Human Life and Problems Venerable K. Sri Dhammananda

Human Life and Problems
Venerable K. Sri Dhammananda

PATIENTS IN A VEGETATIVE STATE AND EUTHANASIA

What is euthanasia, one might ask? It is a word derived from two Greek words: eu meaning good, and thanathos meaning death. Put together, it means, good death.

There has been a long-standing debate on whether legalising euthanasia (where terminally ill people are allowed to commit suicide with the assistance of doctors) is murder or 'mercy killing'. 

The argument for legal voluntary euthanasia states that people ought to be able to die with grace, dignity and in a compassionate manner.

When a member of one's family or a relative becomes seriously ill and develops complications which result in an irreversible coma, he will invariably end up being in a 'vegetative state', or 'brain death', for the rest of his remaining life, causing much sorrow and concern to family members who will have to care and nurse him - a heavy burden indeed which will have to be borne with great courage and fortitude.

'Persistent vegetative state' is an expression which has recently come into use in the medical profession. The 'vegetative state' arises from a severe form of brain damage which results in the patient being unable to move voluntarily, speak or swallow. 

But he can otherwise breathe and the heart beats without assistance. If there are movements, they appear to be reflex actions rather than purposeful gestures.

As life-prolonging technology improves, society is being forced to confront a very basic question: When, exactly, does life end? While there is almost universal agreement that complete loss of brain function is equivalent to death, a debate rages among doctors and the general public alike, when it comes to patients in the persistent vegetative state (PVS).

The diagnosis of 'persistent vegetative state,' according to the Royal College of Physicians in Britain, can be made after a patient has been in an apparently 'vegetative state' for 12 months. As a description of a person suffering from this condition, 'vegetative state' is an unfortunate choice, for human beings are of an entirely different order of creation from vegetables.

The body may die but there is life after death. This belief was held even by the philosopher Plato, who had no idea of revealed religion, over two thousand years ago.

Added to the unimaginable suffering of being unable to move or communicate with their family or those caring for them, these unfortunate people have suffered the humiliation of being discussed and treated as if they were 'vegetative'. And worse, in a number of those cases, at the request of relatives, the sufferers were deprived of nutrition. The relatives described it as 'allowing them to die.' Others describe it as 'starving them to death'.

Surely there is a lesson here for all of us. Life is infinitely precious and there is no justification for taking away the life of a sick person. Indeed, we have an obligation to guard it and strive to make him or her well or, if that is not possible, at least as comfortable as we can.

There is a major distinction in principle between taking steps to end the life of a fellow human being and taking steps to eliminate or minimise pain, to give the sufferer comfort and to preserve his dignity until he breathes his last. Life is sacred and every human being is worthy of respect.

Is a person legally dead if he is in a coma and his vital organs are kept alive by an apparatus of some kind? 

The advanced medical technology and sophisticated procedures available in this century have posed a dilemma to many, as for instance, taking care of people in irreversible coma, commonly known as 'brain death'.

Before recent medical advances, when a patient's heart or lungs failed, his brain would also go 'dead' in no time. Similarly, when the brain failed, heart and lung failure would soon follow.

While medical opinion is more or less thus settled, the legal consequences of doctors' action or inaction in such cases remain questionable. Will they be liable to a charge of murder or manslaughter if they switch off the life-supporting machine in hopeless cases?

Euthanasia, or 'mercy killing' in crude language, is generally understood to mean the merciful act of painlessly terminating the life of a patient suffering from an incurable disease. It is legally and religiously prohibited in the case of humans. While permitting doctors to discontinue treatment, it is illegal for doctors to administer a lethal drug or injection to terminate the patient's life. It is so even though such course of action was prompted by a humanitarian desire to end the suffering.

All this does not however mean prolonging a life at any cost when it is plainly nearing its end. Allowing someone to die implies a recognition that there is some point in terminal illness when further curative treatment has no purpose and that a person in this situation should be allowed to die a natural death in peace and dignity. In no way, should this involve active or wilful destruction of someone's life. Rather, it involves a refusal to start curative treatment when no known cure is possible. While we should respect a person's wish and right to die, we need not assist him to die or commit suicide.

Where as the law considers that the discontinuance of life support may be consistent with the doctor's duty to care for his patient, it does not, for reasons of policy consider that it forms any part of his duty to give his patient a lethal injection to put him out of his agony.

The legal liability of a person who assumes responsibility for the care of another who cannot look after himself, for example, a baby or a frail person, and making the person who is in charge of the other liable for murder or manslaughter for his omission is the same as before. While we should welcome medical technology and the use of new devices such as 'miracle' drugs, organ transplants, haemodialysis machines and so on, we should guard against going down the slippery slope to the valley of euthanasia.

In disconnecting life-support machines after brain death, it is not an exaggeration to say this is a common problem for doctors and next-of-kin of the dying patient. The poser is: Is it better for death to be accelerated in obviously hopeless cases by disconnecting the life-supporting machine?' An immediate thought occurring to mind is, how can we be absolutely sure that the case is hopeless? Miracles can and do happen, although rarely. Whether right or not, one can only safely conclude that there are many unexplained mysteries in this world. This is a matter that has been agitating the minds of the orient for many years.

Buddhism does not countenance euthanasia for two reasons. The first is that every living being has the results of its own past karma to work out, and any interference with his situation will not be anything more than a temporary alleviation of the suffering it is bound to endure. The second reason for condemning the mistaken support for euthanasia concerns the doer and the deed. The very act of killing, whatever its apparent motive, may be related to separation of life from the physical body intentionally which goes against the natural formation of life according to the following five factors: mental - energy, karmic energy, germinal order, seasonal order and the order of natural phenomena. The feeling takes the form of repugnance towards suffering that is being witnessed. He disguises his real feeling as a morally praise-worthy action, and so rationalises and justifies it to himself. If he understood his own psychology better, the hidden forces of cruetly arise at the time of committing the deed.

This does not, however, prohibit the use of sedation and other therapeutic sources to allay the suffering of any person. To be able to relieve someone from suffering by any means and to create an atmosphere for healing should be considered as laudable. All those involved in the alleviation of suffering and in service of the sick should cultivate awareness in their everyday work not merely as an academic and humanitarian involvement, but also associate themselves in the truth that is a psychological process in eliminating selfishness, aversion and delusion.

31 March 2023