Journal of Information and Computational Science ISSN: 1548-7741

How to face Terminal Illness: An Analysis

Sourav Kharan

Ph. D Scholar

Deaprtment of Philosophy

Sidho-Kanho-Birsha University

Purulia, West Bengal

Abstract: Terminal illness being incurable cannot be treated adequately and the final result is death for the patient. It can be categorized under such kind of disease from which patient cannot be recovered in his/her life time with an absolute certainty albeit he/she has been in treatment and a huge amount of money is to be spent . Terminal illness is not neither new in India nor its’ abroad. From the ancient age, the Indians have been trying to discover a way out to face these types of terminal illness. This paper is concerned with the best possible way among the Supreme Court’s ‘living will’, Palliative Care, Life prolonging treatments, Hospice services, Telling the trivial truth and the Spiritual death through which the terminal illnesses could be faced from the Indian perspective. Key words: Terminal, Illness, Spiritual, Death On 9th March, 2018, Indian Supreme Court legalized Passive which is related to terminal illness—a person, who has been suffering from a serious kind of terminal illness and he/she may draft an advance living will. An advance living will is a written document through which a patient can give his explicit instructions in advance about how long the medical treatment to be administered, when he/she has been suffering from a serious kind of terminal illness. When the limited stipulated time, permitted by the patient through his/her advanced will is crossed, the act of Passive Euthanasia can be performed by doctors with the help of the withdrawal of the medicinal treatment along with the deliberate intention to accelerate the death for a long suffered terminally ill patient. On 2018, the Supreme Court of India further declared through the bench constituted of five judges, that the government would honor the advance living wills, only when the terminally ill patient who is in a vegetative state has already given the consent of Passive Euthanasia. But the strict guidelines, in this respect, must be followed. A living will sets out the wishes of the terminally ill patients regarding their treatment i.e. how they want to be treated. The Judges said that the with dignity is a fundamental right and that can be directed

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in advance by a person in the form of a living will, could be approved by the court. Petitioners, who argued that people have the right to die with dignity, when they are suffered from terminal illness, should deserve their judgment; said by the Supreme Court. Be noted that a living will is actually the self permission of Passive Euthanasia. When the Passive Euthanasia is applied upon a patient by a medical professional person, it indicates that the patient has died because either the necessary medical supports through which a patient could be alive have been taken away or some similar steps have been taken which failed to keep the patient alive. This might include: (a) switching off life support machines or (b) disconnecting a feeding tube, or(c) not carrying out a life extending operation or (d)not administrating life - extending drugs. In case of Aruna Ramchandra Shanbaug, Supreme Court passed opinion about Passive Euthanasia, for the first time, in the recorded case history in the India, after being in the vegetative state for near about 42 years as a result of sexual assault. The Supreme Court remarked, Passive Euthanasia may be granted only when the doctors are unanimously agreed and a case has been filed in the court. Aruna Ramchandra Shanbaug was paralyzed, because of severe brain damage since 1973, in the city of Mumbai, after being raped and strangled by a ward attendant in the Mumbai hospital where she worked, and eventually died in 2015. Her death sparked a national debate over Euthanasia. In 2018, Supreme Court Judges drafted a detailed ‘guide lines’ for facilitating Passive Euthanasia. The court said that family members, along with the relatives of terminally ill patients who are seeking Passive Euthanasia can appeal in the court in order to get permission for it. A team of doctors would then be appointed by the court, prior giving the sanction order for the implementation of Passive Euthanasia. As the terminal ill patient is human being and there is no alternative of life, some sort of anxiety is quite natural against the verdict of Supreme Court regarding Passive Euthanasia. These anxieties are as follows:  The pain of terminally patient should be measured properly  ‘Euthanasia’ is an irreversible process, so, before the implementation of euthanasia living will of concerned patient should be justified properly  Though Supreme Court has given the verdict for the implementation of euthanasia for the terminal ill patient, hospitals especially the private hospitals may fix extra charge for it  The huge amounts of bills are disbursed through the medi-claim policies when the patient died normally. In case of implementation of euthanasia, it is natural to ask questions about the disbursement of amounts through the medi-claim companies, as it is not at all normal death  It is a general and ethical obligation of a state to provide health service for every citizen within its territory, when Supreme Court said that the verdict regarding euthanasia is based on the importance of the patient’s will a conflict arises  The Indian Constitution Section—21 says about ‘right to live’ as one of the fundamental right. But when the Supreme Court permitted euthanasia i.e. ‘right to die with

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dignity’ in order to honour the will of the terminally ill patient, the said fundamental right—‘right to live’ seems to be changed as ‘right to how to live’ In fact, life and death of animate objects depend on the Supreme God. The verdict given by the Supreme Court regarding euthanasia has been formed by the human being that is why it never be the above of questions. There may be debate about the basis of the verdict given by the Supreme Court. Once, the verdict has been disclosed for the public, it should be honored and the best way through which a terminal ill patient could die with honor should be sought out. Let us peep into the different ways through which a terminal ill patient could be relieved. 1. Palliative Care From the definition of World Health Organization, it is known that ‘Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life threatening illness, through the prevention and relief of suffering by means of early indication and impeccable assessment and treatment pain and other problems, physical, psychological and spiritual’. The concept of palliative care regarding the death of a terminal ill patient as a normal process affirms the faith in life. It aims to provide relief from distressing symptoms. Death is actually a natural end of life and as well as any kind of diseases that is why it cannot be postponed indefinitely. Through the Palliative care unit the patient and his family can get an integrated wide support through the multi-disciplinary approaches which include psychological, social and spiritual aspects. It integrates a wide support system not only for the patient, but also for the family as a whole. In 1967, Cicely Saunders opened a palliative care center in the London. Later, different countries have taken initiatives to open palliative care as a part of health policy. In India, Kerala, Maharashtra, Karnataka, Tripura, and now Jammu and Kashmir started to give importance palliative care although some states of India still remain indifferent regarding this matter and keep away palliative care from the health policies. According to WHO’s report, in the world every year only 14% peoples are getting privilege from palliative care where 78% peoples are in the poor or middle income group. 2. Life Prolonging Treatments Advanced technology in modern medical science has introduced entirely new way in end of life care through which lifespan can be prolonged or stretched and consequently death may be postponed. Organs that have stopped functioning and made the patient suffering from incurable diseases could be transplanted and thereby patient would be cured. Some diseases which were called earlier as incurable, the concept of incurable diseases have been changed, because of the possibilities of replacement of organs on the basis of its availability. For example, chronic renal failure, chronic respiratory problem, cardiac and liver failure, leukemia and other blood cancers etc. which were categorized as incurable, but now these are not called as incurable in strict sense. Sometimes, literally speaking, life is brought back from the jaws of death with the help of life prolonging treatments like assisted respirator support, artificial maintenance of nutrition and hydration cardiac pacing and so on. For

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example, none can even a doctor can never forecast that a coma patient would never survive in future. 3. Hospice Services Hospice is an approach to care which is not limited only with a specific place. At present Hospice is sometimes provided for ape son who has been suffering from a terminal illness whose doctor has a firm conviction that the patient would die within 6 months or less if the illness runs in its natural process. A hospice service is, actually, a kind of life supportive service, after medical services, in a home like atmosphere. It reminds the sanatorium system of treatment used for the leprosy patients when the leprosy was treated as incurable. In recent times, the concept of old-age-homes is well known which may be compared with the notion of hospice. However, in this age of globalization, the life of human being has become so fast that this type of individualized group should be formed through which terminal ill patients could be able to lead their very short life’s span with peacefully. Be noted that Indian cultural heritage do not encourage these type of approach, because in Indian society believes in a family where all members live peacefully where each and every one should not run for money. The concept of joint family showed that every member have duties towards their family, but these duties were not equal for all, that’s why the aged persons in a family could get care with respect by their own family members who were brought up by them. But, today’s unitary family compels the aged members to live in the old-age-home and to buy the service in the name of hospice service. 4. Telling the Trivial Truth Following the Buddhism, it can be said that ‘to be born is to be suffered’, but everybody wants a peaceful and dignified death. Accidental death or any kind of immature death is painful and may cause the trouble for the other family members for their future life. Any family member draws some short time or long time plans for his life and he/she has some responsibilities and duties toward family and as well as society. When a doctor finally diagnosed about the terminal illness from which his patient has been suffering from, he should disclose all about to the patient as the death is inevitable within stipulated time, in order to reshuffle his plans and programs and thereby could prepare for a peaceful and dignified death. 5. Spiritual Death It is a deep seated custom among the most of people, even the educated people that it is a great misfortune for anyone who has been suffering from such kind of terminal illness. But this negative attitude can be changed in to a positive attitude from the perspective of spiritual death. The terminal illness offers certain opportunities that are not available in case of sudden death caused by some accidents. When a person suffers from a terminal illness, he/she can get some times to settle his/her personal business. At least a few unfinished works could be done by the terminal ill patients. That is why the ancient sages used to consider terminal illness is preferable than sudden death.

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Some terminally ill patients failed to bear the emotional pain which is caused from their previously known premature death and commit . Whether Spiritual death can be the alternative of suicide or not, is a difference issue, but certain ancient traditional customs offer an alternative—a voluntary death through fasting for the terminally ill, known as prayopavesa (Hindu) or santhara (Jain). Satguru Subramuniya Swami, the saivite Hindu monastery on Kauai, Hawail, for example, himself committed prayopavesa when the doctors diagnosed that he had been suffering from terminal cancer, in 2001. During his fast, he continued many of his daily assigned duties and eventually, passed away peacefully, on the 32nd day of fasting. In case of terminal diseases or great disability, in some religions, self–willed death through fasting i.e. prayopavesa is permitted. When the concerned person making such decision about prayopavesa, he should declare it publicly, otherwise no demarcation will be made by the community in which he/she belong, with the act of suicide that is performed privately in traumatic, motional states of anguish and despair. Ancient sages in this regard framed some rules of prayopavesa which are as follows: a) Inability to perform normal bodily purification b) Death will be appeared imminently and/or the condition is so bad that life’s there is no pleasures in life c) Final decision is subject to community regulation Prayopavesa is not suicide because it allows time for the individual to settle his unfinished works and thereby to be close to the God by bracketing himself from the worldly pleasure after a deep contemplation. The ideal practice during the prayopavesa is to beg the forgiveness and to forgive. Through this practice of confession one get dissuasion from all of this life and eventually, concentrate only on the scriptures and the guru’s noble teachings through the meditation which help him to feel the inner power of the immortal self keeping himself abstained from food. In case of terminal illness, prayopavesa offers the opportunity to arrange the death of individual who is suffering from such kinds of disease. In this case, in general, the court will not interfere. If someone decides, he/she should go for prayopavesa in order to get a dignified death; he/she may consult with his other family members whether his decision is right or wrong. After getting the permission from the family members, he/she asks an attorney to prepare a living will along with the direction of the physicians and finally go for prayopavesa, after getting the permission of the concerned community. From the above, it is clear that there are various paths to face the death with dignity and these are—the Supreme Court’s ‘living will’, Palliative Care, Life prolonging treatments, Hospice services, Telling the trivial truth and the Spiritual death. Among these ways the prayopavesa or santhara seems to be the best policy for terminal patient, because this results in a greater degree of satisfaction rather than frustration or guilt of mind at the end.

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References: 1. Dissanayake, Ames, R, T, and Kasulis, P. (Ed.): Self as Body in Asian Theory and Practice. State University of New York Press, New York, 1993 2. Banerjee, S.C.: Indian Society in the . Bharata Manisha, Varanasi, 1979 3. Basham, A. L.: Aspects of Ancient Indian Culture, Asia Publishing House, New York, 1970 4. Byock, I: The Nature of Suffering and the Nature of Opportunity and the End of life, Clinical Geriatric Medicine, 12: 237-252, 1996 5. Cassel, E. J.: The Nature of Suffering and the Goals of Medicine, N Eng. J. Med, 306: 639-645, 1982 6. Crawford, S. C. (Ed.): Dilemmas of Life and Death, State University of New York Press, Albany, 1995 7. Cromwell, Crawford, S: Hindu Bio-ethics for the Twenty-first Century, State University of New York Press, New York, 2003 8. Eutsey, D. E. (Ed.): Patient and Family Issues, Palliative Care: Patient and Family Counseling Manual, MD: Aspen Publishers Inc., Gaithersberg, 1996 9. Field, M. J. & C. K. Cassel (Ed.): Approaching Death: Improving Care at the End of Life, National Academy Press, Washington DC, PP—31-32, 1997 10. Humphry, D. (Ed.): The Practicalities of Self-Deliverance and for the Dying, Time Books International, New Delhi, 1991 11. Peto, R. and R. Doll.: There is No Such Thing as Aging, BMJ, 315: 1030-32, 1997 12. Twycross, R, and I. Lichter.: The Terminal Phase, in D. Doyle, G. W. C. Hanks and N. Mac Donald (Ed.), Oxford Textbook of Palliative Medicine, Oxford University Press, England, PP—977-992. England, 1998 13. Velleman, D.: A Right of Self Termination, Ethics, 109: 606-628, 1999 14. Chatterjee, S.C: & Priyadarshi, Patnaik, & Vijayaraghavan, M.C (Ed.): Discourses on aging and dying, Sage, 2008 15. BBC News 9th march 2018 16. Sarkar, A.K.: Article in Ei Samay, Bengal news paper, 9th April, 2018

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