Assisted Sucide

for the heart-breaking ordeal of Aruna Shanbaug, a nurse who is living in a vegetative state for the past 37 years after being brutally assaulted by a hospital worker. When the news broke that the Indian Supreme court has turned down a mercy killing petition for Aruna, the nurses caring her at the KEM were joyous to the extent of hugging each other and distributing sweets among other staff members.[6] The Life Site News[7] in 2008 reported the following: “India’s press agencies report that Seema Sood, 37, is now walking again for the first time since 1993, when advanced rheumatoid arthritis left her completely debilitated and horribly deformed all her joints. Two years ago, she petitioned the President of India for ‘mercy killing,’ a plea she is now thankful went unanswered.”
The legal status of PAS and euthanasia in India lies in the Indian Penal Code (IPC), which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician-assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. The legal position of PAS in India would be abetment of suicide falling under Section 306 (abetment of suicide) of IPC.[8] So, technically speaking, anybody willing to consider euthanasia or PAS needs to go through the courts of law in India and on no account have the courts considered a clear judgment on this issue allowing a PAS to go ahead.
India is not alone on this issue and most countries have been trying to get judgments on this very topic. A study of 3733 UK doctors on the legalization of medically assisted dying (euthanasia and PAS), contrasting with the UK general public, found that majority of the doctors opposed the legalization of PAS and that a strong religious belief was independently associated with opposition to assisted dying.[9]
There also has been a longer deliberation on the issue of attempted suicide in India, and the IPC Section 309 recognizes it to be a punishable act. The law goes on to define its principle as “Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term which may extend to one year or with fine, or with both.”[8] Section 309 of the IPC had been on a number of occasions challenged in the courts of law in India as in the case of P. Rathinam v. Union of India,[10] where the Supreme Court held that the right to live of which Article 21 speaks of can be said to bring in its trail the right not to live a forced life, and therefore, section 309 violates Article 21. But then this decision was consequently overruled in Gian Kaur v. State of Punjab case[11] by a Constitution Bench of the Supreme Court, which held that Article 21 could not be construed to include within it the “right to die” as a part of the fundamental right guaranteed therein; therefore, it was ruled that it could not be validly stated that section 309 violates Article 21.[12]
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What Indian medical professionals think about physician‑assisted suicide? India is a healthy example of a number of varied cultures, customs, and religions which all have preserved their identities and also mingled with the historic Indian philosophies and rituals. Disentangling religion and culture, customs and rituals, and beliefs and attitudes is a Herculean task in the Indian context. A discussion on PAS at a professional and public level will face a number of complexities such as the moral values of people, how religion and culture will play in the minds of people, whether the intensity of religiosity will overpower type of religion, and so on. A recent survey in Egypt has shown that religiosity rather than specific religion was responsible for doctors to decide whether PAS must be considered. More religious doctors felt that PAS must not be considered and it would be against their belief system irrespective of whether they were Christians or Muslims.[13] There has been limited data published on the perceptions of Indian doctors about euthanasia and PAS. The study mentioned earlier[4] does give some clues, but the limited sample size for that study prohibits generalizations. There is a real need to further study the attitudes of Indian doctors, especially psychiatrists, oncologists, palliative care physicians, and geriatricians, toward the concepts of euthanasia and PAS.
The issue of religious diversity and concepts of suicide in major religions in India Hinduism According to Hinduism, if a person commits suicide, he or she neither goes to hell nor heaven but remains in the earth as a bad spirit and wanders aimlessly until he or she completes the allotted lifespan. The person then goes to hell only to return back on earth to complete the left “karma.”[14]
Committing suicide is considered a violation of the code of Ahimsa (non-violence) and is therefore as sinful as committing murder. “For him who commits suicide becomes Abhisasta (man accused of mortal sin), his blood relations (sapinda) shall not perform the funeral rites.”[15]
Shiskhapatri – The teachings of Swaminarayan has 212 sanskrit verses and talks about do’s and don’ts and it says not to commit suicide even in the holy place.[16]
Islam According to Prof Yusuf Al-Qardhawi (Islamic scholar), “Euthanasia or mercy killing is forbidden in Islam for it encompasses a positive role on the part of the physician to end the life of the patient and hasten his death via lethal injection, electric shock, a sharp weapon or any other way. This is an act of killing, and, killing is a major sin and thus forbidden in Islam.”[17]
“Do not kill yourselves, for verily Allah has been to you most merciful.”[18] “…and (Allah) is the one who gave you life, then shall He ordain you to die, then shall He give you, your life again, truly mankind is ungrateful.”[19]
According to these Quranic verses, most Muslims believe that suicide, attempted suicide, assisted suicide, and euthanasia are all prohibited in Islam.
Christianity According to the theology of the Catholic Church, death by suicide is considered as a grave or serious sin and this belief is based on another belief that life is God’s property and a gift to this world, and nobody else has the right to destroy it. But the Catechism of Catholic Church says, “We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives.”[20]
The view of scripture on the topic is that once a person comes to faith in Jesus Christ, every sin they will ever commit is paid for,[21] and it is also stated that “there is now no condemnation for those who are in Christ Jesus.”[22] The Christians believe suicide to be a sin, but do not believe it is impossible to find salvation.[23]
Sikhism The Sikhs believe that the Gurus rejected suicide as nobody has the right to give or take life. Birth and death are the mercy of the creator and thus the belief that there is no place for mercy killing or PAS in Sikhism. The Gurus tackled the problem of sickness and suffering by providing medical relief and alleviation of pain.[24]
Buddhism For Buddhists, as the first precept is to refrain from the destruction of life, including oneself, suicide is clearly seen as a negative form of action. Buddhism in its various forms affirms that while suicide as self-sacrifice may be appropriate for the person who is an Arhat (spiritual practitioner who has realized certain high stages of attainment), one who has attained enlightenment, it is still very much the exception to the rule.[25]
“Intentionally bringing about the untimely death of a human being, even if it is still a foetus, is (an offence of Defeat.).”[26]
“It is noteworthy that even praising death or assisting death out of compassion, that is, euthanasia, is still considered a Defeat for a bhikku”[27] (Bhikku – a Buddhist monk or a layperson who has taken vow to lead a life of virtue, a Buddhist religious devotee).
Jainism Jainism is one religion that permits suicide with
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104 Indian Journal of Psychological Medicine | Jan - Mar 2013 | Vol 35 | Issue 1 restrictions. Jain Munis and other elderly people have been known to starve themselves to death, although there is no record of application of any other violent means due to heavy insistence on non-violence.
Jain scriptures talk about ending life in a dignified way in Sutra krtraanga and say “When a wise man, in whatever way, comes to know that the apportioned space of his life draws towards its end, he should in the meantime quickly learn the method of dying a religious death.” The scriptures of Sutra krtraanga identifies a holy fast unto death, which through inaction rids the soul of negative karma and brings about death with dignity and dispassion (sallekhanaa), but within the Jain religion and traditions, this method of ending life is not regarded as an act of suicide.[28]
Judaism One who is in a dying condition is regarded as a living person in all respects.[29] One may not close the eyes of a dying person … Rabbi Meir would say: “It is to be compared to a sputtering candle which is extinguished as soon a person touches it‑so too, whoever closes the eyes of a dying person is compared to have taken the soul.”[30]
Assisting and requesting suicide assistance are forbidden among Jews. Leviticus 19:14 says, “Do not put a stumbling block before the blind,” and the Rabbis interpreted that verse to prohibit any type of physical, theological, economic, or moral stumbling block, and assisting suicide is one such stumbling block.[31]
The potential role of psychiatrists in the decision‑ making process A survey conducted by the Association for Palliative Medicine, United Kingdom, supports that the majority of palliative medicine specialists oppose a change in the law on assisted dying. They argue that people who work with dying patients must be taken onboard as they have a wealth of information regarding the matter at hand.[32]
A qualitative observational study done in The Netherlands, which is one of the countries where assisted suicide is legal, suggests that euthanasia practice involves extensive deliberations, the majority of which do not lead to death. Euthanasia discussions lead to two consequences: i. The talk puts the onus on patients to continue discussions toward a euthanasia death. ii. There is a socio-therapeutic component, which tends to affirm social bonds and social life.[33]
Another study in The Netherlands that looked into the reasons for proposing euthanasia reported that the unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%