And Now-the Art Of Dying – Mumbai Mirror 2010
For twenty-five years now, the Indian chapter of the Society for the Right to Die with Dignity has been struggling to get legal recognition to its “Living Will” or “ Ichchaa Maran “ of an individual. Such a document will enable doctors and relatives take critical medical decisions, when it is clear that medical aid will merely prolong a patient’s death and not life.
Euthanesia is illegal and death is too depressing a topic for us. So the members of the Society feel that in this country, their struggle will die a natural death, even if the patients whose case they are fighting may not.
Come the knock of death and people who have always made their own decisions often have no say about the last and most important decision of their lives. The reason may not be that they have not made a decision – but sometimes they are not in a cognitive state to communicate it. So many of them lie in the ICU, pleading for deliverance through their eyes in sunken, wan faces, their bodies connected to life-support.
“The termination of a life that has from all rational points of view ceased to be a natural phenomena, whose continuation cannot be associated with any betterment in quality and whose present quality is abhorrent, should not be considered a sin – just as abortion is not considered a sin in India. It is in view of the possibility of entering this mode of existence tomorrow that one should be allowed to say today that ‘I wish never to continue to live or be forced to live this way’ and issue a legally valid direction for its termination. That is Ichcha Maran,”explains Dr Nagraj Huilgol – chief of Radiation Oncology at Nanavati Hospital and Secretary of the Society for the Right to Die with Dignity. This society is affiliated to the World Federation of the right to Die with Dignity headquartered in Belgium.
That such a wish has not yet been recognised may seem to be ironic in our country, where the overwhelming majority believe in rebirth and death is not a finality; it is just a moving-on experience. There are several instances in the epics of the suffering being allowed to die. Bhishma preferred to lay on a bed of arrows on the battlefield of Kurukshetra, and watch the progress of the war, as he could choose the time of his death. A maimed Sharabhanga entered the flames in the presence of Lord Rama. And the Lingayats, who inter their dead, use the term ‘sow’ rather than ‘bury’. As veteran writer and member of SRDD M V Kamath says, “Dying, like living is an art and if only most of us mastered the art of dying, there would be more happy deaths….Happy for the dying and for those around ….”.
Television producer Sangita Sinha, whose mother passed away last year after being comatose for many agonising weeks says, “As her daughter, I could not bear the thought that I hadn’t done the best. But I didn’t know if taking all that treatment was something she herself would have really wanted. If I had known that she had wished to die peacefully – as I suspect she might have wanted — I might have brought her home to let her pass away in familiar surroundings,” she says, favouring the Ichcha Maran concept. Says Nirmal Chawla, a working mother , “the worst nightmare for a person who has led a full and independent life is to lie there helpless, and become a burden on one’s loved ones. Even Gandhi said that a person suffering from an incurable disease had the right to commit suicide if he was alive only due to the ministration of others. That’s why the Shanti Avedna concept — to be truly spiritual and let nature take over at the end – is so appealing.”
For doctors torn between medical ethics and humanitarian considerations., the legalisation of Ichcha Maran would give them the comfort that their actions are legally valid. The Ichcha Maran, with its carefully built in safeguards against misuse, instructs the physician to desist from indulging in any life-supporting treatment such as artificial ventilation, intravenous infusion or nasogastric feeding tubes. The declarant also directs the physician to administer only those medicines, in appropriate doses, which can relieve the person from pain and suffering, even if the administration of the drug shortens life. These directives are deemed sacrosanct and binding unless the patient in sound mind revokes the will. The right to revoke the will, which the declarant can exercise at any time in his life, rests with the declarant.
To die with dignity is to waltz off the stage of life without pain, without humiliating sores, without being drenched in smelly secretions, without clutching to a laboured breath which in the normal course would have been the last breath.
The Icchcha Maran is therefore the ultimate right of self-determination.