- Dr. A.K. Tharien
Christian Fellowship Hospital Oddanchatram, Tamil Nadu, 624619, INDIA
(Note: Dr A.K. Tharien is the President of the Indian Academy of Social Sciences in Medicine. He founded and built up this hospital in rural Tamil Nadu 40 years ago, after returning from European medical training)
Medical science and technology have made great strides in recent years. The medical profession has today more power over life and death than they would chosen to have. They have power to prolong life where life seems to have lost its meaning and have power to terminate life without suffering. There are many points of view on euthanasia; legal, social and compassionate.
The debate on Euthanasia has again become a live issue in India as the Supreme Court of India in 1994 passed a verdict that attempted suicide is not a crime. According to the Indian Penal code, which was mainly adopted from British Penal Code, attempted suicide was a crime, punishable with years of imprisonment. With the recent medical knowledge gained by researchers and the opinions expressed by eminent psychiatrists all over the world, the judges in their verdict were sympathetic to those who attempted suicide. The Supreme Court of India is the highest court, authorised to interpret the constitution of India for legal matters. They gave the verdict that attempting suicide is a mental derangement and hence not to be considered as a crime. This signifies social approval of suicide and euthanasia which is assisted suicide.
2. What is Euthanasia?
Euthanasia is the deliberate bringing about a gentle and easy death, making the last days of the patient as comfortable as possible. This is to ensure a calm and peaceful death, within the context of relieving incurable suffering in terminal illness or disability. Euthanasia is voluntary, when requested by the sufferer; involuntary or compulsory if it is against the will of the patient; and passive when death is hastened by deliberate withdrawal of effective therapy or nourishment.
3. The Dilemma
While I was working in England, I was resuscitating an elderly lady who was admitted in the hospital emergency ward with severe demonstrable cerebral damage. My chief of surgery an Englishman and devout Christian told me gently, "I don't want to interfere with your procedures but if it were my mother I wouldn't do all that you are doing and would allow her to die peacefully". This is often our dilemma. Should one prolong the act of dying in a case of irreversible death or when life is effectively over. One of the achievements of modern medical technology is the use of artificial life support systems like artificial feeding, dialysis, controlled respiration, pump circulation etc. In some cases it can be so dehumanising, painful, hazardous or costly that other considerations outweigh the aim to conserve life. Euthanasia supporters raise the question, how long to sustain life? A patient might say "I do not want a vegetative existence by drips, drugs and dialysis. I want to die with dignity. I have a right to lay down my life just as I have a right to live".
In the well known Dr. Arthur trial, where Dr. Arthur in U.K. had prescribed an overdose of codeine to a baby, born with Down syndrome with the object of hastening his death, Dr. Arthur was charged with murder. Many eminent witnesses were called to the trial. Most of them justified the procedure Finally the court acquitted Dr. Arthur as his motive was compassion. There is an argument that if a foetus is found to be abnormal and severely handicapped it should be sought out and eliminated before birth as such children are socially valueless. Do not the physically handicapped and mentally retarded have as much right to life like others and and deserve to get the needed care?
4. Death and Dying
The concept of death in the light of new knowledge, is changing. It may be obtained by redefining life. Descriptions of life are organised at many different levels of complexity like molecular, cellular, organ, system, corporal, mental spiritual etc. Human life may be described as the ability, actual or potential to respond to others, or to be self-aware. This is based on cerebral function. Silverman and others in 1969 have established this by extensive studies and confirming it by encephalogram findings. Once cerebral death is confirmed there is no chance for survival though heart and lung functions continue. So it would be quite unnecessary to continue supportive measures after cerebral death.
5. The Christian Concept
According to religious concept Almighty God has created man in his image. He is the giver and sustainer of life. He alone has the right to withdraw life. Life is not a right but a gift of God belonging to God and at all times in His hand. So we have no right to take away deliberately a human life, even one's own.
Euthanasia requests may come out of depression and confusion or out of a feeling of worthlessness, or due to persuasion of interested parties with ulterior motives. Respect for the person of the patient and concern for the family should lead us to use our resources as best as we can to promote life. The essence of our approach to a dying patient is to give ourselves in loving care to meet his need. A patient is not merely a biological unit but a person before God with social and family connections.
Suffering can sometimes be redemptive and purposeful. It is as much as God's opportunity as health and an opportunity for a creative outcome or a witness or an amendment of life.
Let me share with you the experience of two of my friends who faced the issue of caring for children with disability. One was a hospital Chaplain. When a child with disability was born to him, he asked God why this happened to him, but he could not get an immediate answer. He loved that child but the child could not adequately respond to his love in the normal way. This helped the pastor to realise how God loves us in spite of us not being responsive to His love. The other was a colleague of mine and a highly qualified paediatrician. When a child with disability was born to him and his doctor wife, they did their very best to sustain her life. The child became critically ill immediately after birth, needing exchange blood transfusions. Though their colleagues questioned the wisdom of taking such an extreme step for such a child, they chose to have the exchange transfusions. The child recovered and subsequently brought a new purpose to their life before she finally died at 4 months of age. Through this the parents realised that God had a purpose in bringing her to their home. This experience was an act of God to make them aware of the need of caring for many neglected children with disability in our society. So they resigned from their busy clinical work and offered their lives to start a centre for children with mental handicap and special needs. An apparent traumatic experience became the rallying point for a new mission for compassion.
7. Our Guiding Principle
Ever since the time of Hippocrates in the fifth century B.C. the medical profession has been guided by the concept of the worth of each individual human life, which was recently reaffirmed by the Geneva code in 1948, which states, "I will show the utmost respect for human life from the time of conception". "Suffering is evil, and we should take every step to mitigate or relieve it." In the extreme, Hitler had a utilitarian philosophy of life. Any person who had a utilitarian value, he preserved, and others he eliminated. But we respect the unique value of human life. Scriptures says man is made in the image of God. This gives human life, a unique dignity and value. Life should be cherished, supported and cared.
8. Some Practical Suggestions
1. Doctors should serve and care for their patients in love.
2. Deliberate attempt to end or shorten life, whether by omission or commission is unethical in my personal view, and should be restrained.
3. Our society's leaders should proclaim the way of righteousness and truth, against taking innocent lives, and provide compassionate care.
4. Education of medical personnel and people with moral and spiritual values should be done, which may lead to sound legislation.
5. Bring in the principle of love as the motive and mainspring.
Views and ideas and even concepts of ethics are fast changing in the context of the progress of science and technology. The traditional institutions in our society, which protect human life and spiritual values are gradually being pushed aside or getting eliminated. Love is the foundation of ethics. Loving our God with all our heart, soul and mind and loving our neighbour as ourselves, and the two foundations for our ethical practice. Only a code of ethics based on sound principles, can lead our society to lasting happiness, harmony and peace.