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The Right to a Dignified Death

When citizens are not guaranteed the right to health, can they be denied the right to die?

The debate over the right of individuals to a dignified death has opened up again following the recent appeal for euthanasia by a couple in Mumbai. The possibility that the Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2016 could be passed by Parliament has also provided the context for public discussion on the issue.

On 21 December 2017, Narayan Lavate (86) and his wife Iravati (79) wrote to the President of India seeking permission to end their lives through medical intervention. They declared that they have had a happy life, were in reasonably good health, and had no dependents or liabilities. It would be unfair, they argued, to force them to continue waiting to die of serious ailments, which would leave one of them bereaved and destined to a lonely death. Before this, in 1977, C A Thomas Master had moved the Kerala High Court seeking permission to end his life, arguing that he had fulfilled his life’s mission and had no desire to live any longer. In 2000, the court dismissed the petition. Meanwhile, Karibasamma from Karnataka, in her late 70s and fighting excruciating pain from an intervertebral disc prolapse, waits for a time when the law will allow her an honourable death. All three cases voice a common demand for the right to die with honour.

Euthanasia continues to be illegal in India, though the 2011 Supreme Court judgment in Aruna Ramchandra Shanbaug v Union of India & Ors allowed withdrawal of life support in the case of patients who are permanently in a vegetative state with no chance of recovery. It made a distinction between passive and active euthanasia, the former being withdrawal of treatment while the latter indicating the active process of causing death through medical interventions. The current bill aims to legislate the Supreme Court order into law.

The euthanasia debate in India is predominantly shaped by the question of who owns life and who has the right to decide when to end it. While this debate is likely to continue, a productive way to engage with the issue is to understand what the demand for euthanasia implies for the state of India’s public health. Appeals for euthanasia become particularly pressing given how difficult it is to die with honour in India. The government’s discomfort with “living wills”—a will whereby an individual can refuse treatment in the future—and active euthanasia is the possibility of their “misuse” by relatives who may have a vested interest in hastening the death of the elderly. This is ironical given how little the government does to ensure that illnesses are not “misused” by the private healthcare industry.

India is one of the worst countries to die in, especially for those suffering from terminal illnesses. In 2015, the Economist Intelligence Unit brought out a Quality of Death Index, which ranked India 67th out of the 80 countries it had surveyed. In December 2017, a joint report published by the World Health Organization and the World Bank revealed that 49 million Indians are pushed into poverty every year due to out-of-pocket expenditure on healthcare, accounting for half of the 100 million who meet such a fate worldwide. India’s Central Bureau of Health Intelligence data puts the figure even higher. This unconscionable situation is the direct outcome of the sorry state of our public health system. India’s spending on health is among the lowest in the world. The Economic Survey 2017–18 shows that the government spends only 1.4% of its gross domestic product (GDP) on health. The 2017 National Health Policy, which otherwise exudes piety in its abstractions, aims to increase government expenditure to 2.5% of GDP by 2025. By all accounts, this is too little too late.

The situation improves only marginally for the better-off sections. With over 90% of intensive care units in the private healthcare sector, it is largely this section that can access expensive treatments. But this does not improve end-of-life situations for them. Awareness and training in palliative care remain grossly inadequate. For those making profit in the private healthcare sector, there is no incentive to provide such treatment. Instead, treatment for the terminally ill continues to involve prolonging life with expensive, invasive, and painful treatment with very little concern for the patients themselves or their families.

When a government fails to ensure a life with dignity for the sick and the elderly, it loses all moral authority to deny people the right to a dignified death. But the laws of the land make a distinction between right to life, held to be a “natural right,” and right to death, seen as “unnatural.” What remains forgotten is that the state in India arrogates to itself the right to death on many occasions; capital punishment is upheld by law, and “encounter killings” are given legitimacy under sweeping legal provisions in both paramilitary and police operations. However, the demand for the right to death for individual citizens must simultaneously articulate the right to quality and affordable public healthcare, and protection from exploitation by private interests. The current debate on euthanasia should therefore be examined in the light of our crumbling public health system.

Updated On : 10th Feb, 2018


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