By Life Positive April 2007 Death is the only thing definite about life. Here is an initiative that ensures that the sunset of one’s life is a glorious one by Dr Satyavati M Sirsat and Dr Hemang D Koppikar In human beings, as Anno Domini progresses and age advances, there is an occasional fleeting thought of one’s end. It is but natural. Ancient civilizations – oriental and occidental – have cogitated philosophically on this. Now, in the New Age, with greater longevity and the explosive advances in technology and medicine, this question becomes more and more complex. The first protagonist for asserting the question of individual rights was Mr. Minoo Masani, who launched the Society for the Right to Die with Dignity. This is still limping along and comes into prominence when a disgruntled and very old gentleman gets fed up of an unloved and uncared-for life. Another pattern very different from the above is icchamaran. This is practiced by contemplative and evolved souls through anshan/ samalekhana / anveshan / santharo vrat ,mainly in Jainism and has many rules to oversee them. The disposal of suffering humanity has activists for or against – it’s called euthanasia – a good easy death (Eu=good; thanasia = after the Greek god of death, Thanatos). It is classified into (a) active – physician-assisted suicide is another name for it – and refers to a lethal injection that terminates life; and (b) passive – withdrawal of all medicines, life-support systems, nourishment and water. Both these practices while trying to bring a peaceful release from suffering have many unhealthy connotations involving wrong-doing in getting rid of a person with many motives other than compassion and altruism. Human nature has many facets besides love – cupidity, hate, greed – which have been known to misuse euthanasia. It is therefore considered to be a practice coming under criminal law, in all countries, except Holland and a few states in the USA. What then would help a suffering humanity: is there an alternative? Yes, the hospice concept. A hospice is a shelter – initially meant as a rest-house for crusading knights on their way to the Holy Wars. Today, the word means a shelter for the terminally ill and dying – to be sped on their journey to the dark unknown, with love, care, humaneness and peace. It is a natural death – perhaps more lingering than euthanasia, but humane, loved, comforting and tended by soft hands surrounded by God’s mercy – not just ‘mercy killing’ as euthanasia is euphemistically called. The first hospice for dying cancer patients was built in Ireland. The first modern one was built in London in 1967 by Dame Cicely Saunders. The mustard seed sown by her has flourished into a strong sheltering tree. There are hospices for the terminally ill persons (mainly from the dreaded disease, cancer) in Britain, USA, a few in Japan and many in India. The first Indian hospice – the Shanti Avedna ashram – was opened in Bandra, Mumbai, in November 1986 and has completed 20 years. Now it has a new wing to look after terminally ill AIDS patients also. It’ s motto is: “Where there is love, there is no pain” and if there is pain, it is loved. Hospices have spread in large and small Indian cities, and Indian cancer patients, of whom there is a vast number, are well-provided for. Hospices care humanely for the terminally ill; they tend to the dying – medically, emotionally and spiritually – with 24-hour commitment and empathy by a motivated team working in close harmony. Trained counselors also help the family and encourage them to actively share in the care, comfort and support of the dying person. The final days are made as painless, happy and meaningful as possible. Thus the hospice is a boon to the dying and the family. Saunders said very succinctly: “You matter because you are you,You matter to the last moment of your life.And we do all we canNot only to help you die peacefullyBut also to live until you die”. A sunset no doubt, but a glorious one! It is essential to emphasize that hospice care is not passive euthanasia. Take the famous case of Terry Tschiavo, a patient in Tampa, Florida, who was kept alive for over a decade on tube-fed nourishment, without any other life-support systems. Then, at the insistence of her husband, Michael, the only life-support systems – food and water, administered by Ryle’s Tube – were withdrawn and she died within 12 days or so. That was passive euthanasia. In hospice care, when a terminally ill patient with oral or throat cancer is admitted, the first event is to insert a Ryle’s tube for nourishment, because cancers of those sites prevent swallowing. As Michael de Montaigne has said, “Nature forces us to do it: Go out of this world as you entered it. The same passage that you made from death to life, without feeling or fright, make it again from life to death. Your death is a part of the order of the universe, it is a part of the world”. Who would not prefer an end so humane and compassionate as that which the hospice offers? The ideal pattern of death – over which one has no control – is to go during deep slumber. No fuss, no ado; just to slip gently into the good night. It would be a temporary shock to those around – but what a way to go! Comparing the two patterns Euthanasia Hospice Induced death by lethal injection No life- support systems. Food and water (physician-assisted) ad libitum. Instant death Natural death Guilt-ridden family, though the “burden” is Lingering, slow failure of vital systems gone Considered under criminal law naturally (except Holland) Grief-stained relief at the loving farewell Accepted in all religious and societal norms
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