Introduction:

Death can be perplexing to anyone. It drains people emotionally and leaves a void in our hearts which can never be filled. Natural deaths are still easier to accept by labelling it as the ultimate truth of life. However, the ethical issue we have taken up is about death which is induced before time. The background setting for our live case is the very debatable issue of “Euthanasia”. Literally, euthanasia means “Good Death” (Greek: eu = good, thanatos = death). More formally, euthanasia means the intentional act or practice of painlessly putting to death persons suffering from an incurable and distressing disease as an act of mercy, which is not necessarily at the request of the patient.

Forms of Euthanasia:

• Voluntary euthanasia: When the patient has requested the death. • Non-voluntary: When the patient has not made any request and gave no consent. • Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called "physician assisted suicide." • Euthanasia by Action: Intentionally causing a person's death by performing an action such as by giving a lethal injection. • Euthanasia by Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.
Euthanasia evokes a mixed reaction among people who come across it. For some, it is unimaginable to end a human life and yet some think it is justified to end a life which is not worth of dignity. There are several moral and ethical issues concerning this topic and we will examine it in detail in the later part of our report.
The Live Case:
Pinki Virani, a writer, moved a writ petition in the Supreme Court asking that feeding be stopped to Aruna Shanbag, a nurse living in a vegetative state at KEM Hospital, Mumbai, India. The Aruna Shanbag case has been making headlines once every couple of years for the past 38 years. She slipped into her vegetative stage after being strangled with a dog chain while being raped by a ward boy on 27’th November 1973. Aruna was 25 years old then and working at KEM. The blood supply to her brain was cut off, and for close to four decades, she has been confined to bed, force-fed by nurses and doctors at the hospital.In her petition, Ms. Virani said that the continued vegetative existence of Aruna is a violation of her right to live with dignity.
The Aruna case is an ethical black hole. The main question is: no one knows whether Aruna wants to die or not. The only relationship that Pinki Virani has with Aruna is that she has written a book about her. How can a third person, no matter how noble the intention, ask for a stranger’s death? Human Rights people may argue that it is solely on humanitarian grounds that the case must be decided. But how can it be convincing? The crux of the problem lies in deciding that one person who judges whether another’s life is meaningful or not. While we debate the merits and demerits of euthanasia, discuss well-meaning emotion battles with hard-headed reasons, Aruna Shanbag still languishes in her vegetative state in a hospital bed.

Ethical Issues involved in the case:

Death is a natural part of the development process in the life cycle. But the management of death is a controversial topic because efforts to postpone or hasten death have medical, legal and ethical ramifications. Euthanasia is not supported universally as there are several aspects of it which are neither absolutely right nor absolutely wrong but fall somewhere in between. This positioning makes it an ethical issue which is always debatable.

Medical Ethics:

The question is obviously very difficult to answer because different people have different views depending on their stand on euthanasia. Some people deem it unethical thinking of the potential abuse, or its religious implications. On the other hand, prolonging life beyond a certain point seems as unethical as anything else.

No physician or facility would have to comply with assisting a terminally ill person hasten dying. The responsibility of medical treatment rests mutually with the patient and physician, not with just the physician. Then, it also becomes the patient’s responsibility to either resolve the issue with the physician or seek alternative care.
Is physician-aid-in-dying a violation of the Hippocratic Oath?
Strictly going by the Hippocratic Oath which clearly states that “I will neither give a deadly drug to anybody if asked for, nor will make a suggestion to this effect” then euthanasia is clearly a violation of the oath. This has been one of the main arguments of the medics against euthanasia.

But abortion which was considered a serious violation of the Hippocratic Oath 20 years ago is now legal: Euthanasia may have the same fate. Apart from these considerations, Hippocrates in his book Epidemic has clearly stated that “If a doctor cannot do any good then he must be prevented from doing harm”, so in this regard Hippocrates does seem to be inclined towards supporting euthanasia.

Legal Issues:

Euthanasia is legal in very few countries of the world such as Belgium, Netherland, Switzerland, Luxembourg and few states of USA such as Oregon and Washington DC . Other nations are yet to legalize it and face several dilemmas to make it a law. “The difficulty the law faces is that everything becomes a precedent,” explains Dr Pandya of KEM hospital, Mumbai, India. If it is made legal, it can evoke a chain reaction which at some point could become a disaster. The other reason that makes the Government tread with caution is its uncertainty about public opinion. It requires a massive public support to make euthanasia legal which could be difficult to obtain in countries where several religious sects reside.

Religious Issues:

To a great extent, our religious beliefs and our cultural upbringing shape our thoughts to living and dying. Religion becomes a guiding force to accept prevalent norms. Euthanasia has been a debatable issue mainly because of the religious beliefs. Almost all religions, be it Hinduism, Christianity, Islam or Buddhism condemn euthanasia. For the believers, life is a gift from the almighty and only he has the right to take it away. They argue that human beings should not meddle in these matters.

However, in some religions like Hinduism and Buddhism, alleviating sufferings of fellow human being is regarded as the “Dharma” and this allows some flexibility to discuss the issue of Euthanasia. Religions which strictly adhere to the ancient preaching however strongly go against the act. Christianity is against this issue but in countries where it is legal, majority of people follow this religion which again leaves the matter to the judicial system of the country.

Business aspects in Euthanasia

Euthanasia is not only confined to the religious, legal or moral battles. There is another side to this issue which is of economic costs, profits and losses. Since, the issue itself is not legal in many countries, the business side is overshadowed mainly due to the fact that it is prohibited in their country. Even in countries where it is legal, physicians and other health care providers, may pressure patients to request assisted suicide to save resources in the hospital. It can also lead to moral corruption among the physicians and the relatives of the patient to gain monetary benefits.

In developing countries like India where half of the population lives in extreme poverty, providing medical facilities to their loved ones is a distant dream. Even the hospitals lack facilities to provide sufficient care. The medical equipments to sustain terminally ill patients may not be available for a long time. In such cases, euthanasia might be encouraged not to alleviate the patient’s suffering but only for cost containment. Drugs for assisted suicide cost about $75 to $100, making them far less expensive than providing medical care which can influence decision if an employer or company is paying for the medical costs. For H.M.O.s (health-maintenance organizations) profits come not through providing services but from limiting costs, which means reducing services in some cases. This implies that they are in favor of euthanasia only because it would help bring down their costs. Insurance companies may lobby euthanasia for the same reason which means instead of regularly paying back for the high medical expenses, they would have to pay a onetime amount.

Different Perspectives:

As humans, we have a responsibility towards our fellow human beings. Love, Compassion and the ability to act and work towards righteousness makes us what we are. In deciding for another human being, be it our own blood or not, we should think whether the act is truly helping the one who is suffering. The decision to let go should be a collective one and should not be based on any singular identity. While the respect for life is well pointed out through so many aspects, there is a whole new dimension to living with dignity and self-respect. We wonder how many of us actually would like to live a life where we would have to let go of our independence completely and surrender to another human being even for a very basic and minor chore.

Also, there are other questions to ponder upon like who should be given the right to decide the end of life and what is the threshold of pain? People might have several reasons for putting their loved ones to eternal sleep but how do we rationalize their intentions? How can it be assured that there is no moral corruption in the intention? The threshold of pain varies from person to person. What might be unbearable for one could be a minor pain for another. Whose opinion should be considered while making such decisions?

We choose to list the arguments for and against euthanasia before we recommend any actions.

Arguments for euthanasia:

The most widely used argument for euthanasia is that it alleviates the suffering of a patient. Voluntary organizations like the “Right to Die” organizations across the globe support euthanasia for the vast majority of terminally ill patients. They insist that a patient in a persistent vegetative state, or one who has lost the will to live due to a terminal and painful disease, be allowed to die according to his own wishes, peacefully and with minimum pain in his last moments.

Euthanasia provides a way to end a low quality life mainly due to the vegetative state of the patient. How much the patient lives must also be compared to how well he or she is living i.e. focus on a qualitative life rather than a quantitative one.
In developing economies where poverty is wide and resources narrow, euthanasia helps free up medical funds & resources to help other patients who might survive if timely help can be provided through the use of ventilators and other medical equipments.
If the patient is in a condition where he/she can state his/her will to die, then euthanasia becomes a matter of choice. Euthanasia can support the right to die with dignity rather than live in utter distress and humiliation.
Arguments against euthanasia:
The argument against the act mainly comes from religious belief which says this act devalues human life and shows no respect for the sanctity of human life. In all religions, life is a gift from god and only he has the right to take it away.
In countries where it is legal, it might promote Euthanasia tourism where patients go or are taken to euthanize. In Switzerland, tourists are also allowed for euthanasia if it comes from the patient’s will to die.
It can become a means of health care cost containment especially if the cost bearer is another organization. The intention to euthanize a patient can never be judged correctly and moral corruption could be rampant if it is legalized.
For many it is plain hope that improved technology might help alleviate/cure disease and hence a patient should not be euthanized. Hope is subjective but for a mother it can be never ending and hence she may reject euthanasia if it is about her child.
Even if voluntary euthanasia is made legal, it can cause a slippery slope effect which means it could later be modified to involve other cases too.

Hence, there are several pros and cons to the issue of euthanasia. Any decision must be taken after careful review and consideration of the case on individual basis. Euthanasia should be never be generalized and made legal to suit the general mass. We think it should always be based on case-to case basis where individual is given the priority rather than anything else.

Our Recommendations and Justifications for the Aruna Shanbag case:

Aruna Shanbag is a victim of misfortunes. While we sympathize with her, we also are saddened by the quality of her life. While we are nobody to decide whether she should live or die, our group thinks that there is no dignity in the way she is living her life although there was no fault of hers. She was a young and independent woman when the carnal instincts of a ward boy made her a victim crippled for life. It has been 38 years since she has been bed ridden and in a permanent vegetative state. The chances of her coming back to life and leading a normal life are nil. Even if by some miracle she came back to life, what would be her sentiments when she realizes that her most precious and productive time of life were spent lying in a hospital bed? How furious would she feel to find out that she is now 60 years old and absolutely helpless? Would she be able to handle the magnitude of the incident? After 38 painful years in the bed, would her body support her now? How will she deal with the rage that will engulf her for the rest of her old age? Although, we are not in favor of Euthanasia in general cases, we think Aruna deserves to die with dignity and be liberated from the misery of prolonged unproductive and vegetative life. And with due respect to our respective religions, we believe, a rebirth is what Aruna needs to liberate herself from the horrendous present.

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