Dr Saheb Sahu, MD, MPH
Assisted Dying
Assisted dying, also known as physician- assisted suicide or medical aid in dying, is suicide undertaken with the aid of another person. The term usually refers to physician-assisted suicide, which is suicide that is assisted by a physician or other healthcare provider.
Euthanasia
The word euthanasia comes from Greek euthanatos, (eu-easy, thanatos-death) which means easy death or good death. It is the intentional ending of life of a person suffering from an incurable or painful disease at his or her request.
The evolution of assisted dying
Many people object to assist dying on religious grounds: some faiths (Judaism, Christianity and Islam) deem suicide a sin. Others worry that safeguards will prove insufficient, or legalization is a slippery slope. Critics have long predicted that families exhausted by the demands of caring for the sick, elderly relatives will place undue pressure on them to end their lives.
Yet such horrors do not seem to have come to pass. In much of the West public opinion has long favored assisted dying. In 2019, 71% of Spaniards (a deeply Catholic country) supported voluntary euthanasia. Change has been rapid. Assisted dying is now legal or decriminalized in at least a dozen of countries. But it is still rare.Most cases are cancer related, and the number of death is tiny. But they are nonetheless changing how people think about dying. In some countries assisted dying has been extended to those with mental disorders and dementia, even to old people who feel tired of life. A clandestine network of interested people who share methods to kill themselves has sprung up on the internet.
Thirty years ago assisted dying was illegal everywhere except Switzerland. But in 1997 the American state of Oregon approved the Death with Dignity Act, initiating a spate of liberalization. In Oregon two doctors must agree that a patient is of sound mind and has less than six months to live before he or she can receive the lethal drugs. These drugs must be administered by the patients themselves (a physician prescribes it). Since 1997, around 2,000 people have taken advantage of the law in the state of Oregon (250 in 2020), with no wrongful deaths reported. Versions of the law are now on the books of ten American States and the District of Columbia.
Oregon’s laws are being copied internationally, with some modifications. New Zealand’s Oregon-stylelaw came into effect on Nov, 2021. In Australia, the state of Victoria passed similar laws in 2017. Worldwide, euthanasia is legal in Belgium, Luxemburg, Canada, New Zealand, Spain, the Netherlands and Colombia and ten states in United States. In Britain similar laws passed the House of Commons and waiting to be passed in the House of Lords. Three quarters of Britons support a right to die.
Canada offers a better model, because it provides more lee-way for individuals to make their own choices. Anyone whose suffering is unbearable can choose an assisted death. They do not have to be terminally ill. What constitutes “unbearable” suffering is for the patients themselves to decide, so long as they are of sound mind. There is a cooling-off period of ten days, in case they have second thoughts. In many cases, simply having the option of an assisted death gives people a sense of comfort and control. In Oregon a third of those people who receive the prescribed lethal drugs ultimately choose not to take it.
Assisted Suicide Methods
In general, once the requesting patient meets the criteria of the state law, a willing physician prescribes the lethal dose of the appropriate drug to assist in dying. The patient buys the drugs.An oral dose of antiemetic drug (to prevent from vomiting) is taken first,followed approximately half an hour later by a lethal doseof the sedative drug dissolved in a glass of water. The overdose of the drug depresses the central nervous system, causing the patient to become drowsy and fall asleep within 3-5 minutes of drinking it. From drowsiness the patient progresses to coma, followed by respiratory arrest and death which occurs within 30-40 minutes of ingesting the drug. The process is painless.
The Indian Context
Prayopavesa (Sanskrit: प्रायोपवेशनम्, IAST prāyopaveśanam, literally resolving to die through fasting) is a practice in Hinduism that denotes the suicide by fasting of a person who has no desire or ambition left, and no responsibilities remaining in life.Sallekhana also known as samadhi-marana or sanysana-marana is a supplementary vow in the ethical code of conduct of Jainism. It is the religious practice of voluntarily fasting to death by gradually reducing the intake of food and liquids. However, British legal codes had made all forms of suicide illegal in India including the horrible practice of sati.
Since March 2018, passive euthanasia (intentionally letting apatient die by withholding artificial life support such as a respirator or feeding tube) has been legal in India under strict guidelines. Patient must consent through a living will (a legal document expressing the wishes), must be terminally ill or in a vegetative state. The same judgement-law also asked for the scrapping of 309, the code which penalizes those who survive suicide –attempts.
Conclusion
No rules in this area of assisted dying are perfect. All should be subject to revision in the light of new evidence about how they work in practice, or take account medical advances. But the overall principle – that individuals are entitled to choose how they end their lives- is a sound one. According to the Economist magazine (Nov, 2021), “The evidence from countries that allow assisted dying is real and substantial. It relieves suffering, restores a measure of dignity to people at the end of their lives”.
Longevity depends on our genes and our lifestyle. We have no control over what good or bad genes we inherit but we have some control over how we live our lives. Scientific studies are quite conclusive that age-related morbidity can be postponed and longevity can be increased if we live a healthier life style. According to National Institute of Aging, USA-“Finding a “fountain of youth” is a captivating story. The truth is that, to date, no ant-aging remedy has been found.” Hence, do what have been proven to work; do not smoke or drink, be physically active, eat a healthy diet (whole grains, lots of fruits and vegetables, fish and lean meat, low fat dairy products and few eggs a week) and maintain a normal body weight and have some friends.
Death is an event we cannot avoid. Why don’t we die the way we say we want to die? Advances in medicine have eased the line between saving a life and prolonging a dying. Dying is painful, messy, expensive and imperfect. Physician-assisted dying is not an option available to most people. We have no control over when we will die. However, we have some control over where and how we will die. To achieve the twin goals, it will take some advance planning on our parts. When we are old or suffering from a terminal illness, we should discuss with our loved ones about where we want to die, at home or in a hospital. Do we want unnecessary and costly treatments just to live few more months? The decision is ours. But we must let our family members and doctors know our wishes. Putting it in writing in a living will (also known as advance healthcare directive) is even better. As many wise people have said before: “There is no need to rage against the dying of the light. The only way to have a good death is to lead a good life”. Lead a life full of curiosity, compassion, and generosity.
But if you want to have some control over how and where you will die, Prayopavesa or Sallekhana, (a Jain vow) the practice of voluntarily fasting to death by gradually reducing the intake of food and liquidsare not bad options. The most frequently reported symptoms in the early days include thirst or dry mouth and occasional hunger. Wiping the mouth with a wet cloth or glycerin swab on regular basis can help ease symptoms of dry mouth. A person can live quite few days without eating depending on his /her nutritional status. But he /she does not drink any liquid, he or /she will die much sooner from dehydration as it happens in severe diarrhea like-cholera. Most peopleslip into come in 2 to 4 days (depending upon their prior nutritional status) and die in 10-14 days. The process is shorter ifthey do not drink any liquid. But the death is peaceful and painless.
Source
The Economist. Nov, 13-20, 2021
Wikipedia .org