The ‘advance decision’ or ‘living will’ is a very pragmatic solution to the raging debate on mortality, old age and euthanasia. Widely accepted in the UK, it offers a way out of the euthanasia dilemma most modern societies face.
What a living will does is that it allows any healthy person to have a say in how their life ends. In effect empowering them with the ultimate dignity: to end their life on their own terms.
After years of deliberation, western society is convinced that an advance decision is an extension of an individual’s basic right to choose.
If we as adults are allowed to choose whom to marry, to drink alcohol, smoke and how we wish to conduct our lives, then it is only logical that we are allowed a choice in how (and by extension, when) we want to die.
India recognises passive euthanasia. However the living will had run into trouble. A Supreme Court bench had reviewed the matter after the 196th and 241st draft bills of the Law Commission of India and turned it down. Paragraph 11 of the current draft bill gave the attending doctor the final say, in effect making the living will redundant. All this has changed with a five-member Constitution bench allowing passive euthanasia.
However, opinion currently seems to be that this provision would be subject to misuse in India due to existing societal conditions.
This reservation seems to stem from an inability to grasp the nuanced reality. Many people still oppose euthanasia blindly on socio-religious considerations, like the sanctity of life and how it is one step away from legalising suicide.
Moving away from this simplistic and absolute stand, movements like Death with Dignity say that there is nothing noble about putting a person and her family through pointless suffering. Quality of life is as important as sustaining life and this awareness has lead to Do Not Resuscitate guidelines and the legally sanctioned withdrawal of ventilators and life support in special cases in the US.
“In a secular society, it is odd to buttress the sanctity of life in the abstract by subjecting a lot of particular lives to unbearable pain, misery and suffering,” says The Economist, after it recently published a poll showing popular support for assisted-dying.
Sitting at the heart of the debate is how one defines euthanasia. Critical care specialists in India are now talking about the need to move away from the narrow definition of euthanasia as an intention to kill to an intention to care.
Ironically, advances in medical science help us stave off serious ailments but not old age. “As fewer people die of these specific conditions, so more and more of us are dying instead of “multi-morbidities” – the accumulated crumbling of the bodily systems,” writes Maggie Fergusson in her Intelligent Life piece titled ‘How to Die.’
The collapse of joint families and changing lifestyles has meant more and more old people are spending their last days in the clinical environment of a hospital, or a nursing home surrounded by strangers rather than loved ones. Progressive laws can ensure that their last days are peaceful, if not happy.
With dementia and mental illnesses like Alzheimer’s becoming as widespread, as cancer was a generation earlier, an advance decision allows a person to choose while in command of their full faculties. Internationally recognised safeguards, such as expert second opinions and a cooling off period, have been built-in to prevent its misuse.
The Indian society has always been more evolved and sophisticated than the west when it came to matters of death. As Atul Gawande says in his book Being Mortal, the elderly have traditionally enjoyed a higher quality of life.
Allowing advance decision will not just prevent expensive and pointless medical procedures, but also honour Article 21 of our Constitution which promises the right to live with dignity.
(The writer is a freelance journalist. This is a personal blog and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
(At The Quint, we are answerable only to our audience. Play an active role in shaping our journalism by becoming a member. Because the truth is worth it.)