On 9 March 2018 a five-judge Constitution Bench of the Supreme Court of India, headed by Chief Justice Deepak Kumar Mishra passed a ruling legalizing passive euthanasia and sanctioning living wills. This ruling will have serious repercussions and adverse impacts on the poor and vulnerable in India. Euthanasia is not just a legal issue but primarily a moral issue. Often the judiciary and legislatures do not take into account the morality of an action that is under consideration but legislate or rule purely on the basis of utilitarian principles and human considerations. E.g. Laws on abortion, same-sex unions, euthanasia, etc. The Supreme Court has not legalized active euthanasia but only passive euthanasia. But we must look into the moral aspect of this important Supreme Court judgment legalizing passive euthanasia, and see what our moral obligations are as taught by the Magisterium of the Church.
The Congregation for the Doctrine of the Faith in its Declaration on Euthanasia defines Euthanasia as “an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.”
Active euthanasia involves direct killing of a terminally ill patient by administering some lethal drug or injection. Passive euthanasia on the other hand is when the patient is allowed to die by withdrawal of all medical treatment even normal food and water. The end result in both active and passive euthanasia is the same – death of the patient. This intended death is morally culpable whether it is achieved by commission or omission.
The Vatican document quoted above states firmly that “nothing and no one can in any way permit the killing of an innocent human being, whether a foetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for the act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. Nor can any authority legitimately recommend or permit such an action. For it is a question of violation of the divine law, an offence against the dignity of the human person, a crime against life, and an attack on humanity.”
Sometimes it may happen that those who are gravely ill and suffering unbearable pain may ask for death. Or their relations or care givers may want to end their suffering by asking the doctors to put the patient to sleep by a dose of lethal injection or withdrawal of all life support and treatment. Such requests can never be legitimate. The above mentioned Declaration advises us that “the pleas of gravely ill people who sometimes ask for death are not to be understood as implying a true desire for euthanasia; in fact it is almost always a case of an anguished plea for help and love. What a sick person needs, besides medical care, is love, the human and supernatural warmth by all those close to him or her, parents, and children, doctors and nurses.” Therefore, what is required is not passive euthanasia but palliative care when the patient is given all ordinary care with love and affection and respect for the dignity of the person.
While everyone has the duty to care for his or her own health or to seek such care from others, is it necessary in all circumstances to have recourse to all possible remedies? Should life be preserved at all costs?
The moral obligation to preserve life is not absolute. That is to say, that it is not necessary in all circumstances to have recourse to all possible remedies or means.
Moralists tell us that one is never obliged to use ‘extraordinary’ or ‘disproportionate’ means, while ordinary means are morally obligatory. However, it is not always easy to make a correct judgement as to what constitutes ordinary/proportionate means and what are extraordinary/disproportionate means.
A correct judgement as to the means can possibly be made, as the Declaration suggests, “by studying the type of treatment to be used, its degree of complexity or risks, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.”
The rapid progress in medical science and technology has made these decisions even more complicated. For what was extraordinary some years ago seems to be ordinary treatment today and what is ordinary for a rich person may seem extraordinary for a poor person. Similarly what is ordinary in a city may be extraordinary in a rural set up. A decision has to be taken by the sick person (if conscious) or by relatives/doctors taking into account various factors mentioned above.
But opting not to use extraordinary or disproportionate means to preserve/prolong/save life is not passive euthanasia. The Catechism of the Catholic Church teaches clearly that “discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death.” (No. 2278)
While it is true that one is not obliged to use extraordinary/disproportionate means to save or preserve life, however, we are morally obliged to use all ordinary means of treatment including nutrition and hydration. Even when it is legitimate in some cases not to put a terminally ill patient or one whose death is imminent and inevitable, on a ventilator or even to withdraw ventilator, ordinary naso-gastric feeding and palliative care must continue. To starve one to death or to hasten death by withdrawing even ordinary means, even with the best of intentions, is tantamount to euthanasia! And it is morally culpable.
Given the widespread medical negligence of poor and helpless sick and aged in our government hospitals and blatant unethical practices in many a private hospital the present Supreme Court judgment will open the floodgates for its misuse. Despite all safeguards required by law, passive euthanasia will be without doubt misused just like the law on abortion. Innocent, helpless patients will be victims of the greed of their relatives who only wait for the patient to die and would even cause their death due to criminal negligence and willful withdrawal of all medical treatment and even normal care. In the name of mercy killing there will be large number of merciless killings, or deaths caused by intentional withdrawal of ordinary treatment and care. The danger is all too real and great.
Human life is sacred, for God is the author of life. We are only stewards. He is our origin and our destiny. To give life or to take it away is His prerogative. Humans have to only accept it as a gift. And we have the obligation to respect life and preserve it. No one can decide for himself/herself when one likes to be born or when one wants to die. The right to life does not include the right to die. Therefore, human life in all its stages and every state must be respected, treated with dignity and cared for until its natural end.(Published on 26th March 2018, Volume XXX, Issue 13)