Reflective consciousness in ethical issues may have reached a level to validate euthanasia as a concept (“Dead Man Stalking”, by Saubhik Chakrabarti, 14-15 December), but active practice in a living community must, first, satisfactorily resolve three basic issues. Who initiates and benefits from the action, who performs the actual act and by what laws. Indian experience being limited so far, a debate in context requires a look at international experience.

 While ethical laws distinguish between voluntary and imposed euthanasia, medical practice recognises either passive euthanasia, done by withdrawal of treatment, or active euthanasia, where an actual killing drug is obtained  from a physician (physician assisted suicide or PAS) or the physician himself delivers the lethal dose. It is a misconception that euthanasia in all these forms have been legalised in some countries.

   The first legal sanction of euthanasia (the Northern Territory Rights of the Terminally Ill Act 1995, Australia) was repealed on 23 March 1997. Netherlands never had legal sanctions, but because of a “tolerant judiciary “the practice of euthanasia is common among Dutch physicians. A survey there, analysing 839 deaths of mental patients involving 79 doctors, detected as many as 350 ending-of-life decisions.

With supportive medical care becoming increasingly capable of prolonging  human live in its most reduced forms, for example in a  permanent vegetative states (PVS), the western primacy on the autonomy of the individual produced the notion that, as in life, dignity must accompany death. Humanity, in 1974 published a signed appeal, led by noble laureate Linus Pauling, which proclaimed the belief that society has no genuine interest or need to preserve the terminally ills against their wills and that the right to beneficent euthanasia, with proper procedural safeguards, was worth protecting.

Such thoughts ultimately culminated in the practice of writing a “living will” which specifically directs and ethically binds the physician to act as willed when the patient can no longer make his wish known and respect a DNR (do not resuscitate) choice if a person already terminally ill should develop; another life threatening emergency like a cardiac stroke (Patient Self-determination Act, 1991, U.S.A). A further concession to the demand for the right to die was made by the state of Oregon, U.S. It passed the Death with Dignity Act allowing PAS with the provision that the physician will only prescribe the lethal drug for self-administration at the patient’s request. This law has since been upheld by higher U.S. courts of laws and by other American states. 

Colombia was perhaps the first country to accept the right to die as one of the rights of the patients in October 1997. Almost all other countries consider euthanasia, including PAS, to be illegal and deliberate acts, which are charged as first degree murder; suicide in any form being a criminal offence in most countries, including India. Law-makers find it difficult to draft a comprehensive law due to complexities surrounding euthanasia or ending-of –life decisions which may be illustrated by these case reports.

In September 1991, Dr. Boudewijn Chabot in Netherlands was charged for assisting the suicide of Hilly Bosscher, a 50-year-old woman in good physical health but suffering from depression due to the loss of her two sons and the end of her marriage. The question here was whether psychological suffering can be equated to physical suffering. Rose Wend land wants to withdraw the feeding tube of her husband Robert; a 45-year-old “physically and cognitively” disabled man now awake after 16 months’ coma. But her husband’s kin has sued her to prevent his death by starvation and dehydration.

C A Thomas, an 80-year-old man in South India who is in good health, financially secure and content in family life, has challenged Indian laws against suicide saying he ‘should be able to choose when he shall die. Karen Ann Quinlan, a 21-year-old in New Jersey, U.S., deteriorated to a vegetative state from an overdose of pills and alcohol in 19975. Her parents moved several courts to take her off the respirator. But, ironically Karen remained alive minus the respirator for 10 more years.

Physician’s organisations the world over overwhelmingly oppose active euthanasia. Neither the Hippocratic Oath nor the Geneva Convention condones such proposals. In reality, though, doctors often participate in passive euthanasia by withdrawing or declining treatment in terminal cases.