Poke Me: Call for euthanasia premature in India

This week's " Poke Me", invites your comments on 'why a call for euthanasia is premature in India'. The feature will be reproduced on the edit page of the Saturday edition of the newspaper with a pick of readers' best comments.

So be poked and fire in your comments to us right away. Comments reproduced in the paper will be the ones that support or oppose the views expressed here intelligently. Feel free to add reference links etc, in support of your comments.
By Harmala Gupta

It surprises those of us who look after people with life-limiting conditions that we are not asked more often to end lives. We do, occasionally, receive requests but have found that they quickly dissipate once the precipitating crisis is dealt with: unaddressed physical pain, a feeling of guilt, or loss of meaning. Why is this so?

By and large in India, it is families and not individuals who take decisions about their lives, including medical ones. Nowhere is this more evident than when the diagnosis is a life-limiting one like cancer. The patient’s diagnosis and prognosis, the details of the treatment plan to be followed etc., are generally kept away from the patient and discussed by doctors with those who are perceived as the main decision makers in the family.

Patients, too, seem to be happy to play along as not only do they believe that the family and the doctor will do what is in their best interest, but also because they feel that since the brunt of expenses and the burden of care will now have to be borne by the family, it would be churlish for them to insist on their individual right to know. In these circumstances, where the individual affected is not the decision-maker and is not in full control of information regarding his or her illness, legalising euthanasia is out of the question. It cannot be a decision taken by someone else on your behalf when you are up and able. Not all families are happy families and not all doctors are wedded to the Hippocratic oath.

The second reason why our patients, who are often at the end-of-life and of their tether, do not ask for euthanasia is because our teams of doctors, nurses and counselors are skilled professionals who have the medicines and competence to bring immediate relief and alleviate unnecessary suffering. They are trained in a sub-specialty known as palliative care that is not confined to symptom control alone but includes hands-on nursing and training of caregivers in simple nursing tasks.

The counselor on the team seeks to prioritise the most pressing psychosocial and economic concerns to help patients and their families feel less helpless and regain a sense of control over their lives. This care and support continues till the end-of-life for the patient and post-bereavement for the family. Unfortunately, however, our patients are the lucky few, for the vast majority palliative care is a bridge too far.

Once again, the call for euthanasia is premature in a country where people with chronic, debilitating and life-limiting illnesses have no access to end-of-life care that is appropriate, affordable and can be delivered at their place of choice, usually the home. Instead, the reality is that if they live in a city they are likely to be shunted into a critical care unit and at some stage put on life support, which further compounds their misery as well as that of their families. For those who cannot afford such care, it is back to the village to die without any kind of supportive care to ease their pain and suffering.

Surely the answer lies in increasing access to palliative care by training more personnel and providing them with the necessary wherewithal and backup? This is not expensive care as it does not require prolonged hospitalisation or sophisticated interventions. All it needs is good symptom-control and compassionate care that respects the dying process and the right of the patient to continue to live with dignity.

For this to happen, society, including doctors, medical bodies and law-makers must first accept that death is natural and that there is something called the dying process. Efforts should focus on facilitating it in a manner that does not make it grotesque, distasteful and something to be feared. Doctors must have the latitude to take decisions, such as removing life support, or refusing to initiate intrusive measures that they consider futile without fear of legal censure.

This is by no means physician-assisted euthanasia as the intention is not to kill the patient but to do what doctors are sworn to do: to cause the least harm and do what will benefit the patient the most in the prevailing circumstances. For this to happen seamlessly, a palliative care team trained in end-of-life care needs to be at hand to support the treating team and to counsel and prepare families. The Indian Critical Care Society and the Indian Association of Palliative Care have already jointly initiated this process and it is to be hoped that their recommendations will be considered seriously by the government.

The euthanasia debate is both premature and inappropriate for India. A vast majority of our population do not, at present, have access to humane end-of-life care. Moreover, as long as families and doctors follow a “do not tell the patient” policy, offering euthanasia as an option is simply a non-starter.

The writer is Founder-President, CanSupport.