Matters of life, death

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Matters of life, death

Apex court’s living will verdict guarantees life with dignity but pressing issues remain

Undoubtedly the Supreme Court ruling on passive euthanasia, recognising the person’s right to die with dignity if s/he is reduced to a permanent vegetative state from which there is no return, is seen as a landmark relief to suffering patients and kin. But more than a ruling, it is a life lesson that treads the realm of spirituality and that innate enlightening possibility of human growth — courage, compassion and wisdom to the right thing. By equating death as the culmination of a life well-lived and making it part of a ceaseless life cycle, by equalising the right to a peaceful exit with a fundamental right to live on one’s own terms and by upholding the sanctity of the body without decimating it to the putrid agony of terminal pain and degradation, this verdict also upholds the freedom of choice. A person can sign a living will in a sound mind to provision the terms of his death in case s/he slips into an intractable abyss. Many religious leaders have argued that life should be allowed to ebb away at God’s will to expiate one’s sins through suffering but by decriminalising the right to pull the plug, one is actually aiding the natural process to take over. In that sense, prolonging a life artificially when there’s no hope of it spiking up on the monitor is a human intervention that goes against the natural order of things.

The verdict also points out practical issues that need policy correctives. By asking if the right to die can be denied when right to health isn’t honoured, the court is actually spelling out the need to better and prolong human life with suitable and affordable health infrastructure. The ruling is intended to lessen the burden of the lesser privileged who cannot afford exorbitant costs of the ventilator to prolong life that’s irreversibly comatose. This would help free up already scarce life support systems to save lives that can be brought back. However, it is the execution of the order that needs monitoring. And though the court has laid down an elaborate protocol of checks and balances — consenting patient should be of a sound mind while signing the living will and be in the presence of judicial magistrate and two independent witnesses, will be investigated by a double medical board, of hospital and court — there should be an eagle eye on abuse. For example, for terminally ill patients above a certain age, one has to assess whether the “self-determination” is made under duress or coercion by the next of kin preying on a fragile mind. There’s also the issue of revision of the living will, what if the patient does change his mind after execution and challenges its validity. All preventives must include verifying the antecedents of the medical practitioner and witnesses and understanding if they could be in any way beneficiaries of the executioner’s asset base. What should be the position in case of a pregnant woman whose baby can be saved with life support but who has signed the consent before? There will be human questions and specifics that may force a relook and reinterpretation. But in the end one must consider the extraordinary circumstances of having a life that’s neither productive, nor experienced or joyful. Take the case of nurse Aruna Shanbaug, who lay 37 years in silence and pain after a brutal rape reduced her to a permanent vegetative state. Or the desperation of the Thrissur teacher who hung himself diagnosed with a terminal condition when he couldn’t get legal redress.

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