Goya, detail from Self-portrait with Dr Arrieta, 1820

If the ban on assisted suicide, now being hotly debated in Britain, had ever been enforced, the royal family might have been behind bars. For historians claim they were complicit in the lethal injection of cocaine and morphine that ensured that George V’s late-night death missed the inconsequential evening papers to make headlines in the Times. Today, Lord Dawson, the physician who administered the injection, would probably have had prime time TV in mind.

Setting that aside, the debate raises a vital issue that concerns everyone as age and ailment convey intimations of mortality. It is discussed more fervently in affluent societies because the basics of life are so fully guaranteed that it looks like a diminution of individual authority to leave the exit to painful chance. Voluntary termination is less tranquilly contemplated in countries where the struggle for survival makes life itself, in whatever debased form, a luxury. It is ridiculous even to talk of death with dignity in Calcutta when nothing could be more undignified than the way our squalid crematoriums handle the dead. But the choice between lingering suffering and a quick end raises the same social, ethical and legal questions everywhere. It bristles with the same fears of manipulation by unscrupulous relatives motivated by material reasons that surrounded the Hindu practice of suttee.

Making allowance for these factors, the view is gaining ground in the West that terminally ill patients with no hope of recovery are entitled not only to take the decision to die but also to enlist help to facilitate the passage. That implies unimpaired judgment, an irrevocable decision and proof that the process is entirely voluntary. These are not always easy to determine. Modern medicine prolongs life with the hope of recovery. Elaborate counselling can inspire even desperate folk with the wish to live. That urge can flicker back even in the face of the most adverse circumstances. One of my saddest assignments as a very young reporter in Britain was to cover a coroner’s inquest on an unemployed man with an incurable disease whose wife had left him. The man put his head in the gas oven but it was evident from his posture and the oven switch that he changed his mind at some stage. That stage was too late.

The current British debate is not so much about suicide, which remains a crime, as about helping to commit it. The Suicide Act of 1961 stipulates up to 14 years imprisonment for aiding, abetting, counselling or procuring someone’s suicide, but the authorities have so far turned a blind eye to such complicity. Nevertheless, the few who are determined to take their own life and need a helping hand to do so prefer to avoid exposing their helpers (invariably near and loved ones) to the possible rigours of the law. They, therefore, find their way to the Dignitas assisted-suicide clinic near Zurich in Switzerland. They could also go to Belgium, the Netherlands and three American states including Oregon, whose 1994 Death with Dignity Act sanctions volunteer “hasteners”. But, obviously, these options are not open to many, even in a country whose people are comfortably off.

The implicit means test is one cause of argument. The legal anomaly is another. Why should a person get away with doing something abroad that he or she cannot do at home? Beyond that lies the question of whether helping someone to die is tantamount to murder. Though no one mentions George V’s end, Queen Mary, who kissed her royal spouse on the forehead, curtsied and backed out of the room before Dawson’s fatal injection, could be regarded as an accessory to murder. But overshadowing these peripheral dilemmas is the ultimate question about the right to die. None of these questions are contained by national boundaries. Whether or not they are articulated, the questions themselves are universal.

It has all come to the fore because of a number of highly publicized deaths. One was of a paralysed 23-year-old rugby player, Daniel James, whose family helped him to Dignitas. Another was of Diane Pretty, suffering from motor neuron disease, who died in 2002 while her husband’s possible role was being discussed. Several distinguished scientists and academics have signified they will end their lives when they think it appropriate. Nine Chinese victims of uremia have also petitioned for euthanasia. But it’s Debbie Purdy, a musical journalist confined to a wheelchair by multiple sclerosis, who dragged the debate into the open by asking the House of Lords to rule whether her husband, Omar Puente, a Cuban-born violinist she met in Singapore, would be guilty of a punishable offence by helping her to commit suicide. Instructed by the Lords to clarify the legal position, the government has promised new regulations in September. Meanwhile, the director of public prosecution says the “same broad principles will apply” whether the act is committed at home or abroad.

This could mean that what is legal in Switzerland might become legal in Britain. It could also mean that a Briton cannot do something abroad that he or she is not allowed to do at home. Whatever the outcome, legal sanction will not wish away the moral question. Libertarians argue that suicide is the greatest of human freedoms, and that deciding to die is part of the act of living. Francis Bacon held in the early 17th century that an apothecary’s highest duty was to alleviate pain, even if it meant causing death. But that is not the view of the British Medical Association, which overwhelmingly defeated a resolution seeking to legalize assisted dying. Paradoxically, the BMA was less emphatic about prosecuting the escort who helps someone who commits suicide abroad.

Britain’s religious lobby, clinging to the traditional belief that life and death are not matters of human jurisdiction, helped to thwart a bill in the Lords two years ago on assisted suicide. Lord Falconer, a former Lord Chancellor, wants safeguards incorporated in the suicide law and a Labour member of parliament has promised a new bill before the next general election. The most sensible move so far seems to be a measure introduced by Margo MacDonald, a member of the Scottish parliament, that will entitle a terminally ill patient to sign a suicide declaration while still mentally fit and have it attested “by two registered medical practitioners, independently of each other”. If carried out in good faith, the procedure might save a great deal of anguish provided inexpensive or even free local equivalents of the Dignitas centre are also set up as a complementary measure. There is little point in legalizing voluntary death if the means of carrying it out are not also readily available.

Is any of this applicable to India? All of it, I would say, and yet none of it. Human situations are equally poignant the world over, but not institutional conditions. I would be tempted to support some equivalent of MacDonald’s bill but for the knowledge that signatures are easily obtained here and attestation is often not worth the paper on which it is written. But Indians grow old too, suffer from incurable disease, have no one to care for them, and genuinely long for a quick and painless end. Nor is there any lack of courage and independent will. I used to be taken as a child to a site on the outskirts of our ancestral village and told of the ancestress who committed suttee there. Family lore had it that when the daroga came hot foot to prevent the immolation, she held a finger in the flames for him to judge that it was voluntary.

As for the old, the ailing, the helpless and the hopeless, Incredible India’s state hospitals can be relied on to get rid of them in a cruel modern parody of Malthus’ law.