters; sometimes they touch us, yet sometimes they just keep on spinning and don’t involve us at all. The only way to truly know is when these issues do come and knock at your door. Will I feel the same way I do now, when that happens? Will I feel differently? These are experiences that challenge everyone in a different way. Human civilization, as much as it tries to influence individuals, cannot predict the outcome of “x” individual. Each journey is so unique, and “submerges” itself in each human’s psyche, or subconscious. Identities are then called upon by society to testify. I prefer to let the journey take me to that moment, than to predict it now.

      • If I read you correctly, Maria, what you are stating is the experience of dealing with aged is yet to knock your door, so you are presently unsure as to how you will respond. Well, even if you confront such a situation, I have no doubt about the manner of your response. As for me, I have already experienced it in the case of my own mother; she was in a vegetative state for a few months and we ensured that she was cared for in a dignified manner till the very end; the Medicare would have continued as such even if it dragged on for years together. Did I dislike it? Far from it, as my feeling is that it has only refined me as a person. In the final analysis, it depends on how much a person values relationships and what sanctity is attached to life. Thanks for sharing your thoughts…

      • Yes, I’m unsure, in terms of dealing with my own family. Like my mother is someone I would love to take care of, but she has a DNR clause, so I don’t know how I will feel about that.

  6. Raj a brilliant analysis indeed on a question that often comes up in debates as well as in discussions between friends. Knowing very well there is no right or wrong answer I tend towards the view that we humans do not have the mandate to ‘play God’ and decide on someone elses life or death.
    Regards and best wishes,

  7. Such an incredible piece of writing and so very thought provoking. As a nurse myself the tragic story of Aruna and her compassionate colleagues and generations who followed, touches me deeply. This is a most challenging issue and I can appreciate the concern about possible abuse of the legislation. Yet I have witnessed so much suffering on the road to death it leaves me to wonder if there can not be a more humane way to leave this life when one is in a terminal state.

    • Thanks sue, for your comments. Your nursing background was unknown to me, as what stands out in your site is the ebullient and intrepid traveller in you. There is great merit in opting for a humane way of exiting life, sans suffering and risk of abuse inherent in any such conceivable option. Since it is non-existent, it is wiser to be on the side of preserving life, regardless of how difficult the span may turn out to be.

  8. Raj, you have written a powerful and compassionate post on a controversial matter. The tragic story of Aruna is one such case where euthanasia would have been a strong case. If a person no longer has ‘quality of life’ and is unable to participate in society due to terminal illness, or other detrimental disease, I feel the family and person has the right to choose. It’s not living. If it was legislated and sanctions put in place to prevent abuse of the treatment, then it’s worth considering.

  9. Aruna’s tragic case was specially approved for passive euthanasia by the supreme court of India, yet her nursing colleagues in KEM Hospital, Mumbai, were not in favour of letting her go even from her vegetative state. Thus she was taken care of as an in-patient, though abandoned by her family presumably because of the hopelessness of her situation and prohibitive cost of hospital care, in the hospital by generations of nurses for 42 long years till the end of her life… Passive euthanasia may be the way forward, as you are suggesting, in such exceptional cases. But the same must be subject to special approval by court of law on a case to case basis, as a safeguard to prevent abuse. Thanks Luc…xx.

  10. Such a sensitive topic and you tackled it so well, Raj. What happened to Aruna was terrifying but so much love surrounded her until her very last days. To be in a vegetative state, unable to communicate with those around you, it must be scary to have no voice and especially so when family chooses to go another way. You don’t have a choice when you are in that kind of situation – or maybe it’s more along the lines of you have your choice taken away from you…as in the case if family makes a decision on your behalf. I think that story also showed just how loving and compassionate the human race can be.

    • Thanks Mabel, I carried the Aruna story not because it was relevant to the post, more so to highlight an event that will remain as an illustrative example of the finest expression of compassion and humanism.

  11. Hi Raj,

    This is a great and thought-provoking post about an intractable subject.

    If I were to ponder on that core compulsion of what prevents our political, judiciary and societal groups from allowing euthanasia, I seem to come up against aspects ranging from morality, spirituality to a lack of authenticity. The courage of conviction to speak as per one’s own belief, the empathy to be able to get into the minds of the victim’s close ones, the clarity to see what really is the best way forward etc. are usually missing. Even if there is, the need to be ‘doing the right thing’, the need to show up as being politically correct etc. lead to stifling of decisions. And so indecisiveness and a tendency to shift the buck somewhere else prevails……..


  12. Your observations are quite pertinent, but problem is the hazy medico-legal divide and the lack of clarity surrounding most cases. Yet another hurdle is risk of abuse inherent in legalising euthanasia. Abuse is already prevalent in countries where euthanasia is legal. Thanks, Shakti, for your comments.

  13. Euthenasia is compassion. A body can withstand pain, and does, but it’s the loss of dignity that makes most of us afraid, and I’m glad when the time comes I’ll be able to make that choice for myself, and I will definitely choose to end rather than to linger. I think that’s the best gift we can give ourselves – the right to choose.

  14. Aruna Shanbaug is an interesting case with regard to Euthanasia…. This is certainly a polemic issue and that’s probably why there are arguments coming from both sides… When it comes to it I think we need to keep in mind the particularities of the case… It pretty much remind me of abortion, at least when it comes to the reasons or causes to say yes or no… I think that the consent of the person or her most close members of the family is a good point when it comes to decisions… Many laws keep in mind this topic thus an written informed consent, signed in advance as a precautionary measure could definitely help and lit up things. Hugs and best wishes dear Raj!, Aquileana ⭐

  15. My Dear Raj.
    Yet another masterpiece and such a controversial topic.. one which has been debated often when the subject has arisen at home.. I can only put my own views here on what I would wish for myself.
    But this debate as to the rights and wrongs have lots of loop holes to be abused.. So I doubt it would ever be legalised here in the United Kingdom.. Those seeking termination of ones own life through their own consent have to go abroad to Switzerland.

    If I were to know I was in that vegetable state would I wish my life to be ended.. for me personally Yes, why yes, because I know there is Life after death and would not wish others to go through such trauma.. And I hope they could see I would sooner be released to Spirit than kept in prison within a shell of my body.
    Yet if it came to looking after someone in that state, I would.. for each of us have the right to life and no others can make those choices for us..
    And here in is the difficulty.. For we all have the right to live.. And if we are not there to make those choices in sound mind.. No one else should be given the right to play God..

    This is why it is such a controversial topic.. We put our Pets to sleep to end suffering.. Members of my own family have suffered, One being subject to withdrawal of all treatment.. which at the time we did not know was happening, ( this practice within hospitals has now been reviewed here in the UK ) and the pain and suffering as the result was appalling ..

    And its ok when we say these things now, I wonder if when that time came to face us all.. How we all would Cling onto Life… No one can answer for another.. this is why I said right at the beginning.. I can only put my own personal views forward upon what I would wish for myself.. For Life is Sacred.. But I also know there is no real ‘Death’

    Love and Blessings to you and yours Raj..
    _/\_ Sue

    • I respect your views, sue, and your reasoning is very well based. You may wish for voluntary euthanasia, but if you are in my hands, I would only opt to take utmost care of you till your life naturally ebbs away, to assume another benign form either in this or another world…with warm regards and best wishes…

      • That is good to know my friend… 🙂 Like I said no one can make that choice for another.. I would be in good hands.. 😀
        May you continue to enjoy Johannesburg 🙂 Love and Blessings my good friend..

    • Sue, I would say I think the UK is one of the more likely countries to pass some forms of euthanasia laws. I was surprised the USA states who did, did so before the UK as historical progress usually flows the other way.

  16. Good evening Sir, first of all a very good write up on a very relevant topic but I couldn’t quite understand what indirect euthanasia is? As for my view, it is so tricky because if I were to be such a state I would want to die with dignity and wouldn’t want to burden others but if it were to be my loved ones no matter what state they are in I would always want them to be with me and I am sure I will look after them as long as I can.

    • Thanks for your views, shruti; there are no wrong or right positions here, as much can be said on both sides. Indirect euthanasia is already explained in my post; it occurs when a terminally ill patient in severe pain is administered a dose of morphine, which accidentally results in fatality. Death is not intended, but it just happens.

  17. Yes. This is a personal decision that everyone should be able to make for themselves.

    When my cats have died I’ve tended to envy them that they don’t have to go through suffering when their deaths were inevitably close.

  18. This is an incredible post Rajagopal. Thanks so much for writing it.

    In the latter part of the 1990’s I read a tiny book called “A Promise is a Promise” by Wayne Dyer. It was an account of a teenager who in 1970 asked her mother to promise that she would never leave her. Soon thereafter the 17 year old slipped into a diabetic comma, one she never woke up from. The mother kept her word and, with help, cared for her daughter until she herself died 25 years later. (A Promise is a Promise was written while she was still alive.) Then others cared for the daughter until November 21, 2012, forty-two years after she became comatose.

    Reading that book had a profound impact on me. While I don’t remember his exact words, among the things I remember is Dr. Dyer saying that walking into their home felt like being in the holiest of temples. The book also had an incredible story that I won’t relate in full here in hopes you and others will consider reading the book, but the bottom line was learning that some souls come to earth to teach other people how to love, and in so doing may give up their chance for a “normal” life for themselves. The story behind that sentence still astounds me.

    I am a therapist and focus a lot on co-dependency. I would have been concerned that these people were being co-dependent but reading the book totally up-ended my thoughts on that and other things as well.

    Thanks again for writing this post.

    • Thanks very much, Karuna, for dropping by to give your gracious comments. I will try to get my hands on Wayne Dyer’s book, as your recommendation is a strong reason for me to peruse it, specially based on cited story of maternal love expressing itself in the saga of medicare of her son in vegetative state…stay blessed…

  19. HUGE subject to discuss with many sides, only a couple of which I will speak to here, or it will become another article! Fundamentally, I agree that human life is precious, sacred and needs to be protected. However, I agree with your question “Can human beings arrogate to themselves the right to decide on life and death?”, and couldn’t it be said that using machines to prolong life is also playing God? To me, some of the aggressive methods and medicine used today are not the way we honour our gift of life and live in tune with nature/in divine timing. That’s not to say I wouldn’t choose certain medicine and practices, I just mean on the grander scale of what you are talking about, I am not sure I agree someone staying in a vegetative state for over forty years, is actually, the ‘moral’ way. I think speaking about morals is often speaking about religious beliefs and indoctrination, not spiritual Truths. The Truth is, that yes, all life is precious. However, would this woman have survived without aggressive intervention? Would this woman have said she wanted these treatments if she could speak? And in broader terms, away from the case here, do those around the person have the right (as in have righteousness on their side rather than the commonly used, judgment based, right-wrong) to overlook somebody else’s Truth? Do the living not cling to those who may well be at peace and ready to leave this world? Could these people be ready to leave as they have a greater understanding than those in vitality could ever grasp? Would a lot more very sick and old people be able to leave more peacefully if there wasn’t such fear and misunderstanding surrounding death in our current collective consciousness? I am not saying any of that is true, I am just stating we are not in a position to truly see and understand all of the many layers going on. In my opinion, the passive euthanasia in Aruna’s case and any like that one, are just other words for giving your life over to Source/Mother Nature/God/Higher Power- whatever word you feel works for you. It is the natural order instead of trying to defy it. Compassion, kindness, lovingly holding all life dear, equal and valid- as those wonderful nurses who took care of her showed to her- is also the natural order. This is a place every human could be encouraged to come from, in every aspect of life. I totally agree we need to have more access to and greater amounts of compassionate palliative care. Hospices are an invaluable place to a person approaching death and the family that supports them through their passing. I also think we need to respect others’ course of action in life. We can’t see everything, we don’t know the various reasons people have, the conclusions they have come to, the knowledge they have discovered, to choose euthanasia. As you can see from what I have written, I have no answers and yet I do believe we all have the right as humans to choose for all decisions in our life. I understand your desire to err on the side of caution for fear that the law would be misused but as is said numerous times in the comments, lots of laws are abused every day. To me, the laws of state are often created in relation to taking power away from people rather than spiritual law which encourages us to recognise our own sovereignty. I think this discussion shows the importance of families sitting down and speaking to each other openly and honestly about death- about each individual’s views on whether they would want extreme measures or not used on them. Perhaps this is the core issue with these conversations- we need to re-connect to the idea of death and be able to discuss it calmly and in a cognitive state. Perhaps each year families could sit down together for a discussion where each person’s idea of what they think they would want in this kind of situation is recorded every time, to give room for shifting views and understandings. I think people should be allowed to be responsible for their own choices, knowing that in the end, there is no right and wrong, good and bad, only a myriad of perceptions based on programming, culture and the amount of work an individual has done to remove them self from these. Phew. Sorry, that was a very long comment! Thank you for the food for thought, this post will stay with me and has already spurred on a couple of conversations with my friends which I sincerely thank you for. Best wishes and much love.

    • Thanks Laura for your detailed and analytical response. In Aruna’s case, passive euthanasia (allowing subject to die by withdrawing treatment and medical support) was specially approved by the highest court in India; yet her colleagues in KEMH pleaded for her upkeep, taking on the entire responsibility. And the Medicare continued for 42 long years till her life naturally ebbed away. Amidst sensitivities where subjective considerations dominate, there is no room for cold analysis and pragmatism. The patient was in no state to indicate her preference and she was abandoned by her relatives. Yet her colleagues chose to take care of her. So that was that. I do not want to restate my position as it is clearly laid out in my earlier responses….

      • Yes indeed, you made your position clear- my comments are never an effort to change opinion, just to contribute to the discussion! Even though I don’t agree with parts of your stance, I totally respect your viewpoint. Thanks again for bringing forward a subject that opens a broad and impassioned discussion.

  20. What an great article and you have raised many things to think about on a very delicate subject. Working in homecare for several years in the late 1980’s in Quebec my views slowly changed regarding quality of life and dying with dignity. Way before we passed recent laws, some geriatric medical professionals looked the other way but this was in homecare. I embrace the times I assisted people I love as they died and especially feel blessed to have been with both my parents as well. I agree with Karuna, that this is a wondering opportunity to exercise compassion. Having worked with and seen close family die a slow death with dementia, however, I have to say I do not want to put my friends or children through this.

    • Thanks oliana for coming in to my world with your views. Everything happens for a reason, including people slipping into Alzheimer’s or becoming comatose. Things probably fall in place if these are viewed as opportunities that life throws up to exercise compassion. That said, it must also be admitted that such expensive care taking may be beyond the means of many people. Governments and NGOs must step in to fill the gap through best in class hospices and palliative care. It is the responsibility of an enlightened society to care for the aged till the natural end of wishes.. Raj,

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  22. Aruna was an acid test – and we all failed her. Wasting time in debates – when she tossed in living nightmares. Shying away from notifying her rape- and allowing her criminal to escape.
    Her nursing staff did a great job, but morbidity and mortality are 2 different things. They could prevent bed sores, but its her mind that was scarred.
    I wish she had been given an easy, painless escape out of her hellish life.

    • An error of judgment in not reporting the rape, overshadows the entire episode, sweety, even though it was, apparently, done with good intent. Looked at any which way, it was grossly foolish to hush up such an overtly criminal act; it shows how even collective judgment can fail. The criminal may have slipped away from the arms of law, but nemesis will catch up with him. There is an ongoing debate on whether capital punishment (hanging a person to death) should be abolished or not, in light of the most recent verdict on the Bombay blast case. Given the sordid nature of criminal acts taking place around the country, there is no point in even considering abolition of capital punishment. Those elements that are a danger to orderly life must face elimination at least in extreme cases…thanks for coming in, and best wishes…

      • Agree 100%. I cannot fathom how human rights can exist for criminals, b’cos by default that means denying human rights to victims/ survivors.
        I had a debate a few months ago with another blogger and was astonished to discover myself labelled violent, aggressive, extremist etc etc.
        I refuse to feel guilty about wanting to punish the guilty. So glad to find a kindred soul in you.

  23. This is just brilliantly written. what a weak response to your superb words, but it’s impossible to match the quality and depth of your over view. It is an over view of the most careful kind with an amazing story interwoven. I did not know that story and it’s horrifying. I will ask this. Did you decide to leave personal opinion ( yours) out because you strove for this to be an over view? It leaves me wanting to know your personal opinion! I think euthanasia could be abused by relatives seeking speedy deaths of inconvenient relatives, or Governments with budgeting concerns. If there is a way of avoiding this then I believe people who are terminal should have the right to end their suffering. That said, I admire those who do not choose this equally. I can see abuse being a moral issue, but too many people needlessly suffer. The case of dementia is far more complex. I have currently no answer for that. Like many things it will evolve with time. What do you think?

    • Thanks Candy, for your comments. If you read the post carefully, and my exchanges with the many commentators here, my view would be seen to be very clearly set forth. I am not for euthanasia, no matter how difficult the situation. I believe very strongly in the sanctity of life and hence its preservation under all circumstances. I have experienced it in the case of my own mother who was in a vegetative state for a few months before her final end came, and we took care of her till the very end. I also believe, in a larger sense, that suffering is part of human life; it has a refining and cathartic influence, bringing out the finest qualities in humanity. Life is only the better for it, in a spiritual sense, that is….xxxbest wishes.

  24. Hello Sir, I am glad that I stumbled upon your site. Love it. This post is so perfect. Some weeks back, I was talking with my mother regarding the same. My uncle is a bed-patient now and mentally challenged also, just was the case with my grandpa. So, my mother and me were talking about mercy-killing and how it helps families and the suffering person. It’s never going to be legal in India and if it becomes also, to do any kind of Euthanasia(new word which I learned) requires courage and its good not to have courage in these kind of tricky things. It was a very informative post 🙂

  25. While I am not one of those who think that what America does is automatically interesting, I did want to offer the following observation because I am a notary public here in Tennessee and have seen this done many times, as well as recently doing it myself. We have many people here who would blow a gasket if you mentioned euthanasia, yet most (if not all) states in the USA have laws allowing for what you described above as passive euthansia, allowing someone to die. You can see it on television shows when they mention that there is a DNR on file, meaning a Do Not Resucitate order. The legal means to accomplish this varies, but many states have a document called either a Living Will or an Advance Care Plan that spells out the conditions under which the future-patient does not want “extraordinary measures” to be taken. As most of us will likely die in accidents or from diseases, both of which can result in such conditions as mentioned in such a document, the introduction of Living Wills and Advance Care Plans meant that euthanasia is legally allowed, at least as far as passive. The debate still rages over a more active form of it. Death with Dignity is the usual slogan of those in favor. Those opposed seem to be mostly fervently religious or deeply paranoid or both. With the cost of medical care growing, NOT signing a Living Will or Advance Care Plan could mean that you will bankrupt your family with those expenses.

  26. Your position is well appreciated, Tim. The economics of medical care for the infirm, aged, and terminally ill people must be afforded by adequate social security systems, fully funded by the state and non-governmental organisations, whereby the concerned families are insulated from any cost burden. That is the hallmark of civilised societies, not leaving the old and terminally ill in the lurch or allowing their drift to the inevitable…best wishes.

  27. A provocative topic and elegantly argued, Raj. It’s a topic I have dealt with in many situations and have considered from different religious and cultural vantage points. Ultimately, the view that I now hold is based on traditional Ojibwe practices. As a woodlands tribe in northern climates that relied on hunting and gathering, I’m sure you can imagine that life was not easy.

    For the sake of brevity, I will merely describe the “ideal” beliefs in an extremely simplistic way. All life was viewed as sacred. Everyone worked together for the good of the community as a whole and for the survival of the group. They were stewards of the environment for the sake of future generations, taking only what they needed in a spirit of gratitude and reverence. In situations where a member knew that he or she could not contribute to the collective, and in fact would jeopardize the survival of the group by refocusing their activities from what they needed to do in order to survive, he or she would choose a good death – walking away from the camp to die in peace for the sake of the whole. It’s not an option my mother could choose.

    She died a slow death (13 years) from Alzheimer’s Disease. It took all of her considerable savings to pay for her care, and then some. She was cared for with kindness during those years. I don’t regret the decisions I made regarding her care, but it’s not something I want my daughter and grandchildren to experience. As Tim noted above, Advanced Directives (Do Not Resuscitate Orders) offer an alternative. I have faced surgery and had to fight for mine to be honored prior to surgery. It was a condition for allowing the surgery to proceed. I don’t want society or my family to bear the cost of my care when families are homeless and children go hungry, when refugees are risking their lives to simply live. I’ve lived a full and wonderful life and hope I can contribute for many more years. Yet when I can no longer do so, I prefer to follow the ways of my Ojibwe ancestors.

    There is another way to view morality. Societies that have enough for all may have the resources to extend life. Those that don’t but still choose to extend life, as in the case you described, certainly make decisions that cause want and suffering among those who are least desirable in that society’s eyes. How many children could have been fed, housed and educated with those same resources? Of course the larger question is why we waste so many resources on war instead of taking care of people…

  28. Many thanks, dear Carol, for coming in to offer your take on the subject. While I may not agree with it, your views based on Ojibwe practices, are more or less on the lines of Vedic prescriptions. We have read about Shakespeare’s delineation of the ‘seven ages’ of man. According to Vedas, human life consists of four stages, called ‘ashramas’. The first ashrama is Brahmacharya or the student stage, the second ashrama is Grihastha or the householder stage, the third ashrama is Vanaprastha or the hermit stage, and finally the fourth ashrama is Sannyasa or the wandering ascetic stage. Brahmacharya or the celibate student stage, begins with one’s formal education, stretching up to 25 years. During this period, he is a celibate fully focused on his studies and acquisition of life skills under a guru. Grihastha is the married man with family, starting from the time he finds a life partner and assumes responsibility of building up his family, giving in to sensual pleasures and acquiring wealth as necessary. This period lasts until the age of 50 years, within which time he should have fully discharged his responsibilities towards home and family. Thereafter it is Vanaprastha or the retreating hermit stage. One has by now become a grandfather, his children are grown up with lives of their own. At this stage, a man should renounce all sensual and material pleasures, retire from his working life, leave home to live in a forest retreat, to spend time in prayers. The spouse may accompany him. Sannyasa, the ultimate stage, is that of a wandering recluse, totally devoted to prayers and aimed at attaining salvation. There are no bindings whatsoever to mundane concerns. At the time of death, or merger with divinity, the son performs the funeral rites. The woman may be with her husband till the third stage, and at the final stage she remains at home to be taken care of by her son or daughter. In this day and age, this is not strictly followed in its entirety as no one ever retires to a forest. But, in principle, it means that one should, in his twilight years, move away from familial ties, be on his own without burdening anyone, to eventually merge into nothingness…best wishes.

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