The technology of life-sustenance is double-edged. The question of how long a terminally ill patient, for whom treatment is indisputably understood to be futile, should be kept alive by artificial means has been growing more urgent over the years. Euthanasia, that is, physician-assisted suicide, or its other forms, in which the question of the patient?s wish is predominant, is an intensely debated issue all over the world. Supporters of this feel that everyone should have the right to die with dignity. But, for that, heavy legal and medical safeguards are necessary, which very few countries, such as the Netherlands, or states, like the American state of Oregon, are confident enough to offer. The Indian Society of Critical Care Medicine has not talked about euthanasia, but about conditions for the possible withdrawal or withholding of treatment, in its recent recommendation to the law commission. While dying with dignity is the premise of all such proposals, the society has emphasized the need for comfort care for the terminally ill.

Withdrawal of artificial means of prolonging life, such as mechanical or other ways of ventilation or nutrition when the patient is in non-reversible coma, would lessen the emotional and financial burden on the patient?s family and would ensure better use of intensive care facilities. The driving principle here is that treatment is known to be futile. The society?s guidelines are eminently reasonable, but they assume a certain level of professional integrity both among medical practitioners as well as in the medical institutions. The process of dying offers benefits to many. While that is unforgivable and should be stopped, it is also true that in a country with such widely varying economic and educational standards, limiting artificial prolonging of life may pose its own dangers. There are people in India who have been compelled to become professional blood donors, people have been known to sell a kidney in desperation. Selling an organ for a transplant operation is not quite an above board operation with altruistic operators. The recommendations of the Indian Society of Critical Care Medicine are truly welcome, but all the possibilities have to be thought through with care before consideration. A commercial website selling organs, like the website selling euthanasia in Cambodia, would not be helpful.