The Ethics of Ending Life: Euthanasia and Assisted Suicide.

[Nacchinarkiniyan]

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Are Patients Who Seek PAS or EU Incompetent?



Depression is a significant component of many patients’ perspectives at end-
of-life, and it does influence their wish to die in 8.5 to 17 percent of cases.

But depression and other mental illness per se are not synonymous with
incompetence, and their role in end-of-life decisions remains unclear.

Investigations do not consistently show that depression affects patients’
end-of-life treatment decisions.


And depression does not appear to be significantly different between patients who request EU and those who do not.

Studies do suggest that the diagnosis of clinical depression may be missed
by Oregon physicians assisting suicides, but they do not indicate whether
depression affected patient decision-making in a significant way.


-- From the research paper given in the O.P


It is much more difficult for the elderly in India because the sons, daughters and every other relation and friend thinks he/she knows better because they are young. They start sermonizing and declare that the everything is because of depression.


I am so much used to the condecending attitude of the not so elderly in this forum. That represents the general attitude in India.


Living with Dignity is a problem in India.


We will continue the discussions on Euthanasia.

 

[sangom]

< snipped >

"My sincere feeling is that nobody has the right to end his/her own life. Hence I am clearly against PAS and euthanasia."
​

I thought by the phrase "nobody has the right" you meant not only you wouldn't do it, but others must not be permitted to do so as well. If you didn't mean it that way then we have no disagreement.

My dear Nara,

Yes, you are right; if I am the law-giver, then I will oppose (not allow) euthanasia, because I believe that just as this Life was given to each one of us without our having any conscious choice or knowledge beforehand, the end to this Life also must be left to the wisdom of Nature, and not to our limited wisdom. But even as I wrote that line, I knew that I have no authority over the affairs of other people to decide about their lives.

I don't think Jain culture and Tamil culture were mutually exclusive. Before the Bhakti era Jainism was a dominant religion in Tamil Nadu and the Tamil culture and Jain culture had a large intersection. It was not only practiced by (Jain) saints, but apparently by warriors as well when they felt insulted in defeat. I remember reading a story in my elementary school about a king opting to rather die than accept water when it was offered to him with the left hand by the guard.

In any case, Tamil or Jain or both, it doesn't matter, self administered euthanasia was practiced in Tamil Nadu, that much is clear.

Noted, Thanks please.

 

[sangom]

< snipped >

The take home message is 'If anyone wants to die...please dont get anyone else involved in that act"

I personally feel that this idea about euthanasia, etc., has arisen because of the modern thinking that "individual liberty" must be "without any frontiers, whatsoever". I prefer a more oriental (Indian) structure of the society in which the individual is, first and foremost, an integral constituent of the larger group - family, extended family, village, society, language group, etc. and in which even very old people will continue to find acceptance, get accommodated and assisted, until their eventual death due to natural causes.

Thus, others should play a role against anyone taking his/her own life by any means whatsoever - that's my view.
But today's thinking is on entirely different lines. What to do?!

 

[krish44]

Dear Sir,

You see when we pair old guys with old ladies a friendship is formed and both are kept busy...this is often a neglected part of an aging person's life..children,grandchildren etc can never replace the need of a type of love where only a partner/spouse can give.

In fact I suggested to my widower Father In Law to get to know another widowed elderly lady who was family friend of my mum but that did not take off at all! I got a nice firing from my husband and my mother!

My FIL did not take me seriously..he thought I was joking.
Poor FIL.. I think he needs a partner but just not willing to try my suggestion.

For young TB boys they know what to do..after all India has more than enough girls from Kashmir to Kanyakumari.

. To classify some as old and telling them to choose old ladies for a partner may not be wise. though it may not be wrong. senior persons can choose anyone of their choice of any age and build a relationship based on common interests. and hobbies. there are many young ladies who behave like their grand mothers and have similar attitudes and value systems passed down to them by their grand parents lovingly.You seem to be paying a heavy price for your forthrightness. Kashmir to kanyakumari TB boys are not preferred. Only TB girls have some value

 

[renuka]

. To classify some as old and telling them to choose old ladies for a partner may not be wise. though it may not be wrong. senior persons can choose anyone of their choice of any age and build a relationship based on common interests. and hobbies. there are many young ladies who behave like their grand mothers and have similar attitudes and value systems passed down to them by their grand parents lovingly.You seem to be paying a heavy price for your forthrightness. Kashmir to kanyakumari TB boys are not preferred. Only TB girls have some value

LOL! Yes I forgot..you are even smarter yaar..you see I totally forgot that some old men prefer young chicks!

So far my forthrightness is fine..whats the big deal getting some scolding on and off??
I act as if I am listening but actually I do not listen to any scolding..in my mind I just say to myself "Yeah Whatever!" and let the other person Blah Blah Blah!


I dont understand your last line...when you said this:

Kashmir to kanyakumari TB boys are not preferred. Only TB girls have some value.

Do you mean that TB guys are not wanted by anyone anywhere ranging from Kashmir to Kanyakumari or TB guys only prefer TB girls cause they(TB girls) have some values a TB boy is seeking for. Can you kindly clear my doubt?

 

[ashwin_ash]

LOL! Yes I forgot..you are even smarter yaar..you see I totally forgot that some old men prefer young chicks!

So far my forthrightness is fine..whats the big deal getting some scolding on and off??
I act as if I am listening but actually I do not listen to any scolding..in my mind I just say to myself "Yeah Whatever!" and let the other person Blah Blah Blah!


I dont understand your last line...when you said this:



Do you mean that TB guys are not wanted by anyone anywhere ranging from Kashmir to Kanyakumari or TB guys only prefer TB girls cause they(TB girls) have some values a TB boy is seeking for. Can you kindly clear my doubt?

Doctor,

Are we speaking about MDR TB, or XDR TB, or normal Tuberculosis here??!!

 

[renuka]

I prefer a more oriental (Indian) structure of the society in which the individual is, first and foremost, an integral constituent of the larger group - family, extended family, village, society, language group, etc. and in which even very old people will continue to find acceptance, get accommodated and assisted, until their eventual death due to natural causes.

Dear Sangom ji,

With this style usually a person ends up living his/her life all for the sake of others and at the receiving end and being taken for granted.

Some amount of individuality should be there in our lives...yes it might sound selfish to a certain extent but as the story goes :एतदेव जीवितम् एषः एव प्रपञ्चः (etadeva jIvitam, eSaH eva prapancaH)

 

[renuka]

Doctor,

Are we speaking about MDR TB, or XDR TB, or normal Tuberculosis here??!!

LOL!
So far there is no need for Bacillus Calmette-Guerin!

 

[krish44]

LOL! Yes I forgot..you are even smarter yaar..you see I totally forgot that some old men prefer young chicks!

So far my forthrightness is fine..whats the big deal getting some scolding on and off??
I act as if I am listening but actually I do not listen to any scolding..in my mind I just say to myself "Yeah Whatever!" and let the other person Blah Blah Blah!


I dont understand your last line...when you said this:



Do you mean that TB guys are not wanted by anyone anywhere ranging from Kashmir to Kanyakumari or TB guys only prefer TB girls cause they(TB girls) have some values a TB boy is seeking for. Can you kindly clear my doubt?

sorry madam
I am not very good at communication
1. I spent a lifetime marketing concepts and ideas. I was wondering how to sell the concept to old men that they should find someone who will empathise with them , spend sometime with them and. drive away their loneliness and consequent depression . when you suggested they should be only old ladies , another senior felt that we are condescending[have i got the spelling right] towards old people.hence i said let us not talk of age which is a sensitive subject for senior citizen
2Do you know there is an agency in delhi which provide companions to senior citizens who can perform the roles of reading books to them ,help in case of ladies in the kitchen,provide companionship for going to temples,health checkup,similar chores which they may not be able to do on their own without someone assisting them. of course these services are to be spelt out in advance and is a paid service
3 As for comment on TB boys,I was not talking of preference of TB boys. I was thinking of boys from other states preferring TB girls. In north india TB girls marrying north indians has become common place since location preference outweighs TB background. also northerners find these girls more acceptable as compared to other communities

 

[prasad1]

I personally feel that this idea about euthanasia, etc., has arisen because of the modern thinking that "individual liberty" must be "without any frontiers, whatsoever". I prefer a more oriental (Indian) structure of the society in which the individual is, first and foremost, an integral constituent of the larger group - family, extended family, village, society, language group, etc. and in which even very old people will continue to find acceptance, get accommodated and assisted, until their eventual death due to natural causes.

Thus, others should play a role against anyone taking his/her own life by any means whatsoever - that's my view.
But today's thinking is on entirely different lines. What to do?!

I feel very strongly about personal freedom, but I strongly support this post. I too feel that suicide is very selfish act. It is probably due to depression(chemical imbalance) , or emotional problem. Proper medical treatment is needed. It is easy to say that someone fasted to death, IT is extremely difficult and very painful death.

With the new age of medical marvels it is critical to define death, and also the quality of life. I would not want to "live" in a vegetative state. I have known instances were the Doctor has given increasing doze of morphine to numb the pain during the last stages of life (cancer) of a dear one. Is that called assisted suicide? Maybe.

 

[krish44]

I feel very strongly about personal freedom, but I strongly support this post. I too feel that suicide is very selfish act. It is probably due to depression(chemical imbalance) , or emotional problem. Proper medical treatment is needed. It is easy to say that someone fasted to death, IT is extremely difficult and very painful death.

With the new age of medical marvels it is critical to define death, and also the quality of life. I would not want to "live" in a vegetative state. I have known instances were the Doctor has given increasing doze of morphine to numb the pain during the last stages of life (cancer) of a dear one. Is that called assisted suicide? Maybe.

PAS and euthanasia are options that elites can think off. Poor and low income group allow seniors to die without providing treatment and by not going to doctors or hospital.Two women maids I had lost their husbands recently. one of them had a brain haemorrage [pardon spelling,is it ok]. she went to a faith healer since doctor wanted her to take a scan and admit him for extended treatment which she did not do. due to financial reasons. the other womans husband was a an alcoholic .she denied him his quarters of liquor and he died of withdrawl symptoms. both these ladies get a handsome widows pension of delhi govt courtesy shiela dixit now and are happily living it up. even if the the urban poor go to govt hospitals, they receive very bad reception and are not easily admitted due to paucity of beds. both these ladies are tamil jhuggy dwellers. DMDK couldhave done something for them instead of fighting elections. 40 tamil nadu MPs think of their vote banks home. They are the most callous lot

 

[P.J.]

As a doctor I wont do Euthanasia for anyone even if the law permits it.

It is not something I would want to even think about.

It is not easy to be the instrumental cause of death of someone.

renukaji

As a Doctor, your thoughts are appreciated; but think about the patients who suffer unbearable pain due to some chronic health issues, the patient would definitely want to end his life.

Many old people suffering from pain, praying to God, to take them to His Lotus feet is a very common sight in many homes.

 

[Nacchinarkiniyan]

There was a time when the idea of euthanasia was redundant to say the least in India. With a life expectancy of 32 years we never thought about it.

The life expectancy is now around 67 and the middle class can easily live upto 80 and beyond. Almost all the older people in my family are above 85 and some of them are in their 90s.

The thought of staying alive till the late eighties and nineties frightens me.

Why?

Because most of these people do not have all their faculties with them. Many of them walk around with walkers and some of them are in wheel chars. An many of them are senile. I am not talking about Dementia which is very serious but about senility which affect most elderly people. The state of being senile, esp. the weakness or mental infirmity of old age.

senility - definition of senility by the Free Online Dictionary, Thesaurus and Encyclopedia.


I have visited many old age homes and interacted with old people. I have also interacted with old people who stay at home with children and grand children.

I would not like to stay alive walking around in a Walker or Wheel Chair. I would not like to become the object of pity and ridicule.

The Best way to do is planned euthanasia. I will be dead with all my faculties intact.

Suicide is not the best way. The way we have planned is to ensure that we do not to take any steps to prolong our lives. No periodical check ups. No preventive maintenance. All medical treatments are only breakdown maintenance.

There is a Siddhi called Iccha Mritu. With this Siddhi you can chose the time, mode and place of your death. But no one seems to have any knowledge of how to attain this Siddhi.

I am bored. I do not want to live long. I have enough and more money. Foreign travels were interesting once. And pilgrimages were great. But no longer so.

I am not saying that all old people should feel so. Most of them have desires like seeing the Grand children study and get married etc.

I love my grandchildren. But there it ends.

So you get the general idea.

 

[Nara]

... because I believe that just as this Life was given to each one of us without our having any conscious choice or knowledge beforehand, the end to this Life also must be left to the wisdom of Nature, and not to our limited wisdom.

If Nature has any wisdom (nature being jadam can have no such thing) at all it should have thought twice before giving us life, once given to us it is ours to do whatever with it, Nature has lost all its claim over it.

Now, lot of people have written about their old relatives fasting to death, and that is indeed sad. Why can't we make it comfortable for them to end their life the way they want. The right attitude for a medical professional, IMO, humble or not, is to relieve suffering. Give lots of counseling and make sure it is not some passing phase, then, make it as painless as possible, as dignified as possible, for them to end their life, turning the back on them is not moral, it is cruel.

 

[P.J.]

Nara Sir

It is not that the daughters and very close relatives did not try to counsel the old lady, they and Doctors did that.
But the old lady was very adamant and refused any treatment to be given to her.

Only thing was given to her was some pain relieving medicines!!

 

[Nacchinarkiniyan]

" I hope my father dies soon," Dilbert creator Scott Adams wrote Saturday in a frustrated, angry, and poignant blog post. 'My father, age 86, is on the final approach to the long dirt nap (to use his own phrase). His mind is 98% gone, and all he has left is hours or possibly months of hideous unpleasantness in a hospital bed. I'll spare you the details, but it's as close to a living Hell as you can get. If my dad were a cat, we would have put him to sleep long ago. And not once would we have looked back and thought too soon. Because it's not too soon. It's far too late. His smallish estate pays about $8,000 per month to keep him in this state of perpetual suffering. Rarely has money been so poorly spent. I'd like to proactively end his suffering and let him go out with some dignity. But my government says I can't make that decision. Neither can his doctors. So, for all practical purposes, the government is torturing my father until he dies.' Adams also had harsh words for those who would oppose assisted suicide, 'I don't want anyone to misconstrue this post as satire or exaggeration. So I'll reiterate. If you have acted, or plan to act, in a way that keeps doctor-assisted suicide illegal, I see you as an accomplice in torturing my father, and perhaps me as well someday. I want you to die a painful death, and soon. And I'd be happy to tell you the same thing to your face.' His father passed a few hours after Adams wrote his screed. Challenged later by the SF Chronicle's Debra J. Saunders, an opponent of assisted suicide, Adams stood firm on his earlier words. So, can Adams succeed in convincing the U.S. where Dr. Jack failed?"

 

[krish44]

" I hope my father dies soon," Dilbert creator Scott Adams wrote Saturday in a frustrated, angry, and poignant blog post. 'My father, age 86, is on the final approach to the long dirt nap (to use his own phrase). His mind is 98% gone, and all he has left is hours or possibly months of hideous unpleasantness in a hospital bed. I'll spare you the details, but it's as close to a living Hell as you can get. If my dad were a cat, we would have put him to sleep long ago. And not once would we have looked back and thought too soon. Because it's not too soon. It's far too late. His smallish estate pays about $8,000 per month to keep him in this state of perpetual suffering. Rarely has money been so poorly spent. I'd like to proactively end his suffering and let him go out with some dignity. But my government says I can't make that decision. Neither can his doctors. So, for all practical purposes, the government is torturing my father until he dies.' Adams also had harsh words for those who would oppose assisted suicide, 'I don't want anyone to misconstrue this post as satire or exaggeration. So I'll reiterate. If you have acted, or plan to act, in a way that keeps doctor-assisted suicide illegal, I see you as an accomplice in torturing my father, and perhaps me as well someday. I want you to die a painful death, and soon. And I'd be happy to tell you the same thing to your face.' His father passed a few hours after Adams wrote his screed. Challenged later by the SF Chronicle's Debra J. Saunders, an opponent of assisted suicide, Adams stood firm on his earlier words. So, can Adams succeed in convincing the U.S. where Dr. Jack failed?"

frankly,Adams wants the society to participate in mercy killing of his parent. He is just carrying his rhetoric to a feverish pitch . we can learn fom missioneries of charity in india who selfessly look after the old and the dying. Nachinakiniyayan,see in kolkata or delhi where such homes exist. Renuka ji the other day posted about her inability as a doctor to participate in this act of PAS . I believe very strongly against pAS. we have no right to take something we cannot give. .I have gone thru suffering that we undergo when we see senior citizens wither away after repeated trips to hospital.still my view remains the same NO PAS

 

[Nacchinarkiniyan]

frankly,Adams wants the society to participate in mercy killing of his parent. He is just carrying his rhetoric to a feverish pitch . we can learn fom missioneries of charity in india who selfessly look after the old and the dying. Nachinakiniyayan,see in kolkata or delhi where such homes exist. Renuka ji the other day posted about her inability as a doctor to participate in this act of PAS . I believe very strongly against pAS. we have no right to take something we cannot give. .I have gone thru suffering that we undergo when we see senior citizens wither away after repeated trips to hospital.still my view remains the same NO PAS

State your views and please do not sermonize. This is about allowing people to die. Please read from my O.P.

 

[Nacchinarkiniyan]

State your views and please do not sermonize. This is about allowing people to die with dignity and self respect. That is something which the people who are cared for by missionaries of Charity do not have.. Please read from my O.P.

 

[krish44]

atlast somebody says I sermonise. I feel honoured. If you feel missionaries of charity are evil hurting the dignity and self respect of the old and the dying I do not have any answer. from couple of visits I made I found them more dedicated than other Indian charities. All old and infirm require some assistance. if you shrug of assistance and promote PAS many abroad who are throwing money to support parents in india will take this course and makee one time PAS settlement for their parents

 

[sankardas]

The organization 'Dignitas' in Switzerland is (in)famous for suicide tourism. They help in PAS of people with terminal illness. This condition is enforced by Swiss laws. However, Sylvan Luley, one of the deputy directors of Dignitas is of the idea that even healthy people should be allowed to commit PAS.

Now what does our culture (after all it is TamilBrahmins forum) say about this. Suicide amounts to Atmahathi sin in smartha sampradayam (however I'm not sure about the exclusion clauses). As under our culture, a disease(terminal or otherwise) is because of our karma/sins and the right way of approach is that we should go through it.Ultimately it all boils down to the way you take sampradayam regardless of whether it is legal or not. It is legal to be a non-vegetarian, but if you are a stickler in your sampradaya say smartha and you are a Brahmin, you won't eat non-veg food.
Same is the case here.

 

[renuka]

I believe very strongly against pAS. we have no right to take something we cannot give. .

Dear Sir,

I agree with what you wrote..actually its very easy for some to think that it puts and end to suffering but what about the people who have to help out in Euthanasia?? Can they face the fact that they took a human life??

The other day I accidentally stepped on a garden snail that was so happened near my car..I did not see the snail and it died..its shell smashed..the whole day I felt so bad that I accidentally killed a snail..it really feels bad to take a life no matter how small.

As a child aged 6.. I remember we had a dog called Flicker..he was extremely possessive and protective of me..he used to stand guard whenever I went out to play until he become too fierce and never let any kid come near me...he used to chase away every kid and that made some kid fall and injure himself and the neighbours were blaming that we have a very evil dog!

As time went on he become over protective of me and started biting anyone who came near me..even my relatives could not come near me if my dog was there....so my parents took him to the vet and the vet recommended to put him down.

Those days no vet recommended behavioral therapy like Cesar Milan of Dog Whisperer fame..every vet recommended just putting down such fierce and dangerous to others dogs.

Till today my father says that he could see in my dogs eyes as if he was asking 'what wrong did i do?" just before my dog was put down.

So whatever said and done to actually take any life is not an easy thing to live with.

 

[krish44]

Dear Sir,

I agree with what you wrote..actually its very easy for some to think that it puts and end to suffering but what about the people who have to help out in Euthanasia?? Can they face the fact that they took a human life??

The other day I accidentally stepped on a garden snail that was so happened near my car..I did not see the snail and it died..its shell smashed..the whole day I felt so bad that I accidentally killed a snail..it really feels bad to take a life no matter how small.

As a child aged 6.. I remember we had a dog called Flicker..he was extremely possessive and protective of me..he used to stand guard whenever I went out to play until he become too fierce and never let any kid come near me...he used to chase away every kid and that made some kid fall and injure himself and the neighbours were blaming that we have a very evil dog!

As time went on he become over protective of me and started biting anyone who came near me..even my relatives could not come near me if my dog was there....so my parents took him to the vet and the vet recommended to put him down.

Those days no vet recommended behavioral therapy like Cesar Milan of Dog Whisperer fame..every vet recommended just putting down such fierce and dangerous to others dogs.

Till today my father says that he could see in my dogs eyes as if he was asking 'what wrong did i do?" just before my dog was put down.

So whatever said and done to actually take any life is not an easy thing to live with.

thanks for yr comment. I was getting ticked off by naachi ji and would have met the fate of yr favourite dog put to sleep

 

[prasad1]

Let us not have a rigid stand on this. We do not know what future holds for us. I am at this point in time leaning against PAS. I am for my freewill not to extend life on artificial support. There might be be contradiction in these two statement, but it absolves the physician of legal obligation. To me quality of life is more important than the duration of life.

 

[Nara]

... we have no right to take something we cannot give.

Why? This does not make logical sense. If you hold to this view there are many things you have to give up, not the least of which are antibiotics.

.I have gone thru suffering that we undergo when we see senior citizens wither away after repeated trips to hospital.still my view remains the same NO PAS

It is obvious that you have the right to say no to PAS, but by the same token, you have no right to say PAS must be banned for everyone because you don't like it.

PAS is not equivalent to putting down aggressive dogs, this is just a straw man.