Euthanasia in the Indian Context Dr Vina Vaswani

Euthanasia in the Indian Context Dr. Vina Vaswani MD M Phil Department of Forensic Medicine & Toxicology Dr. Ravi Vaswani MD Department of Medicine Yenepoya Medical College Mangalore, India

How long must I continue to suffer such intolerable pain? When will I be permitted to accept “sweet peace” or even to ask for it?

Sigmund Freud • 1939 – 83 years of age • More than 30 surgical procedures • Crude prosthesis to eat and talk • Max Schur, Physician and friend liberated him from his agony

The Indian context 2006 • • • Venkatesh – 25 yr youth Muscular dystrophy Terminally ill Wished to donate organs Sought right to die; denied by court • Sparked a country wide debate

BIRTH Anayasena maranam Vina dainena jeevanam “To lead a life without pity and court death DEATH without pain”

Anatomy of Euthanasia • Definition – Gentle easy death • Act or omission designed to hasten death • To relieve the suffering of a dying or incurably sick person

Types of Euthanasia • • Voluntary Active Euthanasia Involuntary Active Euthanasia Non-voluntary Active Euthanasia Passive Euthanasia (Termination of life sustenance) • Indirect (Covert Euthanasia) • Physician assisted suicide

Vedic & Buddhist concepts • Karmic theory • Value of human life is to be found in capacity of conscious choice • Applied within narrow confines • Hospice care • Overcome death once & for all • No active intervention

Theological perspectives… Christianity • Sanctity of human life • God’s calling • Withdrawal of life support acceptable by modern theologists

The Netherlands • 1970 Dr. Gertrude Postma • Royal Dutch Medical Society - “force majeure” • 1990 - 2300 cases of Euthanasia (1. 8%) • Criteria: – Patient’s initiative – Unrelieved suffering – Second physician

The Netherlands • Right to Suicide • Can seek help of doctor • Slippery slope? ? ?

Belgium • Second country in the world to legalize Euthanasia • Suicide can be practiced without giving doctors a license to kill • “Constant & unbearable physical or psychological pain" resulting from accident or incurable illness • Minors cannot seek assistance to die

Australia • Legalized in Northern Territory • 1995 - Rights of Terminally Ill Act • Not a broad legislation but individualized • Subsequently the law was overturned • Euthanasia not permissible but several statutes permit refusal of life-saving treatment

United States of America • “Right of possession & control over one’s body” linked to “Doctrine of Informed Consent” • Common law but not Constitutional right • Initiatives to legalize Euthanasia rejected in polls • Advanced directives: Living wills & Proxy appointments

USA (continued) • Oregon approved Euthanasia on time limited basis. Struck down by Fed judge • 1992: Michigan Dr. Death • Acquitted twice but eventually incarcerated • Right-to-die organizations chosen “assisted suicide” as first station on road to Euthanasia

United Kingdom • Tony Bland - A victim of English football tragedy • Withdrawal of nutrition, etc • ‘BEST INTEREST’ test • No validity of Advanced directives Thou shalt not kill, but needs not strive officiously to keep alive

Japan • Public opinion in favor • Medical profession against • Debate on “Family Unit Advanced Directive”

India • Rathinam vs Union of India 1994 - attempt to distinguish suicide from euthanasia • Sec 306 & 309 of IPC • Articles 14 & 21 of the Indian Constitution • 1994 Supreme Court - Sec 309 unconstitutional • 1996 - Volte-face Gian Kaur vs Punjab • Right to live not equal to Right to die

The Issues. . . • Right to die vis-a-vis Right to live • Is there a difference between killing & letting die? • Should Euthanasia be legalized? • World Medical Association - 1987 • Law reforms • Public acceptance after debate

Our study • Open ended questionnaire • Likert type scale • Hypothetical situation where euthanasia is requested • 30 responders. 2 refused.

Where do we stand? • Singular attempt to side step the core issue of Euthanasia • Social, Professional and Public discussions need of the hour • Better Hospice and Managed care

The song that I came to sing, remained unsung The time I got was used in stringing my instrument Thank You