Shaji George Kochuthara CMI

The Basic moral position on euthanasia is that it is ‘playing God’

A Constitutional Bench of the Supreme Court of India, headed by the Chief Justice, ruled that the fundamental right to life and dignity includes the right to refuse treatment and die with dignity. This ruling has raised many legal as well as religious and ethical questions. This is not the first time that a ruling on “right to die” is given by an Indian court. The decisions of the courts also has been varied, namely, in some cases, the ruling was in favour of the right to die, whereas in other cases it was against. For example [mentioning only a few cases], in the ‘Smt. Gian Kaur vs. the State of Punjab’ case (1996), the court ruled against the right to die, and made it clear that right to life does not include right to die. On 7 March 2011, as part of the verdict in a case involving Aruna Shanbaug, the Supreme Court of India legalized passive euthanasia. However, on 25 February 2014, a three-judge bench of the Supreme Court termed this judgement as ‘inconsistent in itself’ and referred the matter to its five member Constitution bench. On 9 March 2018, the Constitution bench ruled in favour of passive euthanasia. Even without making a detailed analysis of various cases and rulings in this regard, it must be clear that the courts have been taking varied positions whether the right to life includes the right to die. Although a more definite ruling has been given by the Constitutional Bench now, we cannot be sure that the issue has been settled definitely even in the legal circles.

Apart from the legal issues, moral issues are still complex. We cannot identify law and morality, though they are related. Just because something has been legally approved, we cannot claim that it is morally acceptable. We believe that life is God’s gift, and hence only God has ultimate authority over it. Just as we do not have the choice or right to be born, we also do not have the right to decide to die. It is the prerogative of God who has given us life. Otherwise, it is ‘playing God,’ encroaching God’s prerogative, an on-going temptation that humans have.Although we cannot claim that there is consensus among moralists regarding euthanasia, the basic moral position on euthanasia is based on this argument that it is ‘playing God,’ that humans do not have an ultimate right over life.

Besides this basic moral position, there are other issues that euthanasia raises. In its on 9 March 2018 ruling, the Constitutional Bench has legalized passive euthanasia and has sanctioned ‘living will.’ That is, in the case of terminally ill, life-supporting means can be withdrawn after due consideration, keeping the prescribed procedures. This may include withdrawal of food and water. (The Court has not permitted voluntary or non-voluntary active euthanasia, that is, the use of medication to intentionally end the patient’s life). Sanctioning living will gives the patient/person the possibility of giving a statement in advance expressing one’s desire regarding future medical treatment in circumstances in which one is no longer able to express informed consent. Although the court ruling is acclaimed as upholding the right to die, there are concerns that it will also lead to a right to kill. That is, there are possibilities that the provision given for passive euthanasia is misused by the treating doctor/s or immediate relatives of the patient.

On the one hand, the guidelines prescribed by the Supreme Court places huge responsibility and burden on the treating doctor. In case there is a living will, the doctor has to ascertain the genuineness of the will from the Judicial magistrate, in whose custody it is kept. Following this, the doctor has to evaluate the medical condition of the patient, possible treatments available, alternative treatments, consequences, and then discuss with the immediate relatives of the patient, make sure that they have understood the situation, etc. After this, a medical board consisting of experts has to be constituted. There are long and very complex procedures to be undertaken, which involves also the Judicial magistrate, and in certain cases the District collector and even the high court. Many doctors may not consider such complicated procedures practical, and this may result in the evasion of the procedures, or fulfilling them just for the sake of formality. In case there is no living will, the case is left to close relatives, upon whose request the procedures are initiated. Although in many cases the relatives may be well-motivated, in other cases it is possible that they are motivated by economic gains after the death of the patient, lack of willingness to take care of the patient, etc. There is also the possibility that such people try to influence the treating doctor. Unethical practices in many private hospitals and negligence and corruption in the government hospitals will only facilitate such misuses.

The distinction between ‘ordinary’ and ‘extraordinary’ means used to sustain a patient is a difficult one. For example, the Church allows the discontinuation of ‘extraordinary’ or ‘disproportionate’ means used to sustain a patient in life. For the Church, in such cases it is not actually ‘passive euthanasia,’ but it is only the refusal of ‘over-zealous’ treatment; in such cases there is no will to cause death, but the natural death is accepted (Catechism of the Catholic Church, no. 2278). The availability of the medical technology in the given circumstances, the economic and health condition of the patient, etc. are some of the criteria in discerning whether the means used is ‘ordinary’ or ‘extraordinary.’ Besides, what was considered extraordinary a few years back might be considered ordinary today; what is considered extraordinary in a rural setting may be considered ordinary in an urban setting. Leaving the discretion to relatives and doctors in such cases may lead to arbitrary decisions motivated by selfish gains.

In the Indian context marked by economic inequality and poverty there are other pertinent issues. The permission given for passive euthanasia may lead to further discriminations in medical care, and denial of even ‘ordinary’ or basic means of life supporting equipment and care to the poor. Thus, it may be used to easily eliminate the poor, the aged and so on. That is, the concern that the right to die with dignity may be used as a ‘right to kill’ is not an exaggerated or unrealistic concern, but a real concern.

In the Court judgment the ‘dignity in death’ is linked to choosing to die without suffering. This poses further questions. In the religious approaches, especially according to the Christian vision, suffering has a particular importance. Is suffering bad in itself? Is suffering against human dignity? On the one hand, suffering cannot be said to be an absolute value in itself. There is no need to seek suffering or inflict it one oneself or others. Moreover, we are also called to alleviate the suffering of others. But, suffering is a reality in life; it is an integral and unavoidable part of life. Human beings attain their dignity not avoiding suffering, but accepting it when it is necessary. The cross of Jesus is the best example for this. Suffering on the cross leads Him to the glory of the resurrection. In short, suffering can lead us to greater dignity and meaningful existence.

Not only in the religious vision, in the world of literature and philosophy we find the importance of suffering and how it brings out dignity and greatness of human beings. That is why the Greek tragedies, the Shakespearean tragedies and modern tragedies like the novels of Thomas Hardy continue to inspire us. We do not consider the heroes of those tragedies who had to suffer as having lost their dignity. Instead, it is suffering that makes more evident their dignity and greatness. Hence, attempts to define human dignity in terms of avoidance of suffering do not seem to come from a sound philosophy of life. I am reminded of Pope St John Paul II who inspired a number of people through the way he accepted his suffering. If suffering is understood as negative in itself, as something against human dignity, it may gradually lead to a value system that prefers death to any kind of physical or psychological suffering. That will be unrealistic, destroying the dignity of human existence itself.

In the moments of extreme pain a person may say that she/he wants to die. That may not be coming out of a desire to die. Instead, in most cases it may be an expression of a greater need of love, support and care. It is natural that in moments of physical or psychological pain we think that death would have been much better. But, we know that it is also an attempt to overcome that suffering finding a meaning for that suffering. Only through that process we realize the value of our life, attaining greater dignity. In short, considering suffering as opposed to dignity may not seem to be coming from a sound vision of life. Until the last breath, there is meaning for life. It is through accepting the suffering with courage and determination that more glorified dimensions of the personality are revealed. Besides, what the suffering person needs is the loving care and support of the dear and near ones. When such care is given, the suffering person will find the strength to face the suffering with dignity. Thus, it will also make more evident the greatness of human solidarity even in the midst of suffering.