307
Chapter-7 Summary and Conclusions Analysis discussion and interpretation of empirical data gathered from the field leads the researcher to culmination of his research endeavour by presenting the summary of his findings and drawing certain conclusions related to the problem chosen for investigation. The aim of the present chapter is to do the same. Obviously, the logic of research demands that the findings should be presented in the context of the objectives of the study so that it becomes possible to know the extent to which the objectives have been achieved. In order to do the same it is proposed to present the research endeavour in a nutshell along with its major findings and conclusions drawn under the following sub-heads: (1) The Research Problem: Its Objectives and Research Methodology; (2) Major Findings; (3) Inferences and Implications; and (4) Suggestions for further Research.
7.1 The Research Problem: Its Objectives and Research Methodology The present study was designed to investigate the attitudes of doctors, lawyers and academics on the issue of legalizing euthanasia and physician assisted suicide in context of their gender, age and length of experience. The present study revolved around four dimensions of the problem under investigation: (i) favourable or unfavourable attitude of respondents towards legalizing euthanasia in India; (ii) the reasons which accounted for their supporting or opposing legalization of euthanasia; (iii) the risk involved in legalizing the same; and (iv) suggestions for minimizing or eliminating the risk of its abuse or misuse. The following objectives were set to be achieved by the present study: (1) to explore and identify the attitudes of the Doctors, Lawyers and Academics on the issue of legalization of euthanasia including Physician Assisted Suicide and its forms; (2) to compare their
308
attitudes among themselves with reference to three social variables namely, gender, age and length of experience in the profession; (3) to explore and ascertain their arguments for and against euthanasia including the bases of their attitudes; (4) to know and identify the possible areas of the risk of abuse of legalization of euthanasia by the patient himself, his family relations or surrogates and medical professionals; (5) to explore the ways and means by which the risk of abuse of legalization of euthanasia can be minimized or eliminated; and (6) to compare their views vis-à-vis each other as well as in summation taking the sample as a whole. The following research questions corresponding to the above objectives were also posed as under: (1) What are the attitudes of the doctors, lawyers and academics on the issue of legalization of euthanasia including physician assisted suicide in India? Their attitudes have been elicited with reference to the patient’s illness, chance of recovery and cost of their treatment. (2) Is there any influence of their gender, age and length of experience in the profession on their attitude towards euthanasia? (3) What is their stand as proponents or opponents of euthanasia and on what grounds they justified their stand? (4) What are the risks involved in legalizing euthanasia in their views? How it can be abused or misused and by whom? Particularly, from the point of view of the patient’s relations or surrogates and medical professions. (5) What suggestions they can offer as safeguards for minimizing or eliminating of abuse of euthanasia (including PAS), if legalized? (6) What are the areas of their consensus and differences comparatively viz-a-viz each other as well as holistically?
In order to achieve the above objectives and to find empirical answers to the research questions, it was decided to adopt the descriptive research design. The Doctors (843), Lawyers (2365) and Academics (400) constituted a population of size 3608. It was decided to carve out an equal sample of 100 respondents from the
309
above mentioned professional categories available to the investigator of the present study. The structured questionnaire was administered to the selected sample of 300 respondents. Their responses have provided the bricks and mortar for the present thesis.
Data, collected through the above questionnaire were classified, discussed, analyzed and inferences drawn by using appropriate statistical techniques like Cronbach’s alpha, Z test and Chi Square test. The analysis of data along with application of statistical techniques was carried out through computer at Centre for Study of Developing Society, Rajpur Road, New Delhi.
7.2 Major Findings
The major findings of this research project are presented objective wise in the following manner:
7.2.1 Attitudes towards Legalizing Euthanasia and PAS
As stated above the first objective of the present study was to explore and identify the attitudes of doctors, lawyers and academics towards the issue of legalizing euthanasia and physician assisted suicide in India. The related question posed was: What are the attitudes of the doctors, lawyers and academics on the issue of legalization of euthanasia including Physician Assisted Suicide in India? Their general attitudes towards legalizing euthanasia in India were elicited by constructing the items with reference to the patient’s illness, chance of recovery and cost of their treatment as well as the forms of euthanasia. The major findings related to this objective were as follows: (i) The doctors included in this survey have shown favourable attitude towards legalizing euthanasia in India; (ii) The lawyers have also shown favourable attitude towards the issue of legalization of euthanasia and PAS; and (iii) In the same way the academics also manifested a
310
favourable attitude towards legalizing euthanasia. Taking the sample as a whole, it can be concluded that in general the respondents of this study have favoured the legalization of euthanasia and PAS in a significant majority.
7.2.2 Gender, Age and Length of Experience in Profession and Attitude towards Euthanasia and Physician Assisted Suicide
The Second objective of the research was “to compare their attitudes among themselves with reference to three social variables namely, gender, age and length of experience in the profession.” The objective was further clarified by the research question raised in the following words: “Is there any influence of their gender, age and length of experience in the profession on their attitude towards euthanasia?” The major findings related to this objective were as follows: (i) As regards the demographic variables of gender and age the facts emerged that they were not discriminator of doctors’ attitudes towards legalizing euthanasia and PAS. But the social variable of length of experience in the medical profession has shown a significant relationship with the doctors’ attitudes towards PAS. But this variable could not show any dependence between their general attitudes towards legalizing euthanasia. (ii) In case of lawyers the gender has not been found to be a predictor in their general attitude towards legalizing euthanasia but the remaining two variables, i.e. age and length of experience have been found to exhibit a dependence between them and their above attitude. As regards their attitude towards legalizing PAS in India the observed data have shown independence between all the three variables, i.e. gender, age and length of experience in profession and lawyers attitudes. (iii) Lastly, in case of academics the fact emerged that there was no association between their gender, age and length of experience and their attitudes towards legalizing euthanasia as well as PAS. As regards the totality of the sample included in this study, it can be concluded that their attitudes
311
towards legalization of euthanasia and PAS in India and the variables of their gender, age and the length of experience have not shown any significant dependence between them. Their attitudes and the above mentioned variables have been found to be independent of each other.
7.2.3 Reasons / Bases for Supporting or Opposing Legalization of Euthanasia Thirdly the objective set before the present project was “to explore and ascertain their arguments for and against euthanasia including the bases of their attitudes.” The key question posed read as follows: “What is their stand as proponents or opponents of euthanasia and on what grounds they justified their stand?” The search was led to the following major finding: (i) A very significant majority of doctors preferred the following reasons for favouring euthanasia and PAS: It would empower the individual to die with dignity rather than go on suffering from an incurable and painful disease. The same argument was further strengthened by the principal of the individual autonomy, humanism and compassion. The remaining one-fourth doctors have shown unfavourable attitude towards legalization of euthanasia and PAS. They have professed the following reason doing so, in order of priority: rampant corruption in public life; sanctity of life and religious faith; last and least reason has been added that the issue should be debated only within the corridors of legislature and not in the public. (ii) The lawyers have professed the following reasons (in order of priority) for supporting legalization of euthanasia and physician assisted suicide: empowering the individual to die with dignity, no sense in prolonging a life which has lost all meaning and purpose, respecting individual autonomy, and humanism and compassion. As regards their reasons for opposing the legalization of euthanasia and PAS, the lawyers have shown preference to the following: rampant corruption in public life in India, sanctity of
312
human life, religious faith and such issue should be debated only in corridors of legislative bodies alone. (iii) The academics have accounted for their favourable attitude towards legalizing euthanasia and PAS on the basis of the following reasons: it would empower the individual to die with dignity rather than go on suffering from an incurable disease. It was further substantiated by the doctrine of individual autonomy; and humanism and compassion. Those who were opposed to the issue explained their reasons for doing so, in the following manner (in order of priority): rampant corruption in public life; sanctity of life and religious faith; lastly, they have added that the issue should be debated only within the corridors of legislature and not outside it.
Summatively to conclude, it may be stated that the three major reasons for favouring legalizing euthanasia and PAS, as professed by our respondents could be identify as follows: to empower the individual to die with dignity rather than go on suffering from an incurable and painful disease; the principle of individual autonomy; and humanism and compassion, whereas the reasons for unfavourable attitude were identified as follows: rampant corruption in public life; the principle of sanctity of life and their religious faith.
7.2.4 Risk of Abuse or Misuse of the Law of Euthanasia or PAS if Legalized The fourth objective of the present study was worded as: “to know and identify the possible areas of the risk of abuse of legalization of euthanasia by the patient himself, his family relations or surrogates and medical professionals.” The question posed in this direction read as follows: “What are the risks involved in legalizing euthanasia in their views? How it can be abused and by whom? Particularly, from the point of view of the Patient’s relations or surrogates and
313
medical professionals.” The major findings which emerge out of the data gathered from the respondents were as follows: It is interesting to mention that in a very significant majority all the respondents belonging to three sub-categories of our sample i.e. doctors, lawyers and academics have identified the following risks of its abuse or misuse if euthanasia and PAS were legalized: (i) The observed data have clearly indicated that in the opinion of more than three-fourth majority of the respondents the legalization of euthanasia and PAS would increase the chances of its abuse or misuse and they have also identified the following parties who could exploit the euthanasia law for their selfish ends were: the patient himself, his relatives or surrogates, the medical professionals. Besides identifying the parties which might be prompted to abuse or misuse the euthanasia law, if it was enacted, they have also concurred that the following might be reasons for motivating them for such abuse and misuse: economy, inheritance weariness and vested interest. (ii) A more than six out of ten the respondents have highlighted the fact that the prevailing socio-political conditions are not yet ripe enough to legalize euthanasia and PAS because the Indian society was still afflicted by a large number of illiterates and rampant corruption. In other words they have opined that the present conditions in India were not congenial for legalizing euthanasia and PAS. (iii) The respondents of the present study were further found to be in agreement with the view that euthanasia and PAS, if legalized in India, would open the door for the exploitation of the poor by the rich. Because there existed a vast class-cleavage in the existing social structure in India. (iv) Lastly, a very significant majority of doctors, lawyers and academics, gauged independently and severely agreed that the prevailing medical scenario was also not favourable for undertaking euthanasia legalization because there was no dearth of unethical medical practice.
314
7.2.5 Suggestions, Safeguards and Protocol against the Abuse of Euthanasia and PAS Law
The fifth objective of the study was “to explore the ways and means by which the risk of abuse of legalization of euthanasia can be minimized or eliminated.” The key question posed read as follows: “What suggestions they could offer as safeguards for minimizing or eliminating of abuse of euthanasia, if legalized?” For the sake of better understanding their suggestions made for elimination or minimizing the risk of abuse or misuse of the euthanasia law if it is to be legalized were divided in five categories as follows: (i) provisions for age of majority and minority of patient; (ii) provisions for voluntary and well-informed request of the patient;(iii) provisions for consultation with other physician and psychiatrics if necessary; (iv) provisions for assistance/attention of the physician; and (v) provisions for reporting, reviewing and publishing of such cases.
It is also worth mentioning that the above safeguards are also known as due care criteria or protocol to be followed in international laws related to euthanasia and PAS. The analysis and discussion of the observed data reflected that taken severally all the three sub-categories of our sample, i.e. doctors, lawyers and academics were found to be supporting all such measures in a significant majority with slight differences here and there. It is to be kept in mind that the suggestions were related to the coping mechanism for risks involved or safeguards to be included in the enactment of law on euthanasia or PAS in India. The suggestions also laid down the due care criteria to be observed before taking decision for euthanasia and PAS. The major findings related to this dimension or the problem were as follows: (i) the first suggestion related to the criterion of the age of the patient who makes a request to his physician for hastening the end of his life so that he may die with peace and dignity. In view of the majority of our respondents the following criteria should be observed in this connection: (a) the patient should
315
have attained the age of adulthood, i.e. 18 years or above; (b) in case of a minor patient between 12-18 years of age the consent of the parents or guardians played a critical role. Before complying with the request of a minor for termination of his life, his attending physician must consult them, even if he found the patient to be capable of making a reasonable appraisal of his condition. In case of minor between 12-16 years he should not proceed to comply with the request of the patient, if his parents were unable to agree. In case of the minor patient between 16-18 years of age he might comply with such a request provided the parents also did consent; (ii) criteria for judging the voluntary character and well-informed request of the patient the following steps have been suggested by the significant majority of the respondents: the physician should satisfy himself that the request of the patient was fully voluntary i.e. has emanated from his own free will, without any coercion, intimidation or pressure and also that the request was well informed meaning thereby that the patient was fully aware of the terminal nature of his illness, none availability of any alternative therapy and no chances of recovery. For this purpose it should be stipulated in law that patient should make at least three requests for voluntary euthanasia, two verbal and one written separated by a period of 15 days to his physician; (iii) The third due care criteria is related to the statutory consultation with another physician and a psychiatrist if necessary. It should be stipulated that the consultation with another competent physician and his written opinion should be obtained before arriving at a decision on the voluntary request of the patient for euthanasia and PAS. In addition to it a psychiatrist should also be consulted if the attending physician felt that the patient suffered from a psychological disorder or depression; (iv) Fourth important stipulation generally made in international law, permitting voluntary euthanasia and PAS is related to that the procedure for the same should be made in a manner which can make the final exit of the patient as peaceful as possible. Naturally, it could be possible only
316
if the procedure for implementing the request of the patient was carried on with due medical care and in attention of the attending physician. The majority of our respondents have agreed that if euthanasia and PAS are legalized in India the law should also provide for the same procedure; (v) The last stipulation in euthanasia law is regarding registering, submitting it to a duly appointed review committee, and having reviewed, publishing it for public awareness. In view of the majority of the respondents of this study the same provision should be made in explicit terms in the law, if proposed to be legislated in India on legalizing euthanasia and PAS. The following major conditions could be stipulated for this purpose: (a) every case of euthanasia and PAS should be properly recorded by the attending physician; (b) it should be reported to a district review committee with supporting documents; (c) the district review committee should consist of five members which should include at least one senior doctor, one senior lawyer and an academician; (d) that committee should not only be statutory but also be empowered to personally contact the attending physician and get any information; (e) the review committee should be required to give its final verdict on it; and (f) having thus reviewed every such case might be released for publication in order to make public aware about it. Before closing the findings on the suggestions made for safeguards against the risks involved in legalizing euthanasia, another facet of the controversy over the issue of legalizing euthanasia and PAS has been related to the issue of living will or advance directives in international arena. It was decided to elicit the views of the respondents of the present study on the legitimacy of the issue – whether living will should be legalized in India so that it may be binding on the attending physician. It may be worth recalling here that the law commission of India in its report-196 on Medical Treatment to Terminally ill Patients (2006)1 has opposed its legalization and has supported its view by solid reasoning. The recent Supreme
317
Court judgment delivered in Aruna Shanbaug case (2011)2 has, however, remained silence on this issue. A significant majority of doctors and academics included in this study have favoured the legalization of living will. Whereas the lawyers appeared to be standing on the borderline of the favourable and unfavourable views 51:49 respectively.
7.2.6 Comparative and Summative Findings
The last objective i.e. the sixth objective set before the study was worded as “to compare their views vis-à-vis each other as well as in summation taking the sample as a whole.” The related research question posed in this connection was as follows: “What are the areas of their consensus and differences comparatively as well as holistically?” Major findings of the present study in respect of the above question have been as follows: (1) Comparatively speaking all the sub groups of our sample of the study i.e. doctors, lawyers and academics have exhibited favourable attitude towards legalizing euthanasia. Of course, their agreement differed vis-à-vis each other in magnitude, statistical differences did exist among them. The academics were found favouring euthanasia by more in majority strength than doctors and lawyers. Similarly, doctors were more in favour than lawyers. Summatively speaking it can be concluded that the significant majority of the respondents have exhibited a favourable attitude for legalizing euthanasia in India. As regards the association between the variables of their gender, age and length of experience and their attitudes towards legalization of euthanasia a cladioscopic scene did emerge. The gender of the respondents did not exhibit any such association. In other words no dependence was found between their favourable attitude towards legalizing euthanasia in India and their gender. As regards the association between the age groups of respondents and their attitudes towards euthanasia. A slightly cladioscopic scene emerges while comparing the sub groups of samples of doctors,
318
lawyers and academics vis-à-vis each other. There was no associationship between the age of doctors and academics and their attitudes towards euthanasia whereas the reverse was found to be true in case of lawyers. Finally, comparing the respondents of their profession has shown no dependence between their age and attitude towards euthanasia. When the relationship between the length of experience in profession and the attitude of respondents towards euthanasia was gauged, it was found that their existed no such association for sample as a whole. Comparing the respondents on the basis of their profession it was found that there existed a dependence between the length of experience of the lawyers and there attitude towards legalization of euthanasia whereas the doctors and the academics did not exhibit any association between their length of experience and the attitude. On the basis of the summative analysis of the respondents of our study, however, it can be concluded that there existed no association between their attitude towards legalizing euthanasia and their gender, age and length of experience in the profession. In other words, their gender, age and length of experience were not found to be a discriminator of their attitude towards legalizing euthanasia.
(2) As regards the attitude of the respondents of this study, i.e. doctors, lawyers and academics, it was found that they did exhibit a favourable attitude towards legalizing PAS in India, both comparatively vis-à-vis each other and summatively. While comparing their attitude towards PAS on the basis of three variables i.e. gender age and length of experience in the profession it was found that summatively speaking, there was no association between them. In other words, the variables of gender age and length of experience in the profession of doctors, lawyers and academics and their attitude towards legalizing PAS were found to be independent of each other. But the comparative view of the relationship of the variables with their attitude an exception was found in case of doctors only,
319
whereas their gender and age did not reflect any association with their attitude towards legalizing PAS. Their length of experience in the profession, however, was found to be a discriminator of their attitude.
A comparison of the attitude of doctors, lawyers and academics towards legalizing PAS in India on the basis of their gender, age and length of experience in profession yielded the following facts: (i) both comparatively and summatively no association was found between their gender and age and their attitude towards legalizing PAS; (ii) as regards the variables of length of experience, it was found that there was a dependence between their length of experience in profession and doctors attitude towards legalizing PAS whereas no such relationship was found in case of lawyers and academics; (iii) summatively speaking taking a sample as a whole, the study has not exhibited any association between the gender, age and length of experience of the respondents and their attitude towards legalizing PAS. (3) As regards the respondents’ reasons for their favourable attitude towards legalizing euthanasia and PAS the following facts have emerged: (i) A significant majority of the respondents (195) of the present study have perceived the reason for their favourable attitude in empowering the individual to die with dignity rather than suffering from an incurable and painful disease (the first rank order obtained among reasons). Indirectly they have supported their favourable attitude by the principle of quality of life, meaning thereby that there is no sense of prolonging a life which has lost all meaning and purposes (the second rank order obtained). It can further be substantiated by the thesis of respect for individual autonomy (third rank order obtained). Of course, this picture has emerged on the basis of the summative view. Comparatively speaking there is slight variation in the observed rank orders in case of doctors who have given priority of individual autonomy over the reason of senseless prolonging a life which has lost meaning and purpose. As
320
regards the fourth and fifth rank orders assign to the reasons by our respondents for their favourable attitudes towards the issue both summatively and comparatively could be stated as follows: it would mean an act of humanism and compassion and that advance medical treatment and technology being costly should be utilized only in those cases which stand better chances for recovery. Nearly two third respondents have opted the above mentioned reasons for exhibiting their favourable attitude, the remaining one third of them have expressed their (105) unfavourable attitude towards the same. They have identified the following reasons for explaining the reasons for doing so in order of the ranks obtained on the basis of their preferences : there is near unanimity among them on this inference both comparatively vis-à-vis each other and summatively. (i) that there is much public corruption in India people would misuse it for personal gains; (ii) that human life is sacred no one has a right to end it; (iii) that their religion did not allow it; (iv) that the issue of legalization of euthanasia deserved to be debated only in legislature assembly / parliament and not outside it.
(4) Having analyzed the attitudes of doctors, lawyers and academics towards legalizing euthanasia in India, it was logical to know their views regarding the risks of its use and abuse, if any. Furthermore an attempt was also made to identify the parties who might be motivated to abuse or misuse the euthanasia legislation if adopted the search on this dimension has yielded the following facts: (i) a significant majority of our respondents both comparatively vis-a-vis each other and summatively for the sample as a whole have opined that there were definite risk involved in legalizing euthanasia and PAS in India; (ii) legalization of euthanasia would increase of its abuse by the patient himself, his relatives and surrogates for the reasons of economy, inheritance, weariness and vested interest; (iii) euthanasia should not be legalized in India which has a large number of illiterates and rampant
321
corruption; (iv) euthanasia if legalize in India it would open the door for the exploitation of the poor by the rich; (v) conditions are not ripe in India for legalization of euthanasia because there is no dearth of unethical medical practice. (5) As regards suggestions for minimizing or eliminating the above risks our respondents both comparatively vis-a-vis each other and summatively taken the sample as a whole have made the following due care criteria to be included in legalizing euthanasia and PAS in India: (a) the patient should have attained the age of adulthood, i.e. 18 years or above; (b) in case of minor 12-18 years the consent of the parents or guardians played a critical role. Before complying with the request of a minor for termination of his life, his attending physician must consult them, even if he found the patient to be capable of making a reasonable appraisal of his condition. In case of minor between 12-16 years he should not proceed to comply with the request of the patient, if his parents were unable to agree. In case of the minor patient between 16-18 years of age he might comply with such a request provided the parents also did consent; (ii) criteria for judging the voluntary character and well-informed request of the patient the following steps have been suggested by the significant majority of the respondents: the physician should satisfy himself that the request of the patient was fully voluntary, i.e. has emanated from his own free will, without any coercion, intimidation or pressure and also that the request was well informed meaning thereby that the patient was fully aware of his terminal nature of his illness, none availability of any alternative therapy and no chances of recovery. For this purpose it should be stipulated that patient should make at least three requests for voluntary euthanasia, two verbal and one written separated by the period of 15 days to his physician; (iii) The third due care criteria is related to the statutory consultation with another physician and a psychiatrist if necessary. It should be stipulated that the consultation with another competent
322
physician and his written opinion should be obtained before arriving at a decision on the request of the patient for voluntary euthanasia and PAS. In addition to it a psychiatrist should also be consulted if the attending physician felt that the patient suffered from a psychological disorder; (iv) fourth important stipulation generally made in international law, permitting voluntary euthanasia and PAS is related to that the procedure for the same should be made in a manner which can make the final exit of the patient as peaceful as possible. Naturally, it can be possible only in case the procedure for it is implemented with due medical care and in attention of the attending physician. The majority of our respondents have agreed that if euthanasia and PAS are legalized in India the law should also provide for the same procedure; (v) The last stipulation in euthanasia law is regarding registering, reporting and submitting it to a duly appointed review committee, and having reviewed, publishing it for public awareness. In view of the majority of the respondents of this study the same provision should be made in explicit terms in the law intended to be legislated in India on legalizing euthanasia and PAS. The following major conditions could be stipulated for this purpose: (a) every case of euthanasia and PAS should be properly recorded by the attending physician; (b) it should be reported to a district review committee with supporting documents; (c) the district review committee should consist of five members which should include at least one senior doctor, one senior lawyer and an academician; (d) that committee should not only be statutory but also be empowered to personally contact the attending physician and get any information; (e) the review committee should be required to give its final verdict on it; and (f) having thus reviewed every such case might be released for publication in order to make public aware about it. As regard the issue of legalization of living will in India, it can be stated that it has also become an international controversy including India. It can also recall that the
323
Law Commission of India (2006)3 in its Report No. 196 on Medical Treatment to Terminally Ill Patients (Protection of Patients and Medical Practitioners) has also opposed it. The Supreme Court judgment in Aruna Shanboug case (2011)4 is silent on this issue. It is worth mentioning here that the issue of living will has a critical importance in relation to the issue of legalization of euthanasia, esp. voluntary euthanasia. In case living will legalize it would automatically be binding on concerned parties in cases of terminal illness. It was, therefore, the respondents of the present study were also asked to give their explicit opinion about it. The significant majority of the doctors and academics included in this study have favoured the legalization of living will whereas the lawyers appeared to be standing almost on the border line dividing minority and majority (51:49) respectively. It can therefore be concluded that the majority of respondents in totality favoured the legalization of living will in India.
7.3 Inferences and Implications
What emerge out of the major findings discussed above? The answer to this question demands a holistic view of our conclusions, keeping in view the sample of respondents as a whole. The major inferences and implications may be presented in the following manner:
1. The doctors, lawyers and academics included in the present study have shown a favourable attitude towards legalizing euthanasia and PAS in India. It implies that the time demands a serious attention to the issue of the legalization of euthanasia in India in context of terminal and painful illness. It may introduce in mass media for public debate.
2. The variables of gender, age and length of experience in the profession have not been found to be the predictor of the attitude towards euthanasia in context of professionals i.e. doctors, lawyers and academics included in this
324
study. It implies that a wider study including a cross-sections of Indian society is needed to gauge the impact of such variables on attitudes of people of India towards legalizing euthanasia and PAS.
3. The respondents have highlighted the following reasons which may account for their favourable attitude towards legalizing euthanasia and PAS: (i) It would empower the individual to die with dignity rather than go on suffering from an incurable and painful disease; (ii) It would mean a respect for individual autonomy; (iii) Humanism and compassion; and finally (iv) It would save the scares and costly life support system, only on those patients who had a fair chance of recovery.
Those who exhibited unfavourable attitude towards legalization of euthanasia and PAS had explained the following reasons for their attitude: (i) Prevalence of much corruption in public life; (ii) People may abuse or misuse such laws for their personal gains; (iii) The principle of sanctity of life; and (iv) Religious faith.
On the basis of the above it may be inferred that a very significant majority of our respondents have placed for legalizing euthanasia and PAS on the ground of dignity of human life and individual autonomy; a minority of them who were found opposing the based their arguments on the following: Sanctity of human life, religious faith and prevalence of much corruption in public life in India The above inferences may imply that the professionally trained segment of Indian society has come to believe in dignity and quality of life of an individual rather than the sanctity of life in whatever miserable and tortures form it existed.
4. The major findings discussed above also lead one to infer that a highly significant majority of the respondents were aware of the risks of abuse or misuse involved in legalizing euthanasia and PAS in present day India. They
325
have further identified that the following parties may abuse such legislation for their nafiours gain: the patient himself, his family relative and surrogates, medical professionals and rich people. They have further highlighted the following sources for likely use or misuse of such legislation: economy, inheritance, weariness and vested interest.
They have further highlighted the following social conditions which might be held responsible for germinating the above risks: (a) high rate of illiteracy; (b) much prevalence of corruption in public life; (c) a strong social cleavage among rich and poor; (d) no dearth of unethical medical practice in medical profession. The above inference implies that the respondents were aware of the risks involved in legislating for euthanasia and PAS in India. It further implies that a strong ‘due care criteria’ should be included in the legislation in order to minimize or eliminating such risks.
5. The respondents of the present study have suggested the following due care criteria to be included in any legislation, aimed at providing euthanasia and PAS in order to check the use or misuse such legislation: (a) A person suffering from a terminal illness requesting for hasting the end of his life should have attained an age of majority i.e. 18 years and above; (b) In case of a minor patient between the age of 12 to 18 years the consent of the parents/guardians with the request of the patient must obtained; (c) Before arriving at a decision, the attending physician should satisfy himself about the voluntariness and well informed request of a such patient for determining the voluntary character of the request of the patient, the attending physician should ensure himself that such a request has emanated from his own free will, without any pressure, intimidation and coercion. It may further be stipulated that patient should make at least three requests for voluntary euthanasia, two verbal and one written separated by at least a period of 15
326
days to his physician. It implies that a patient should have been provided a sufficient time to withdraw his request for voluntary euthanasia; (d) As regards the criteria for determining whether the request of the patient is well informed or not the attending doctors should see that the patient was fully aware of terminal nature of his illness, none availability of any alternative therapy and no chance of recovery; (e) The respondents have also suggested that it should be made mandatory for the attending physician to have a consultation with another competent physician and obtained his written opinion on the case. In addition to it, if the attending physician feels that the request for the voluntary euthanasia was an outcome of his mental disorder like depression, he should consult with a competent psychiatrist also before arriving at a decision on a patient’s request; (f) They have also suggested that the procedure for executing the request of the patient for voluntary euthanasia and PAS should be done in the due care and in attention of the attending physician. In order to make his final exit as peaceful and painless as possible; (g) The respondents have also made concrete suggestion for recording, reporting and reviewing each and every case of voluntary euthanasia. In their opinion, any legislation permitting voluntary euthanasia should include the following stipulation: every case of euthanasia should be recorded with all connected papers and be reported to duly constituted statuary District Review Committee. It should consist of five members who should include a senior doctor, a senior lawyer and an academician. The Review Committee should empower to personally contact the attending physician and discuss the case in hand if necessary. The Review Committee should give its written and final verdict on the case. Having thus, reviewed
327
Finally, the respondents of the present study have favoured the legalization of the living will also.
The holistic reading of the foregoing inferences implies that the respondents of this study have exhibited favourable attitude towards legalization of euthanasia and PAS. However, it is worth mentioning that they have voted for voluntary euthanasia only. That is why they have suggested a detailed due care criteria before taking an action on the request of the patient. It should also be noted that the respondents have suggested for legalizing voluntary euthanasia in both its active and passive form. Because they have not made any differentiation between the two. Perhaps they did so because whatever were the case active or passive form of voluntary euthanasia the end result was the same – the final exit of the patient. It is in sharp contrast of the recommendation of the Law Commission of India on Medical Treatment to Terminally Ill Patients (2006)3 as well as Supreme Court judgment in Aruna Shanbaug Case (2011)4 both of the above mentioned authorities have advocated / permitted only passive voluntary euthanasia, i.e. withholding or withdrawing life support system from the patient. Indirectly the above implication also leads one to conclude that the respondents of this study did not favoured involuntary or non voluntary euthanasia. Their advocacy for legalizing living will is also in sharp contrast of the recommendation of the Law Commission of India on the same subject.
7.4 Suggestions for further Research
During the survey and analysis of collected data it was realized that there existed certain gaps in euthanasia research. Indirectly the gaps pointed out the limitations of the present research exercise. It is true that a systematic effort has been initiated in this direction but much more is needed to be done. The following suggestions
328
are made where a systematic research should be undertaken on priority bases so as to enable the concerned authorities to formulate a sound national policy on legalization of euthanasia:
1. The present study presents a small survey of highly educated and trained professionals i.e. doctors, lawyers and academics. A large scale survey of a cross section of society should be made to elicit people’s views on legalization of euthanasia.
2. The present survey tried to explore and identify the attitudes of doctors, lawyers and academics towards the problem it was done by the help of constructing two scales: (a) general attitude scale including multidimensional statement related to the problem and (b) specific scale to know the attitudes of respondents to legalization of physician assisted suicide (PAS). It is suggested that a specific study should elicit the views of a selected group of people to know their views on legalization of various types of euthanasia, taking them separately in India.
3. The present study did not make any distinction among the various categories of doctors e.g. their field of specialization in medical practice. It may be fruitful to know the views of doctors towards legalization of euthanasia on the basis of their speciality. There are medical areas which usually deal with such terminal illness like cancer and AIDS. It would be fruitful to examine their attitudes to the problem under investigation.
4. It may be interesting to explore the views of those patients and their relatives on the legalization of euthanasia and PAS who have been transferred to the terminally ill patient ward or hospices. The study might reflect the views and attitudes who are immediately facing the critical situation of terminal illness.
329
It may show their wishes and willingness to make a request for voluntary euthanasia.
5. The study has tried to gauge the role of three social variables, i.e. gender, age and length of experience in the profession in the determination and prediction of the attitudes of respondents towards legalizing euthanasia in India. It is therefore suggested that a more comprehensive social factors might be included in order to find out the role of social context of the patient. For example, socio-economic status, level of education, occupation, rural and urban background and political affiliation.
6. India has a diversity of religious faith nearly all the world religious exists here besides, many other religious denominations. It might be interesting to find out a relationship between different religious affiliations and the attitude towards legalizing euthanasia in India.
7. The National Sample Survey type studies should be undertaken in different parts of the country in order to arrive at a right decision on the problem of legalization of euthanasia in India.
8. Lastly, a regressive study should be undertaken to examine and evaluate each and every criterion to formulate a due care criteria before taking a step towards legalization of euthanasia and PAS. Only a simple, workable and stringent criteria is needed to plug the whole which may germinate the risks involved in it.
While summing up the present study acknowledges that a scientific endeavour in any field of study is an on-going process. The present study in its own humble way has achieved all the objectives which were set before it and made some contributions towards filling up the gap which existed in area of euthanasia research. This study, however, does not propose to claim any finality
330
in regard to either facts gathered or to the inferences drawn. If it succeeds in provoking further research in the field of euthanasia and PAS, its effort would naturally be fructified.
Notes and References
1. Law Commission of India (2006)
Medical Treatment to Terminally ill Patients (Protection of Patients and Medical Practitioners) Report No. 196, New Delhi.
2. Aruna Shanbaug Case (2011) Death Dilemma, Times of India, Tuesday, 8th March, New Delhi, pp.14-15.
3. Law Commission of India (2006)
Op. Cit.
4. Aruna Shanbaug Case (2011) Op.
