Reproduced from India Legal, Published April 29, 2019, p.44-45
A handful
of VVIP deaths in recent times puts the focus back on the landmark judgment of
the apex court last year where it held that the right to die with dignity is
also a fundamental right
By Dr KK
Aggarwal
We often
see that politically sensitive deaths are put on hold until the security threat
is over or to avoid violence and unrest. Sometimes, this is done to deal with
the politics of succession.
According
to a recent report in The Times of India, which later created a
controversy, former Tamil Nadu CM J Jayalalithaa died on December 4, 2016, at
5.15 pm and not on December 5, when her death was announced to the public; this
was done in view of security reasons. Similarly, a view abounds that former
Prime Minister Indira Gandhi was taken to the All India Institute of Medical
Sciences (AIIMS) in New Delhi at 9:30 am on October 31, 1984, after she was
shot by her own security guards, but fearing violence, it was only late in the
evening that she was declared dead.
Very
recently, speculation raged over whether the chief minister of a western state,
although clinically dead, was being kept alive with some specific purpose in mind.
Maharaj Ashutosh’s frozen body has been kept for the last five years on the
grounds that he is in samadhi and will come back to life.
Doctors
face such situations occasionally. The medical question thus arises: Can death
be postponed scientifically? There can be two situations, delaying the
declaration of death or delaying the process of death. In the first case, a
dead person is kept on a ventilator till the death can be announced. The second
situation is encountered in intensive care units (ICUs), where doctors often
delay the process of death by way of interventions, which otherwise are not
going to help. Often, the request comes from relatives living outside the
country.
Medically,
we know that natural death is an active process and not instantaneous, unlike
unnatural deaths. So, it is possible to halt the process at any stage by giving
heavy sedation, anaesthesia, keeping the body on a ventilator or in a state of
therapeutic hypothermia.
But can we
play with the life of a dying person? A dying person also has legal rights. In
the 2018 case of Common Cause vs Union of India, the SC held that the
right to life and liberty, as envisaged under Article 21 of the Constitution,
is meaningless unless it encompasses within its sphere individual dignity. The
right to live with dignity also includes the smoothening of the process of
dying in case of a terminally ill patient or a person in persistent vegetative
state with no hope of recovery.
In this
case, the constitution bench specifically held that the decision by a treating
doctor to withhold or withdraw medical intervention in the case of a patient in
the terminal stage of illness or in a persistently vegetative state or the
like, where artificial intervention will merely prolong the suffering and agony
of the patient, is protected by law. Where the doctor has acted in such a case
in the best interests of the patient and in bona fide discharge of his duty of
care, the law will protect the reasonable exercise of a professional decision.
Further, in
the said case, the SC settled the law with respect to euthanasia. It observed
that there is an inherent difference between active euthanasia and passive
euthanasia as the former entails a positive affirmative act, while the latter
relates to withdrawal of life support measures or withholding of medical
treatment meant for artificially prolonging life. In active euthanasia, a
specific overt act is done to end the patient’s life whereas in passive
euthanasia, something is not done which is necessary for preserving a patient’s
life. It is due to this difference that most countries have legalised passive
euthanasia either by legislation or by judicial interpretation with certain
conditions and safeguards.
Vedic
sciences recognise that death is not instantaneous but is a process, and we
must recognise and respect that process. As per the Upanishads (Prashnopanishad
and Chandogya Upanishad), the first to go are the karmendriyas (the last
to go is speech or Vak Vriti), then the gnanendriyas (the last to
go is hearing, mind, intellect, ego and memory or Mano Vriti) followed
by prana (Prana Vriti). The last to go is the metabolism (tejas),
which merges with the Sat or consciousness.
At every
stage, the process may be reversible or irreversible, which should help decide
whether to continue with life support or not. If the clinical situation is
irreversible, it is better not to postpone death. Till there is breath in the
body, one can halt the process by artificial ventilation, and till the
metabolism is functional, one can halt the process by artificial hypothermia.
It is possible to preserve the last breath or heart beat by freezing the body
and, years later, by warming the body and doing effective CPR, it is possible
to reproduce the pre-frozen state. We do it every day when we freeze sperms,
ova, organs and cells.
Way back in
1969, Elizabeth Kubler-Ross, a pioneer in the field of near-death studies,
identified the five stages of grief for the imminent loss of one’s life—
denial, anger, bargaining, depression and acceptance. In the first two phases,
the patient is often confused, and in the absence of spiritual chaplains to
counsel him or her, the easiest way for the doctors is to postpone death till a
family member starts accepting the facts.
Ayurveda
“recognises that each person is made up of a unique body type and psychological
personality”. Vata dosha represents the forces of movement; pita
the metabolism; and kapha the structure. Vata imbalance needs a
lot of handholding, support, calming therapies, nurturing and a deep sense of
connection with others to heal. Vata governs depletion, destruction,
decay, necrosis, debility, dissolution, and the process of wasting away and
shutting down. Signs of impending death such as change in smell, bodily organs
shutting down, core temperature instability, gurgling breathing (death rattle)
and mottling of the skin are all vata symptoms. Terminal agitation, a
dying patient’s behaviour of responding unpredictably, is also linked to vata.
Pitta individuals can be over-controlling
and demanding. They and/or their family members are very direct and intense,
and communicate in an explosive way due to their feelings of helplessness.
Strategies to support pitta patients and families in the dying process
include cooling, relaxing and stress-diffusing forms of aromatherapy, breathing
practices, yoga nidra and guided meditation.
Imbalanced kapha
manifests as stubbornness, lethargy, withdrawal, depression, and issues of
attachment and possessiveness. Kapha individuals are slow to change, but
once change is implemented, they are steady and enduring in new habits. When
working with them in the dying journey, it’s important to understand that they
may experience a longer grieving process. Kapha individuals can also
internalise emotions and not show them, even though they feel very deeply.
Honouring relationships is crucial, as is self-care for caregivers and families
who have deep attachments to individuals who have passed on.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of
Medical Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of
India
Past National President
IMA
