Good Life, Good Death

The measures that we put in place to avoid violations of the spirit of euthanasia will determine our standing as a humane society.

By Author  |  Pramod K Nayar  |  Published: 18th Mar 2018  12:43 am

The Supreme Court’s recent verdict on euthanasia holds the right to life and dignity as including the ‘right to refuse medical treatment and, concomitantly, the right to die with dignity.’ The judgement stated that the fundamental right to a ‘meaningful existence’ must be taken to mean a human being’s right to choose to die without suffering. It also proposed the creation of a ‘living will’ (first drafted by the Euthanasia Educational Fund in the early 1970s in the USA), so that an individual could state in advance that medical treatment should be stopped in case of irreversible brain death.

Incidentally, the judgment comes close to the anniversary date of one of the most famous euthanasia cases in world history – Terri Schiavo, whose life-sustaining apparatus was disconnected following a protracted legal battle (launched in 1998) and civil society debate, died on 31 March 2005. Terri had spent the years 1990-2005 in coma.

Conflicting Views

‘Euthanasia’, derived from the Greek, means ‘good death’. In medical practice, it could be of various kinds: active, passive, voluntary, involuntary, assisted suicide and patient-assisted suicide.

The debate around euthanasia, like that around abortion, polarises all cultures. Medical, theological, legal scholars have endlessly debated the term in conjunction with other key concepts, all of which are locally and culturally determined: ‘quality of life’, ‘voluntary’, ‘vegetative state’, ‘good life, good death’, among others. Activists from fields as diverse as disability studies and medical ethics have been a part of the debate.

Organisations such as the American Humanist Association, as far back as 1973, argued that those who oppose euthanasia on the premise that ‘death is the most terrible thing that can happen’ are not concerned with the quality of life itself. Whether the choice of death is integral to the idea of ‘life with dignity’, as the SC judgement implies, is a moot one. Culturally, this linkage (choice of death and life with dignity) opens up the debate in other realms, a debate structured as questions rather than propositions.

Does dependence upon other humans, or technology, automatically mean the loss of dignity? It is now established that all humans, by virtue of being mortal and injurable, are vulnerable (the very word vulnerable is derived from ‘vulnus’, meaning injury), but only the sick, the infants and the old are helpless (as argued by philosopher Adriana Cavarero).

This means, the debate around individual dignity is not a debate about vulnerability but around conditions that ‘reduce’ a person to helplessness, and dependency. But can we consider the state of helplessness and dependency, ask Bogdan and Taylor, as integral to all human life, as a stage arrived at some point in every individual’s life? So, is the notion of ‘dependence’ itself a social construction that places greater value on independence and individual autonomy and deems all dependence an undignified and horrific state of being? Or can we think of dependence as one more aspect of human life?

Cultural Factors

This is arguably a debate popularised best, perhaps, by the Oscar-winning film, Million Dollar Baby. Maggie (Hillary Swank), confined to bed as a quadriplegic, the result of a spinal cord injury incurred in the boxing ring, says to Frankie (Clint Eastwood): ‘I can’t be like this, Frankie. Not after what I have done …People chanted my name …I was in magazines …Don’t let ‘em keep taking it away from me. Don’t let me lie here till I can’t hear those people chantin’ no more’.

The film, as critics have noted, effectively aligns disability with the loss of dignity and a diminished quality of life, and even death. It must be noted that the film does not portray Maggie as being in pain. Does disability, such as Maggie’s, necessarily mean she is near death? This implies that having a body dependent on technology or care is a body without inherent dignity.

But, as disability scholars argue, bodily impairment becomes disability when it meets social conditions and structures (staircases, doors, transport systems, and such) that are designed with one kind of human body alone in mind, and rejects different kinds of bodies.

The debate here shifts into what any culture might value as life itself: what kind of life is worth living/sustaining? And which lives are less-than valuable in terms of investment in care and help? This set of questions draws attention to cultural factors that contribute to the stigmatisation of certain conditions (including Alzheimer’s) that then result in ‘downgrading’ the patients to the status of ‘nonpersons’.

Alleviating Pain

One argument that emerges in the debates around euthanasia is: with progress in medicine, longevity is assured. But with longevity come the debilitating risks of age, such as strokes or dementia. This means, the extension of life does not always ensure a reasonably satisfying quality of life in this same extended version. Being in a state of suffering (which has a place in certain religious doctrines as purifying, redeeming) and chronic pain is deemed, in these same debates, as equivalent to the loss of dignity.

But the existence of a suffering body does not point only to the suffering body. It points, also, to medical technology and developments, structural conditions of, say, homes and hospitals. Can we also consider the continued existence of a person in pain a socially generated state of being where enough measures of care and pain-control are unavailable?

This means, shifting the focus from the suffering body to the conditions in which life can only be lived through the endurance of pain. It points to social structures and processes that do not contribute to the alleviation of pain (the creation of pain-management therapy/medicine will contribute in large measures to altering this situation).

Following from this is the larger socio-cultural concern: if we advocate euthanasia as a necessary choice, would it affect the way end-of-life care or care for the terminally ill is funded, researched and advocated?

Intrinsic Worth

Euthanasia is also justified, in many quarters, by pointing to the costs, economic, emotional and social, of sustaining a life irreversibly ‘damaged’. Such an evaluation places an enormous burden on the sentient terminally ill, disabled, irreparably injured or those of advanced age, to choose euthanasia because this choice is expected of them as responsible citizens (Cohn and Lynn) and members of a society.

Thus, a person in any of these states of being will be under emotional and social pressure to seek a termination of her/his life, simply because this becomes, like etiquette, a moral obligation to society. Whether this could be deemed active or passive euthanasia then remains to be seen.

The debate also invites us to ponder the question whether human life – biological life – has any intrinsic worth. Does biological life, restrained for various reasons, from contributing economically, emotionally, physically and intellectually to the social order of humanity, cease to have worth? That is, would a person’s worth be measured in these terms alone, and not simply for being a biological being?

The debate calls for attention to how any culture or society values ‘life itself’. Would a life unable to, for various reasons, contribute, be then open to destruction? If we assume that all human life is intrinsically valuable simply by virtue of being a biological life, then the question of its contribution means that we have an instrumental view of the human: s/he has worth only when her body and mind contribute whatever the social order deems valuable.

Would this then mean that certain types of contributions made – say emotional or forms of labour – by ‘different’, non-normative, disabled, variously challenged, bodies would be rejected as valueless? Historically speaking, this has resulted in large-scale marginalisation of the labour, and by extension labouring bodies, of certain segments of society, engendering race, ethnicity and caste-based discrimination.

Completed Life

Individual autonomy and agency, valued highly today, is at the core of the euthanasia debate (although the very meaning of terms like human autonomy, choice and control have seen massive, if inconclusive, debates). Like the Lavates from Mumbai who have sought euthanasia for themselves, individuals seek to assert their choices even (or is it ‘especially’?) over the matter of their death.

It is when they come to believe that their productive life is over – they have led ‘complete lives’ (and ‘completed life’ is the government of Netherlands’ key term in its euthanasia policy) and they are deteriorating, that people like the Lavates – who have stated that they do not wish to experience the suffering of advanced age – seek euthanasia.

However, this awareness of the so-called uselessness of one’s life, and the urge to assert agency one final time, is itself socially inculcated, through cultural training. It is what the society and culture believes and promotes as a ‘fulfilling life’ that the individual imbibes as a cultural value.

Does a society’s ‘culture of life’, a phrase made famous by American President George Bush in 2005, include a uniform quality of life for all kinds of individuals, including the terminally ill, the disabled, those in chronic pain and those in Persistent Vegetative States? This is a key question for the proponents and opponents of euthanasia.

Who Decides

There is also another matter to be considered. Much of the euthanasia requirements demand an extremely careful evaluation and procedural integrity in the medical system. In a country like India, where medical certificates and such are not always reliable, issuance of statements about the vegetative state of any individual can be easily achieved too.

Scholars note that the family has an important role to play in the debate, since the family may be called upon to take the decision, or approach medical-legal authorities to make the decision, about active or passive euthanasia.

However, families are not always the supporting environment for certain kinds of life – numerous reports in the public domain exist about how family members are classified as ‘mad’, with the help of medical experts, and put away for good. That is, it is not the individual concerned alone who is involved in the decision-making about life support but the medical, legal and family members too. Do family members also have the right to choose end-of-life care as much as the individuals?

If the last group so chooses, it might result in influencing decisions favourable to them rather than to the individual whose life then is terminated. Given such a context where people can be consigned to the domain of the ‘vegetative’ without too much effort, the precautionary measures a society puts in place to avoid such terrible violations of the spirit of euthanasia will determine the foundations of that society.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Delve Deeper

(The author is Professor, Department of English, University of Hyderabad)