Life is full of questions and the curious one will want answers. But, there are questions that can’t be answered. Like, why we die? When will we die? And, How will we die? Any answer to these questions is incomplete and it becomes questionable.  A paradox of sorts.

If at all there is one supreme desire in man, that is about avoiding death. A wonderful desire but beyond realisation. There are no chiranjivis, immortals, among men. In Mahabharata, the Hindu epic, there is an episode known as Yaksha’s questions or ‘Yudhishtira and the Yaksha’ where Yaksha asks Yudhishtira (Dharmaraya) many questions (125 approx) and the answers Yudhishtira gives are enlightening and revealing. Two questions touch upon the distressed among men and death.

Yaksha asked: What do Kshatriyas have that ignoble men have?

Yudhishtira replied: Abandoning the distressed makes them resemble the ignoble.

Yaksha asked: What is  wonderful?

Yudhishtira replied: Everyday men die, yet everyone thinks he will live for ever. What is more wonderful than this?

Two lessons to learn here. Do not abandon the distressed. Do not think you will live for ever.

Therefore, Death is certain, there is no doubt. But its manner, place and time are absolutely uncertain. Hence, Lord Buddha wanted us to order our lives accordingly. Some deaths, following incurable and painful diseases for a prolonged period, are traumatic. Our Supreme Court (SC) in its landmark judgement in January 2023 (two years have passed since) had simply restated Buddha’s thoughts on Death. The SC’s ruling permitted the ‘Right to Die With Dignity’ for terminally ill patients. Those suffering excruciating pain, with no hope of recovery or in a persistent vegetative state who no longer benefit nor get cured from life-sustaining treatment must be enabled to die with dignity.

Our Health Minister Dinesh Gundurao has rationally explained the purport of the Supreme Court’s judgement in the following words. He said the implementation of the SC’s decision would be beneficial to both the doctors and the family of the patients. [Though not to the hospital!] This would take away the guilt feeling of the patient’s family members, which would haunt them, when the Life-Sustaining Treatment (LST) is either withheld or withdrawn as per law. Now, because of the SC directive there will be a dignified closure to such patients’ treatment enabling them to die in dignity.

The SC recognised that the Right to Life under Article 21 of the Constitution also encompasses the Right to Die With Dignity.

Happily, Karnataka Government has decided to implement the SC’s directive in this regard though late by over two years. To some governments wisdom dawns rather late. Let it be. However, the good news is that while the State Government has decided to implement the LST directive of the SC, it has also decided to introduce an Advance Medical Directive (AMD) known as a Living Will which enables patients to record their wishes about their future medical treatment to end the misery, expense and die peacefully.

I had written about Living Will in this column on April 2, 2018, when the SC allowed Passive Euthanasia in case of terminal illness. Let me reproduce the article titled “Living Will: Die with Dignity.”

Man must not only live with dignity but also die with dignity. That may not be the law of nature, nor the intention of God. God is supposed to be kind and compassionate both to his believers and non-believers alike but what do we see?

That was one of the reasons we had Mother Teresa in Kolkata, kind and compassionate, who assured a death with dignity to the destitute, sick and dying. As for helping man to live in dignity, that help should either come from the rulers or from the conscious effort of the individual himself. Man has a choice here. He may not care for a dignified life. That is his choice. But, NOT so with death. Here he has no choice, except if he commits suicide.

Imagine, young or old, confined to bed for years in a vegetative state under the care of the dear and the loving ones. It is a miserable life both to the sick and to the dear one looking after that person. To use the expression of Jean-Paul Sartre, the French philosopher of Existentialism, in such a situation both the sick and the dear one become both an oppressor and an oppressed.

Let me explain. The sick is an oppressor of his dear one attending on him 24×7. Caring for the sick months or years together is no ordinary task. As for the dear one, his or her prolonged years of care for the terminally sick is an act of oppression of the sick. Oppression is in the very act of caring!

It is possible the dear one may only feign love for this sick person while secretly praying for his or her early end!

However, we cannot hold the sick guilty because illness comes to an individual unannounced, stealthily, imperceptibly.

Thus, in real-life situation, we are pushed into the world of paradox facing a ‘to be or not to be’ question. A moral dilemma. The criminal law (IPC, CrPC etc.) does not help either the sick or the attendants. After all, serving the sick is service to God. The flip side of this ideal of service is that not serving the sick is a sin. This is the Christian religious injunction and the British rulers respected that belief so much so they incorporated it in the law. This was the catch for all those who are living in sick-bed with artificial life support. In some countries of Europe, however, in this age of reason, euthanasia was allowed legally — causing gentle and easy death in case of incurable and                         painful disease.

I am so happy, India’s legal system is gradually moving towards the age of reason from the age of moribund customs and superstitious beliefs. The Supreme Court of India has finally put its stamp on the long-pending demand by the wise amongst Indians for permitting passive euthanasia. I was happy to read the headlines in the newspapers of this piece of news — Supreme Court approves passive euthanasia, upholds right to die with dignity.

The Supreme Court, in its wisdom, has also told us how to go about exercising this choice of euthanasia. It has permitted the sick, while fully aware of the nature of development of their sickness in the future, to create what it calls a Living Will that will allow an individual to decide against artificial support. The historic and most humane decision came on Friday, March 9, 2018 from the Supreme Court.

The significant interpretation of the Article 21 of the Indian Constitution made all the difference, when the Supreme Court said, “The right to life and liberty, enshrined under Article 21 also includes the right to die peacefully and with dignity.”

The judgement has special significance because it was delivered by a five-Judge Constitutional Bench headed by the Chief Justice of India (CJI) Justice Dipak Misra.

This Living Will, also known as Advance Medical Directive, upholds a person’s right to choose passive euthanasia in the eventuality of a terminal illness with no hope of recovery, an irreversible or permanent vegetative state. Removal of the life-support system does the job. The Court has, however, in its wisdom not allowed what is known as active euthanasia which means killing a person (patient) through the use of lethal injection.

Ironically, the opposition to euthanasia came from the government.

Reason: The patients may not be aware of medical advancements that could cure them. A frivolous argument. If there is such a cure available, doctors would certainly not proceed with euthanasia.             How can they?

There were many gems of reasoning in the judgement. Is refusing to take treatment (or food) and allowing disease to take its natural course not suicide? And punishable under IPC? Doctors put forward their own argument. Euthanasia is against their Hippocratic Oath. Well, the Court said: “When the sanctity of life is destroyed should we not allow them to cross the door and meet death with dignity?”

A Living Will determines about your medical care during your lifetime when you are able to speak or write for yourself. This Living Will is used only in situation where you are incapacitated, mentally incompetent or unable to communicate. The Living Will might designate an agent to make decisions, dictate what kind of life-support treatment the patient needs, discuss pain-management, personal grooming and bathing instructions, the religious and spiritual concerns of the patient and may even mention the funeral or memorial plans!

Therefore, all things considered, I guess it is wise to execute a Living Will. Ask your doctor or your lawyer.

My friend Raghavan, a city pharmacist says, “A Living Will absolves the succeeding generation of GUILT as it is they who will be under tremendous financial drain and emotional strain too.” Being a pharmacist he should know.

e-mail: voice@starofmysore.com