Kerala - Kochi

‘Give palliative care, not the option of death’

KOCHI: Doctors and volunteers in the palliative care movement in Kerala have opposed the Law Reforms Commission’s recommendation for legalising euthanasia for those who are terminally ill and in extreme pain, such as cancer patients.

Several medical professionals point out that the tremendous advances made in palliative care in the State have made the end-of-life phase of the terminally ill more bearable and needing no euthanasia. They also feel that voluntary palliative care, which has attained something of a cult status in Kerala, especially in Malabar, is diagonally opposite to euthanasia. Experts also pick up holes in the commission’s use of terminology which they say would lead to confusion.

The Law Reforms Commission, headed by V.R. Krishna Iyer, has recommended to the government to enact ‘The Kerala Terminally Ill Patients (Medical Treatment and Protection of Practitioners and Patients) Bill’ drafted by it. The Bill “is to provide for the protection of patients and medical practitioners from liability in the context of withholding or withdrawing medical treatment, including life support systems, from patients who are terminally ill.” The proposed Bill allows terminally ill patients, those who are in extreme pain and those who are in a vegetative condition, to opt for death by refusing treatment.

“Medical science today has the know-how to control most of the difficult symptoms, including chronic pain, and most of these do not involve expensive treatment,” points out Dr. K. Suresh Kumar, director, Institute of Palliative Care, Kozhikode. “What the State should do is make such treatment and care available to the patients and not just legalise euthanasia.” He says that once euthanasia is legalised, many terminally ill patients would be under ‘moral pressure’ to opt for it without wasting their families’ resources.

“I have faced many euthanasia requests from my patients. It is not just uncontrolled physical pain that prompts these requests, but a complex background of physical symptoms, financial problems, social isolation, helplessness and frustration. They are veiled requests for help,” says Dr. Suresh Kumar.

“The power relationships in our health care are very imbalanced and the patients and family are not even provided with essential information most of the time. In such a situation, empowering the medical establishment with power to kill can have serious implications and chances for misuse,” he points out.

He says that Kerala’s attempts at caring for terminally ill patients have been regarded as a model for the rest of the world. “It is surprising that the Law Reforms Commission has failed to take notice of what is happening here.”

Prof. M.R. Rajagopal, professor of pain and palliative medicine, SUT Academy of Medical Sciences, Thiruvananthapuram, who is one of the early leaders of the palliative care movement in Kerala, says that the Law Reforms Commission seems to have used confusing terminology in their recommendations. Euthanasia and physician- assisted suicide (PAS) involve wilful termination of life. Generally it involves administration of intravenous lethal drugs, he adds.

Withdrawing or withholding life support in the context of incurable illness is entirely different. Death must be viewed as the inevitable consequence of life and hence there is no point in prolonging life using artificial life-support systems. Needless interventions at the end of life must be avoided and natural death must be allowed. This is not ‘mercy killing’ and hence no new law is required for withdrawing treatment in such conditions.

Dr. Rajagopal points out that the global community is worried about the possibility of abuse of euthanasia. Sometimes, old and ‘useless’ people are bumped off in the name of euthanasia. Those countries that had legalised euthanasia have an effective system to deliver palliative care. He asserts that palliative care is the humane and viable alternative to euthanasia.

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