Monday, 7 March 2011

Supreme Court of India legalises passive euthanasia, but doctors divided over mercy killing

Syed Akbar
Hyderabad, March 7: Doctors are steeply divided on Supreme Court's order legalising passive euthanasia for terminally ill patients or those in irreversible comatose state.
While a section of doctors feels that legalising passive euthanasia will hamper research in medical sciences and tantamount to denial of the basic human right to life, others are of the view that it will reduce the suffering of the terminally ill patients and those living in permanent vegetative coma. Though they are divided on passive euthanasia, they all agree that active euthanasia should not be allowed in the country.
Still others argue that euthanasia, or "good death" as the word means in Greek, is an inappropriate medical term. They say death, forced in any form - whether active or passive euthanasia - is "not good" and doctors subscribing to medical ethics should not enforce it on their patients.
Leading surgical oncologist Dr Mohana Vamsi minces no words when he says he will never suggest that his patients choose euthanasia. "Even if the patient is terminally ill, I will not perform euthanasia, even if it is passive. As a doctor, it's my duty to continue with the treatment and it is ethically wrong to stop the efforts," he argues.
Dr Vamsi believes that if terminally ill people or those in coma are allowed to choose passive euthanasia, it will affect scientific research and development of new medicine. "Medical technology has advanced to such a stage that even cases declared as terminally ill have survived for months and years. There have been several instances of people coming out of coma," he points out.
According to senior physician Dr Aftab Ahmad, passive euthanasia can be carried out if all the relatives of the terminally ill patient arrive at a consensus. "As doctors we face a lot of dilemma in dealing with terminally ill cases. If doctors and relatives come to an opinion on passive euthanasia, then there's no harm. But in active euthanasia there's always the problem of judgmental error and no amount of regret later will bring the patient back to life," he said.
Infectious diseases expert Dr Suneetha Narreddy welcomes the Supreme Court order. She says, "if a patient has the right to take medicine, he also has the right to stop it. One cannot force a cancer patient to take chemotherapy if he does not want it. Similarly, in passive euthanasia, life support system or medication is withdrawn. But active euthanasia should not be allowed."
MNJ Institute of Oncology former director Dr T Mandapal suggests that there should be nation-wide debate on passive euthanasia before it is made law. "Passive euthanasia is welcome, but there should be enough safeguards to ensure that it is not misused. The patient should be given the choice whether to be continued on life support system and medication or withdrawn from medical aid," he said.

What is Euthanasia?
Euthanasia is a medical term which in Greek means “good death”. In other words it means assisting a terminally ill person or one in coma to die. There have been debates all over the world whether euthanasia should be legalised. India has thus far taken a rigid stand on euthanasia arguing that it’s illegal and against medical ethics and clear violation of the Hippocratic Oath.
Euthanasia is often described as active and passive.
In active euthanasia, doctors administer a lethal injection, generally sodium pentothal, to allow a terminally ill patient to slip into deep slumber. The patient dies in sleep, without pain. The lethal dose is given either by the doctor attending on the patient, or the patient himself takes the lethal injection. Active euthanasia is otherwise called mercy-killing. If the patient himself takes the lethal dose, it is also described as assisted suicide.
Supreme Court has declared that active euthanasia is illegal.
In passive euthanasia, the terminally ill patient or one in coma is hastened to die a natural death through withdrawal of life support systems, medication and food. For instance, if a patient is on ventilator, it is withdrawn to enable him to die. Passive euthanasia is basically denial of medical facilities to a terminally ill patient.
Supreme Court is in favour of passive euthanasia but has put a lot of conditions for it to be implemented, as there are chances of its misuse.

Recent euthanasia pleas in Andhra Pradesh
* 2004: K Sujatha, mother of chess player Venkatesh, knocks the doors of AP High Court seeking permission that her son be allowed to be euthanised. Venkatesh was lying on bed with muscular dystrophy and wanted to donate his organs. The High Court rejected the plea.
* 2010: K Jagannadham and K Manohar of Ramakkapet village in Medak district sought the intervention of the AP State Human Rights Commission for their mercy killing. Both the brothers are victims of muscular dystrophy and crippled. The SHRC has not responded to their plea.
* 2011: Devudamma, a old woman in Visakhapatnam, has petitioned the district collector that she be mercy-killed. The woman is healthy but has been subjected to untold harassment by her grandchildren.

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