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LETTER TO EDITOR  
Year : 2012  |  Volume : 37  |  Issue : 1  |  Page : 60-61
 

Euthanasia: Does the onus rest with the physicians?


1 Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
2 School of Public Health, PGIMER, Chandigarh, India

Date of Submission06-May-2011
Date of Acceptance03-Dec-2011
Date of Web Publication19-Mar-2012

Correspondence Address:
Binod Kumar Patro
School of Public Health, PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0218.94030

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How to cite this article:
Patra S, Patro BK. Euthanasia: Does the onus rest with the physicians?. Indian J Community Med 2012;37:60-1

How to cite this URL:
Patra S, Patro BK. Euthanasia: Does the onus rest with the physicians?. Indian J Community Med [serial online] 2012 [cited 2020 Nov 25];37:60-1. Available from: https://www.ijcm.org.in/text.asp?2012/37/1/60/94030


Sir,

Honourable Supreme Court of India pronounced a landmark judgment of legalizing passive nonvoluntary euthanasia in March 2011. This judgment was in response to a mercy killing petition for Aruna Ramachandra Shanbaug who was lying in persistent vegetative state over three decades. [1]

Aruna was employed with KEM hospital, Mumbai, as a staff nurse. While on duty she was assaulted by a ward boy resulting in hypoxic injury to her brain. Since then she is in a state of impaired consciousness and almost complete loss of motor and sensory functioning. She is being provided with outstanding nursing care by the KEM hospital staff for the last 37 years.

The judgment turned down the request of mercy killing and upheld the wish of the KEM staff to provide Aruna with life-supporting care till she meets with her natural death. Alongside the judgment has set precedence of request for withdrawal of life-supporting treatment in certain conditions. The application of such a request can be made by caregivers or treating physician to the high court. The court would then appoint a board of doctors consisting of a physician, a neurologist and a psychiatrist for clinical assessment of the case. Request by a person who is close to the patient and is providing care would be given utmost importance. A patient's wish if by any way can be known is to be considered supreme in reaching a decision.

Euthanasia is derived from two Greek words, 'eu' meaning good and 'thanatos' meaning death. [2] By definition euthanasia is purposely ending life of someone at his explicit request. In countries where euthanasia is legal, certain conditions are mandatory to be fulfilled for the decision of euthanasia. Foremost among these is the presence of a voluntary, well-considered and long-standing wish to end life. The person should be in terminal stage with very short life expectancy for which no curative treatment is available. The person should have unbearable suffering and the decision of euthanasia should be made after consultation from a second physician. [3]

Depending on the mental competence of the individual concerned, euthanasia may be voluntary, involuntary or nonvoluntary. Voluntary euthanasia is with patient's consent and involuntary does not involve patient's consent. Nonvoluntary euthanasia is performed when the patient does not have capacity to express a wish. [4]

Further, euthanasia is classified into two categories according to the way of administration. Active euthanasia results from acts of commission, like administration of medications that hasten the process of dying such as barbiturates, opioids, etc. Passive euthanasia involves acts of omission which often involves withdrawing of life-supporting measures like artificial feeding and artificial respiration. [5]

A wish to end life in the terminal stage of illness is increased in the presence of physical or psychological suffering, feeling of being a source of burden for others, higher level of demoralization, less confidence in support systems, less satisfaction with experiences and religious beliefs. [6]

Traditionally, doctors are considered saviors and preservers of life. Hippocratic oath prohibits administration of lethal medicines to patients even on request as also any such suggestion to be made by doctors. Physicians who provide care to patients at the end of life often face the moral dilemma of ending life vs. perpetuating suffering in the face of incurable medical conditions. Modern medical advances have prolonged life even in terminal stages by making provisions for life-supporting interventions. Clinical judgment about recovery and survival cannot be made definitively in all cases. Adding to the complexity of the problem is the physician's own moral and religious beliefs which guide the attitude of physicians toward ending life. In a study of physician's attitude towards euthanasia, it was found that only 26.6% of doctors from India agreed for euthanasia in patients with motor neuron Disease and only 25% doctors agreed for euthanasia for patients with cancer. [7]

Euthanasia is not getting legal sanctions in many countries owing to the fear of slippery slope effect which might lead to death of patients against their wish. [8] Active voluntary euthanasia is legal in countries like Netherlands and Belgium where autonomy and self-determination are given supreme importance. Active nonvoluntary euthanasia is illegal all over the world, whereas passive nonvoluntary euthanasia is legal in countries like India, Albania, and parts of United States and United Kingdom.

As per the current legal provision, physicians are entrusted with the job of making a clinical assessment of patients for whom request for euthanasia has been made. In addition to making an assessment of chances of recovery and survival, assessment of suffering of the affected patient should be given equal importance. A provision for acceptance of "living will" in a situation when the person is not in a condition to communicate his wish would guide the clinician's in reaching a conclusion. Quality of life should be given more importance than sanctity of life while taking the ultimate decision. Economic, social, moral and legal aspects of a health condition are more important than the clinical state in arriving at a decision.

 
   References Top

1.Available from: http://judis.nic.in/supremecourt/helddis3.aspx. [Last accessed on 2011 Mar 20].  Back to cited text no. 1
    
2.Chao DV, Chan NY, Chan WY. Euthanasia revisited. Fam Pract 2002;19:128-34.  Back to cited text no. 2
    
3.Onwuteaka-Philipsen BD, van der Heide A, Muller MT, Rurup M, Rietjens JA, Georges JJ, et al. Dutch experience of monitoring euthanasia. BMJ 2005;331:691-3  Back to cited text no. 3
    
4.Lavery JV, Dickens BM, Boyle JM, Singer PA. Bioethics for clinicians:11. Euthanasia and assisted suicide. CMAJ 1997;156:1405-8.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Tillyard AR. Ethics review: 'Living wills' and intensive care - an overview of the American experience. Crit Care 2007;11:219.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Kelly B, Burnett P, Pelusi D, Badger S, Varghese F, Robertson M. Terminally ill cancer patients' wish to hasten death. Palliat Med 2002;16:339-45  Back to cited text no. 6
    
7.Abbas SQ, Abbas Z, Macaden S. Attitudes towards euthanasia and physician assisted suicide among Pakistani and Indian doctors: A survey. Indian J Palliat Care 2008,14:71-4.  Back to cited text no. 7
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8.Norwood F, Kimsma G, Battin MP. Vulnerability and the 'slippery slope' at the end-of-life: a qualitative study of euthanasia, general practice and home death in The Netherlands. Fam Pract 2009;26:472-80.  Back to cited text no. 8
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