It is interesting to note that the issue of euthanasia was debated in India in 1928. Probably this was the first public debate on euthanasia to be reported. A Calf in Gandhi’s ashram was ailing under great pain. In spite of every possible treatment and nursing... the condition of the calf was so bad that it could not even change its side or even it could not be lifted about in order to prevent pressure ulcers / sores. It could not even take nourishment and was tormented by flies. The surgeon whose advice was sought in this matter declared the case to be past help and past hope. After painful days of hesitation and discussions with the managing committee of Goseva Sangh and the inmates of the ashram, Gandhi made up his mind to end the life of the calf in a painless way as possible. There was a commotion in orthodox circles and Gandhi critically examined the question through his article which appeared in Navajivan (dated 30-9-1928) and Young India (4-10-1928).[ Probably this was the first public debate on euthanasia and animal / veterinary euthanasia and the debate also covered the issue of human euthanasia] It is equally interesting to note that Gandhi and his critics discussed the issue of “painlessly ending the life to end suffering” without using the term “euthanasia”. But, he meant the same. Further it is more interesting to learn that at various instances Gandhiji had touched upon the issues of the present day debates on Voluntary euthanasia, Non-voluntary euthanasia, Involuntary euthanasia, as well as passive euthanasia, active euthanasia, physician-assisted euthanasia and the rejection or “termination of treatment.” Gandhi advocated the development of positive outlook towards life and strived for the humane nursing and medical care even when cure was impossible. It was the way he analysed Karma and submitted to the will of the God.
This paper seeks to touch upon lesser known facts on Gandhi and portrays the social usefulness of Gandhi’s thoughts in changing social reality.
Mahatma Gandhi and the Early Debates on Euthanasia
Euthanasia is a complex, contentious and emotional issue. As and when someone moves the court seeking euthanasia, we see it grabbing the headlines in the media and getting heated up into a polarised debate before dying down! The word euthanasia (eu-tha-na-sia) is derived from the Greek words eu, meaning “good” and thanathos, meaning “death”. Thus, the word euthanasia meaning “easy death” or “happy death” has been defined as the intentional and painless ending of life of a patient suffering from a very painful and incurable disease of terminal nature or irreversible coma. This act or practice of painlessly putting to death came to be identified as “Mercy killing” or “daya maraNa” (in Kannada).
Historically, the first apparent recorded usage of the word “euthanasia” meant “dying quickly without suffering”. It has been mentioned by Philippe Letellier in his work that the early historian Suetonius used this word to describe the death of Emperor Augustus. (“... experienced the “euthanasia” he had wished for..“) Such usages, synonymous to this word are also found in Sanskrit psalms and hymns of ancient India. Thus, the early concept of euthanasia was simply experiencing a “good death” or “easy death” or “happy death” akin to the meaning of Sanskrit synonyms “svacchanda mrithyu” or “anaayaasena maraNam”.
Later, early in the 17th century the English philosopher Sir Francis Bacon used the word “euthanasia” to emphasise on the physician’s responsibility to alleviate the unbearable physical sufferings of the body. This usage came to be identified as the first use of the word “Euthanasia” in the medical context as the painless inducement of an easy death or quick death to end the unbearable and incurable sufferings. Generally, since the early days of its use in the medical context the term euthanasia is popularly known by the term “mercy killing” as the patient suffering from intolerable and incurable suffering is shown mercy by administering of a lethal agent to peacefully end the suffering. Here “euthanasia” is just an intervention to end life and does not mean a natural phenomenon of “easy death” or a death of choice.
With this background study we may infer that the term “euthanasia” used in the medical context finds no correlation with its original meaning in Greek or to the similar words and synonyms of Sanskrit language. And further, none of the religious text and ancient laws do mention about “euthanasia” or similar terms akin to the modern day concept. However, the practice of so called euthanasia to hasten death, or its variants in ancient Greece and Rome, or the one said to be supported by Socrates, Plato and Seneca too needs to be seen separately as a topic different from the present day euthanasia which is a medical intervention. So after leaving behind the burden of historical facts and debates on the ancient context of euthanasia and their forced correlation for validation of the present day realities, we have to limit the scope and extent of this deliberation to “euthanasia” as defined in the medical context and its impact on the Indian society. It is for this discussion the Gandhian perspective provides much relevant resource for reflection.
In the medical context “euthanasia” encompasses many aspects which lead to the intentional termination of life in a painless way to end the suffering that is unbearable and permanently incurable as the modern medicine has no answer or means or interventions available upto the date to cure the malady. Whenever the cure is said to be impossible, “care” or “palliation” becomes the only recourse. When the palliative medicine too fails to alleviate the pain and sufferings the idea of euthanasia seems to be more relevant.
Euthanasia is basically classified into three types:
1) Voluntary euthanasia: This is done under the consent of the patient.
2) Non-voluntary euthanasia: This is the type where the consent of the patient in unavailable or the patient is not mature enough or incapable to give the consent. This requires the consent of the guardian. (In case of infants and children)
3) Involuntary euthanasia: This is done against the will of the patient or at the insistence of another person.
Further, each type can be divided into passive euthanasia, active euthanasia, and Physician assisted euthanasia. Passive euthanasia is the same as the “termination of treatment” or withholding treatment and supportive measures. Active euthanasia is causing death by introducing something lethal. Physician assisted euthanasia is also known as Physician Assisted Suicide, where the physician prescribes the drug and the patient takes it or the third party administers it to cause death. Active euthanasia, Physician assisted suicide and all forms of involuntary euthanasia are illegal, unethical and unacceptable to the civilised society. In addition to the above mentioned variants there is a less known and subtle way of inducing death to a terminally ill patient. This is done by the administration of high dose pain medication that relives pain and may also hasten death. Hence it is known as the rule of double effect to painlessly end life.
The life supporting interventions of the modern critical care medicine and practice has done incredible things to prolong life and meticulously work towards bringing the patient out of danger and gradually back to the normal health. But, one cannot be certain about the outcomes of the high risk treatments that prolong life with an optimistic intent. If anything goes wrong at any stage then the condition of the patient may worsen to make him / her totally dependent on artificial support systems. On the other side, the lack of affordable medical infrastructure and tertiary healthcare facilities has added to the increase in the number of terminally ill patients. Thus the issue of euthanasia arises due to the incapability and inconsistencies of the modern medicine or due to the shortcomings of the health care sector and the absence of competent palliative healthcare infrastructure. Therefore, with the given plight of the sufferers and their caregivers, any debate on euthanasia cuts across many aspects such as ethical, legal, religious, cultural and humanitarian issues which prick the conscience of the civilised society. It is at this context, as a researcher working on Gandhian Studies, I like to examine and place before you the Gandhian perspectives on Euthanasia.
Instances reflecting Gandhiji's perspectives on Euthanasia
1) Case of an ailing calf (September, 1928)
A Calf in Gandhi's ashram was ailing under great pain. In spite of every possible treatment and nursing... the condition of the calf was so bad that it could not even change its side or even it could not be lifted about in order to prevent pressure ulcers / sores. It could not even take nourishment and was tormented by the flies. The surgeon whose advice was sought in this matter declared the case to be past help and past hope. After painful days of hesitation and discussions with the managing committee of Goseva Sangh and the inmates of the ashram, Gandhi made up his mind to end the life of the calf in a painless way as possible.
There was a commotion in orthodox circles and Gandhi critically examined the question through his article which appeared in Navajivan (dated 30-9-1928) and YI (4-10-1928).[ Probably this was the first public debate on this cause in India]
"In these circumstances I felt that humanity demanded that the agony should be ended by ending life itself. The matter was placed before the whole ashram. At the discussion a worthy neighbour vehemently opposed the idea of killing even to end pain. The ground of his opposition was that one has no right to take away life which one cannot create. His argument seemed to me to be pointless here. It would have point if the taking of life was actuated by self-interest. Finally, in all humility but with the clearest of convictions, I got in my presence a doctor kindly to administer the calf a quietus by means of a poison injection. The whole thing was over in less than two minutes.
"But the question may very legitimately be put to me: would I apply the same principle to human beings? Would I like it to be applied in my own case? My reply is 'yes'; the same law holds good in both the cases. The law, 'as with one so with all', admits of no exceptions, or the killing of the calf was wrong and violent. In practice, however, we do not cut short the sufferings of our ailing dear ones by death because, as a rule, we have always means at our disposal to help them and they have the capacity to think and decide for themselves. But supposing that in the case of an ailing friend, I am unable to render any aid whatever and recovery is out of question and the patient is lying in an unconscious state in the throes of agony, then I would not see any himsa in putting an end to his suffering by death.
"Just as a surgeon does not commit himsa but practises the purest ahimsa when he wields his knife, one may find it necessary, under certain imperative circumstances, to go a step further and sever life from the body in the interest of the sufferer. It may be objected that whereas the surgeon performs his operation to save the life of the patient, in the other case we do just the reverse. But on a deeper analysis it will be found that the ultimate object sought to be served in both the cases is the same, namely, to relieve the suffering soul within from pain. In the one case you do it by severing the diseased portion from the body, in the other you do it by severing from the soul the body that has become an instrument of torture to it. In either case it is the relief of the soul within from pain that is aimed at, the body without the life within being incapable of feeling either pleasure or pain.
"To conclude then, to cause pain or wish ill to or to take the life of any living being out of anger or a selfish intent, is himsa. On the other hand, after a calm and clear judgement to kill or cause pain to a living being from a pure selfless intent may be the purest form of ahimsa. Each such case must be judged individually and on its own merits. The final test as to its violence or non-violence is after all the intent underlying the act.”
This stand of Gandhi was criticised by many readers. Gandhi answered to their objections through his journals Navajivan, dated 7-10-1928 and Young India, dated 11-10-1928. Below are the questions put by his critics followed by his answers:
1. If you believe in the law of karma then your killing of the calf was a vain attempt to interfere with the operation of that law...
“I firmly believe in the law of karma, but I believe too in human endeavour. I regard as the summum bonum of life the attainment of salvation through karma by annihilating its effects by detachment. If it is a violation of the law of karma to cut short the agony of an ailing animal by putting an end to its life, it is no less so to minister to the sick or try to nurse them back to life. And yet if a man were to refuse to give medicine to a patient or to nurse him on the ground of karma, we would hold him to be guilty of inhumanity and himsa. Without therefore entering into a discussion about the eternal controversy regarding predestination and free will I will simply say here that I deem it to be the highest duty of man to render what little service he can.”
2. What warrant had you for believing that the calf was bound not to recover? Have you not heard of cases of recovery after the doctors have pronounced them to be hopeless?
“I admit that there was no guarantee that the calf would not recover. I have certainly known cases that were pronounced by doctors to be hopeless and were cured afterwards. But even so I hold that a man is bound to make the utmost use of his reason, circumscribed and poor as undoubtedly it is, and to try to penetrate the mists of ignorance by its light and try to act accordingly. And that is precisely what we do in countless cases in our everyday life. But strangely paradoxical as it may seem, it is nevertheless a fact that the moment we come to think of death the very idea frightens us out of our wits and entirely paralyses our reasoning faculty, although as Hindus we ought to be the least affected by the thought of death, since from the very cradle we are brought up on the doctrines of the immortality of the spirit and the transitoriness of the body. Even if it were found that my decision to poison the calf was wrong, it could have done no harm to the soul of the animal. If I have erred I am prepared to take the consequences of my error, but I refuse to go into hysterics because by my action I possibly cut short the painful existence of a dying calf say by a couple of hours. And the rule that I have applied to the calf I am prepared to apply in the case of my own dear ones as well.
Who knows how often we bring those we love to a premature end by our coddling, infatuation, wrong diagnosis or wrong treatment?”
In the above case of active euthanasia, Gandhi appears to be a strong supporter of euthanasia. He is also critical about medical negligence or wrong diagnosis or wrong treatment that brings unwanted death.
This case can be taken as an instance of veterinary euthanasia which catapulted itself into a debate of ills and wells of all sorts of euthanasia/mercy killing/ culling for ending the suffering! At this juncture, he speaks of applying the same in the worst cases of ailing human beings when cure and care are impossible and the minimal maintenance too fails!
2. Parchure Shastri’s case (Yeravda 1932)
Parchure Shastri was a Sanskrit scholar suffering from a highly infectious type of leprosy. He wrote to Gandhi quoting some Sanskrit verses and asked whether he could end his life, as he was not likely to be of any use to the society. In his reply Gandhi wrote:
“If you are really convinced that you would not be able to do any service to the society, that you would be only a burden to society, well, I feel there should not be any objection for ending the life. But I would not advise ending life by drowning. I would feel it more advisable to end one’s life by observing fast.”
Here we can observe that though the ailing Shashtri was determined to euthanatize himself by drowning, Gandhi was of the view that Shashtri’s suffering was not due to terminal illness but was due to the frustration of stigma and societal rejection. However, in this case Parchure Shastri did not end up his life. Instead he became the inmate of Gandhi’s Sevagram Ashram and Gandhi himself nursed and looked after him. And this was a striking instance that demonstrated Gandhi’s commitment to ‘care’ when ‘cure’ was totally impossible. Gandhi’s words had instilled confidence in the patient. Gandhi provided shelter and care to him and the patient was asked by Gandhi to recite verses from the scriptures and also to officiate as a priest! This is the humane face of care giving which helps the patients to come out of extreme anxiety.
Here is Gandhi’s letter to Shastri:
May 7, 1945
BHAI PARACHURE SHASTRI,
I have your beautiful letter in Sanskrit. You have risen from the death-bed. Recover fully. Achieve complete victory over the mind. I am well. Blessings from BAPU.
3. In a talk with with Jairamdas doulatram (May 21,1935)
“ A lingering death is worse than a quick death brought about by disregarding or refusing the artificial aids that the so called science has provided.”
Here Gandhi’s thought sounds akin to the present day concept of refusal of life-supportive measures through artificial means and machines that could prolong life even when care and minimal maintenance becomes impossible.
4. In Kasturba Gandhi’s Case:
By February 20, 1944... Kasturbai's condition was declared grave. Devadas Gandhi was for the penicillin injections as a last remedy, but his father advised against it.
"You cannot cure your mother now, no matter what wonder drugs you may muster. I will yield to you if you insist. But you are hopelessly wrong she has refused medicines and water these two days. She is in God's hands now.
“You may interfere, if you wish to, but I advise against the course you are now adopting. And remember you are seeking to cause physical pain by an injection every four or six hours to a dying mother."
In this case Gandhi’s view can be compared to today’s rejection / termination of treatment or ‘the refusal to give consent’ that has been partially recognised as a right of patients and their kin. It is seen as a way to minimize the suffering due to the harmful effects of the high risk treatments and procedures when the death is certain and imminent.
The instances mentioned above do validate that Gandhi supported euthanasia. His views were based on a paradigm of selflessness different from today’s basis for the debate on euthanasia. In spite of his act of allowing euthanasia to the ailing calf in his Ashram, Gandhi had not generalised euthanasia as the only alternative to end the suffering of the patients who were in vegetative state due to terminal illness. He viewed it as the last option to be exercised after much contemplation. According to him each case was to be judged on its own merits and its degree of ‘selfless intent’. This is where the Gandhian ethical excellence of selflessness precedes the necessity of an action even if it is sanctioned by law. From the instances discussed earlier we can identify Gandhi’s strong commitment to Ahimsa and humanitarian ‘care’ even when ‘cure’ was totally impossible but life was bearable. In a way it can be concluded that the Gandhian perspective upholds selflessness, Ahimsa, Patient Autonomy, Self-determination and the right to die with dignity. For a student, researcher and an enthusiast on Gandhi, Law, Public Policy, Spiritualism and Medicine; these instances and early debates / contemplations provide a better insight and outlook on Gandhi’s concept of Ahimsa. In totality, when viewed in the perspective of Gandhian Studies these aspects throw light upon the lesser known / unknown facets of Gandhi and the usefulness of Gandhian thoughts in the changing social reality.
Bibliography / References:
[This write-up is prepared for the purpose of education and inter-seminar discussions]
[ Mr. Vinith Rao, Researcher & Coordinator, Gandhian Study Centre, MGM College, Udupi -576102]
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