K. Venkatesh passed away on December 17. His poignant efforts to serve others even in death raise profound moral questions that no society will find easy to answer. Venkatesh came to national attention when his mother appealed to the Andhra Pradesh high court that her son be allowed to die before incurable muscular dystrophy rendered his organs unfit for donation. The court rejected his initial request, but then appointed a panel of doctors to look into the matter. But death does not operate according to the schedule of the court.
In this case, there were actually two distinct questions at stake. The first was whether there are circumstances in which the Indian state should legally permit euthanasia. The second was whether Venkatesh's particular grounds for seeking termination of his life should be valid in any permissible scheme allowing for voluntary euthanasia. The answer to the first question should be a qualified 'Yes', the answer to the second, 'No'. But what the case clearly highlights is the archaic nature of our laws. The law governing suicide is still framed within a 19th-century ' and, one must say, Christian ' framework that criminalizes it. And despite the Supreme Court's judgment in Gian Kaur vs State of Punjab (1996), drawing a distinction between suicide and euthanasia, no legal framework exists to address this delicate question.
This morally sensitive question is not amenable to resolution within the inflated rhetoric of rights. The right to die is not, as the Supreme Court implied in the Rathinam case (1994), a right in the sense that its unilateral exercise can be freely permitted. Society has a stake in the death of individuals by virtue of that death's consequences. It also has an interest in affirming the sacredness and value of life. But the term, 'sanctity of life', can mean two different things. It can mean that life is immensely valuable and ought to be preserved. Or it can mean something stronger: that there are no circumstances under which anything else can ever override the importance of life.
The latter claim is obviously false. It would imply that even the slightest risk to life is morally condemnable. I doubt if much that is characteristic of human activity would survive such a view of the absolute unconditional importance of life itself. And the practices of many Indian religious traditions (apart from the more deplorable case for sati), sallekhana in Jainism for example, have made room for some form of voluntary euthanasia. The sanctity of life does not entail that there are no circumstances where prolonging life is not simply an affront to the value of life itself.
The core argument for permitting voluntary euthanasia is based on an idea of autonomy. We respect people when we treat them as authors of their own lives. Part of what it means to be an author of your own life is to make important decisions concerning that life in accordance with your own conception of how you want your life to go. Many people think that decisions about dying ought to be part of this conception of authorship over your life. This is not simply because they fear the suffering that might be involved during the last stages of life. Like Venkatesh, they desire to retain their dignity and as much control as possible during the terminal phase of their life.
Consider a condition in which a patient is suffering from a terminal illness, with little possibility of benefiting from a cure and is, as a direct result of that illness, in impossible mental and physical agony and impossibly dependent upon others or upon technology to keep a bare remnant of life alive. Such a patient ought to have the option of a dignified exit. To insist on an absolutist conception of the sacredness of life in the face of such suffering is to hold a concrete person hostage to the abstract value of life. It is to respect an abstraction called Life, rather than the concrete person who embodies it.
The real difficulty in recognizing voluntary euthanasia is practical. There are three lines that are very difficult to draw in practice. The first is ascertaining whether a patient has indeed reached a stage where the affront to the dignity of life far surpasses the value of life. The second issue is ascertaining whether the patient did or would have given free consent to hasten his own death. The line between a free decision and one taken under pressure is immensely thin and there are few clear ways of drawing it. The third issue that makes euthanasia complicated is that it calls into question the distinction between acts and omissions that is central to our morality. What exactly is the distinction between killing someone and not taking steps to prolong his life' And if passive euthanasia, letting someone die, is permitted, why shouldn't active euthanasia, taking steps to hasten death, also be permitted'
Finally, is permitting voluntary euthanasia a slippery slope towards permitting non-voluntary forms of euthanasia as well' Even if it is not literally true, would we not be better off affirming the absolute sacredness of life over the value of autonomy' At least, that is a safe protection against abuse.
More than abstract arguments, these practical difficulties have prevented most societies from legalizing euthanasia. The Netherlands and Belgium have the most liberal regime in this respect, and in the United States of America, the supreme court has left it up to individual states to allow euthanasia. In the end, I suspect the decision to legalize euthanasia turns, not on abstract arguments over the value of life or the claims of autonomy. It will turn upon the confidence a society has that its institutions, doctors, families and patients, can draw the lines in the right kind of way. The weight of practical difficulties suggests that euthanasia should be made legal, but subject to stringent conditions that make it very rare.
Venkatesh's desire to serve others through donating his organs was exemplary. But had the court allowed the use of his organs before he was brain dead, it would have contravened the Transplantation of Human Organs Act that prohibits the use of organs before a patient is brain dead. There is a separate debate over whether the definition of brain death is too stringent a condition on permitting the use of a dying patient's organs, in particular because modern technology can keep a patient alive well beyond any common-sense definition of life. This issue is distinct from the issue of euthanasia. Again, the issue of exactly where the line is to be drawn is a tricky one. But there is a good case to be made that the presumption should be in favour of the stringent definition.
If the argument for voluntary euthanasia is premised upon the value of autonomy, then it is in society's interest to affirm that individuals not be treated as instruments to others' goals. In the clich'd philosophers example, it would be wrong for a doctor to kill a patient even if killing the patient would yield organs that could save three other lives. The value of life and the value of autonomy cannot be made subject to a utilitarian calculus. Subjecting life to such a calculus would risk making an individual life valuable because of its instrumental value. And a society that treats individuals as instruments is not a society that is likely to respect life, autonomy or persons.
The stringent definition of brain death is to guard against such use of patients. So while there may be a case for euthanasia, that case ought not to be made to rest upon the fact that donated organs might be valuable to others. But although Venkatesh's wish was not granted by the court, even in death he has affirmed the value of life, by raising profound questions about its meaning and value.