DEALING WITH DEATH

T. VIJAYENDRA

Sangatya

CONTENTS Prolonging Death: Capitalism And Old Age

Living Will / Advance Directive

Florence Nightingale The Blac !ole

"n #emoriam: $itaram $hastr% &'thanasia( $'icide And $an%asa

PROLONGING DEATH
Capitalism and Old Ag "* W!" Wants Old P "pl #

"+d li e to ,e -or ing 'p to . da%s ,e/ore " die* B't " am not li el% to* " envied m% /ather ,eca'se he died at the age o/ 01 and still -as managing his a//airs on his o-n* On the other hand( m% mother -as incapacitated /or man% %ears and the last /e- months she developed ,edsores and died in miser%( and ever%one -as happ% to see her go2 " am 3) %ear old and it scares me 4li e it does so man% o/ 's5 that " ma% have the same /ate as m% mother had* From the age o/ 61( " have ,een on asthma medicine( /rom the age o/ 31 " am on ,lood press're and cholesterol medicine and no- m% nees are getting reall% pain/'l* What triggered this essa% -as the ne-s coverage o/ deaths in France* Deaths in France $ometime ,ac a,o't 16(111 old people died in France d'ring an 'n's'all% hot s'mmer* France has a longevit% /ig're o/ 07 %ears* #ost o/ these old people lived in old age homes* #ost doctors and relatives had gone /or vacations to 8hotter+ climates* The ,odies sta%ed in morg'es /or -ee s* &ven a/ter their ret'rn( man% relatives did not -ant to claim these ,odies and let the $tate arrange the /'neral* &ver%,od% ,lamed ever%,od% incl'ding glo,al -arming* One 'nstated lo'd /act -as that ever%one -as relieved that the% died( perhaps incl'ding some o/ the old people themselves* What happened in France is( o/ co'rse( an e9treme case* "n most a//l'ent co'ntries the n'm,er o/ old people is increasing at an alarming rate* "n developing co'ntries( too( the rich and the middle class are living longer* "ndia has an average longevit% /ig're o/ 3: %ears* Comm'nities are d%ing and so are the traditional s'pport s%stems /or the old people* There are not eno'gh old;age homes and /e- o/ them are ade<'ate* II. Old Ag is a N $ P! n"m n"n Till the 1=th cent'r% most people died ,e/ore the% reached the age o/ 61* &ven toda% most poor people in Asia( A/rica and Latin America die earl%* Th's( the longevit% /ig're o/ 3: %ears /or "ndia act'all% means that the a//l'ent here are living m'ch longer than 3: %ears and that the poor are still d%ing ,e/ore the% reach 61 or so* Toda%( in "ndia( there are a,o't :6 million old people a,ove the age o/ 31 %ears( -hich is a,o't :*6 > o/ "ndia+s pop'lation* "n the 8developed+ co'ntries this percentage is higher and in the poorer co'ntries it is lo-er* These old people on the -hole are is a ,'rden on the earth* 4This incl'des the present a'thor also*5 #ost o/ them 4this incl'des the present a'thor also5 are p're cons'mers* And since the% are /rom a//l'ent societies( their cons'mption levels are /ar a,ove average* "n the mar et it is the %o'ng -ho are so'ght a/ter* Older people are /orced to retire* The% do not /ind an% prod'ctive or meaning/'l -or * B't no- the reverse is also tr'e in the West ? ,eca'se o/ the pensions crisis people are ,eing -arned the% -ill have to -or till :1( li e it or not2 Possi,l% the pension /'nd .

managers -ant people to die ,e/ore the% can claim their pensions2 A /e- old people are o/ co'rse ver% rich and po-er/'l* #ost o/ these are corr'pt politicians and ,'siness people* At the other end( there are a /e- old people -ho are 8nice+ people( that is( -ise( caring( lova,le and respected* B't the over-helming ma@orit% o/ old people are ordinar% 'n-anted people2 """* Old Ag is a Ra%& t'

The Medico-industrial complex Old age is a rac et created ,% the medico;ind'strial comple9* This is the second largest ,'siness a/ter the armament ind'str%* Both control people and nations* The medico ind'strial comple9 controls people and nations ,% creating dependencies* A'st as the militar%;ind'strial comple9 s'rvives on small;scale contin'o's -ar/are( the medico;ind'strial comple9 also s'rvives in rich people having prolonged illnesses( involving e9pensive treatment( ,'t not d%ing* People a,ove 31 %ears o/ age ideall% s'it this p'rpose and the% pa% nearl% :1> o/ the medical ,ills* This is a ne9's o/ loot ,et-een the health care s%stem( medical technolog%( dr'g ind'str%( pension and ins'rance schemes and ho'sing ind'str%* Britain is an e9ception( -here the National !ealth provides health services /ree at the point o/ deliver%* Capitalism s'rvives on individ'alism and insec'rit%* A /ear o/ old age is generated right /rom the da% one starts -or * $ocial sec'rit%( pension and ins'rance scheme v'lt'res arrive -ith one+s /irst pa% chec * Credit cards( loans /or cons'mer d'ra,les and ho'sing loans /ollo-* A ,ig ch'n o/ one+s pa% chec vanishes into pension and ins'rance scams* Lovel% media images are created as to ho- a -ise old man is en@o%ing his old age -ith children and grandchildren2 No- each o/ these is a -ell; no-n rac et* &ver%da% some-here or the other a pension or ins'rance scam is ,eing e9posed* When old age act'all% arrives the pro,lems sho- 'p* The ho'se has to ,e repaired reg'larl% ,eca'se the constr'ction is poor* With &ver% ,rea /ast %o' are s-allo-ing hal/ a doBen pills to eep this or that s%mptom 'nder control* And %o'r pension is not eno'gh* And as -e said a,ove the old people are 'n-anted( lonel%( 'nhealth%( depressed and 'nhapp%* The% are living in -hat the nat'ralists call 8Boo conditions+* For e9ample( in nat're a sparrolives a,o't . %ears* "n a cage( ho-ever( it can live 'p to 1. %ears2 B't a ,ird in a cage is also lonel%( 'nhealth%( depressed and 'nhapp%* A'st li e o'r old people2 The abuse of medical ethics Boo s have appeared a,o't ho- rapacio's the dr'g ind'str% is* "rrational tests and s'rgical proced'res ta e a ,ig toll on mone%( health and sometime li/e too* !o-ever( it is in the interest o/ the ind'str% to eep the patient ill ,'t alive* One o/ the -orst a,'ses o/ the health care s%stem is prolonging death* As "van "llich has said( death is de/ined as the stage -hen the patient is 'na,le to pa%* A ne- c'lt're has come into ,eing sa%ing that li/e per se is precio's and that a person has to ,e ept alive no matter ho- m'ch he is 7

s'//ering or -hether he himsel/ -ants to live s'ch a li/e* $ome time( the converse can also ,e tr'e* Cecentl%( a man -ith inc'ra,le disease -ent to the Co'rt o/ !'man Cights to ma e s're that doctors don+t stop li/e s'pport s%stems* "n other -ords( he -ants to go on e9isting( even in a vegeta,le state* "n this( the religio's organiBations( and partic'larl% the Catholic Ch'rch( have pla%ed a po-er/'l role* This has led to an enormo's amo'nt o/ s'//ering to the patients and their /amilies* "n man% cases it has also /inanciall% ,ro en the /amilies* On the other hand( millions o/ %o'ng people are d%ing all over the -orld /rom 8c'ra,le+ diseases li e malaria( t',erc'losis( lepros%( cholera and diarrhoea* B't the% cannot pa% and hence the% have to die2 "D* A (Nat)*al+ li, '

What is a t%pical nat'ral li/eE We @'st have to see a tri,al /amil%( -hich is not %et serio'sl% a//ected ,% 8modern+ li/e* Fp to the age o/ /ive or so the child sta%s near mother and the /amil%* #an% children died at child,irth or a /e- %ears later i/ the% -ere -ea lings* Then( the child starts going o't -ith the elders and helps in some activities that helps the /amil%* This can ,e /ood gathering( carr%ing and /etching* "t is also an apprenticeship* The child learns a lot* B% t-elve %ears s/he starts vent'ring alone or 8gangs+ o/ children ,egin moving on their o-n( e9ploring( learning and getting to ,e sel/;s'//icient* B% eighteen( the %o'ng ad'lts start their o-n /amilies( ,% thirt% all the children are ,orn and ,% the time the% are /ort% the% are read% to go2 #ost 8old+ people in their /orties contin'e to -or till a /e- da%s ,e/ore the% die* The% 's'all% die -ith ver% /e- da%s+ illness or none* The ca'ses o/ death are more 8nat'ral+ and not 8Boo condition+ deaths o/ contemporar% old people* These can ,e h'nger and /amine( enco'nters -ith -ild li/e( poisono's insects( reptiles( ,acterial and viral disease and accidents* $'ch a li/e does not /ace the diseases o/ o'r time( s'ch as cancer( heart attac ( ,ac ache( dia,etes or even menopa'se* #ost o/ these occ'r a/ter 61 and are related to li/est%le patterns* Their li/e c%cles are similar to other living ,eings in nat're* #ost people till the 1=th cent'r% lived this ind o/ li/e* Fntil )11 %ears ago( there -as no pop'lation pro,lem* "n 11(111 B*C* the pop'lation o/ h'mans on earth -as less than a million2 Lessons from the past What -as the ,asis o/ li/e in the pastE One -as that ever%one -as -or ing( altho'gh the% -or ed m'ch less than -e do* This -as so ,eca'se there -as no leis'red class 4-hich cons'med enormo's reso'rces5 to ,e s'pported( and the nat'ral reso'rce ,ase availa,le -as m'ch higher* Toda% there are h'ge -aste/'l ind'stries s'ch as armament( pharmace'ticals( cosmetics( to,acco( alcohol and so on( -hich g'BBle nat'ral reso'rces* The% also demand h'man la,o'r and cons'merism( all o/ -hich ca'se m'ch o/ o'r pro,lems toda%* $econdl%( individ'alism and cons'merism in modern societ% is ,rea ing do-n comm'nities* "n the past( the /amil% and comm'nit% provided m'ch o/ the caring needed in illnesses* Ph%sical la,o'r( reviving comm'nities and red'cing cons'merism is the main lesson -e can learn /rom the past*

D*

Li-ing $it! Dignity

Reviving communities/ communities of a new type To revive comm'nities( /irst -e have to 'nderstand -h% comm'nities are ,rea ing do-n* The% are ,rea ing do-n ,eca'se the old societ% -as 'n/ree in man% -a%s and c'r,ed people+s aspirations* No- that cannot ,e reversed* Old t%pe o/ comm'nities comm'nities have to go2 The driving /orces are individ'alism and cash econom%* "/ %o' have mone% in %o'r poc et %o' are /ree to do -hat %o' -ant to do2 No-( individ'alism has come to sta% ,eca'se people cannot give 'p the /reedom the% have achieved* B't dependence on cash econom% and cons'merism can ,e red'ced* The need /or comm'nit% -ill al-a%s ,e there ,eca'se the h'man species is a social species* What -e need is a ne- t%pe o/ comm'nit%* A comm'nit% not ,ased on po-er and a'thorit% ,'t on /reedom* A /ree association o/ /ree people2 "n s'ch a sit'ation the insec'rities -ill ,e less and one can avoid( to a large e9tent( the rapacio's ne9's o/ medical ind'strial comple9( ins'rance scams and ho'sing loans* A rational health care The rational health care -ill essentiall% ,e ,ased on comm'nit% care* "t -ill ,e ,ased on caring and not /leecing* "t -ill ,e ,ased on a health% li/e st%le ? a good mi9 o/ mental and man'al o'tdoor -or ( a health% diet and a stress;/ree( peace/'l tran<'il li/e2 "llnesses and diseases can and -ill still occ'r ,'t the% can ,e more e//ectivel% dealt -ith in s'ch a sit'ation* "n health care there are three components ? no-ledge ,ased reass'rance( relie/ and c're ? in decreasing order o/ importance* A -ell;trained and e9perienced doctor can indeed pla% a ver% important role* !o-ever( he -ill ,e m'ch more e//ective in delivering health care in a comm'nit% ,ased health care s%stem than in the present mar et ,ased s%stem* VI. Dying $it! Dignity. D"%t"*s and D at! #ost classics in medical literat're( in all s%stems o/ medicine( as the doctor to respect people( red'ce their s'//erings and -hen death is inevita,le( not to prolong the miser%* !o-ever( as -e have seen a,ove( a ne- c'lt're has come into ,eing -here prolonging li/e at all costs has ,ecome a l'crative ,'siness at the cost o/ the patients and their /amilies* O/ten( doctors are helpless ,eca'se o/ the press're o/ this c'lt're and the possi,ilit% o/ the patient+s /amilies ta ing them to co'rt* Famil% mem,ers( in t'rn( /eel helpless lest their neigh,o'rs sa% that to save mone% these people let the patient die2 We need to restore the concept o/ living and d%ing -ith dignit%* Euthanasia and the Living Will There are man% cases -here it is no longer good to prolong li/e( -hich in /act amo'nts to prolonging death* "n some co'ntries medicall% assisted death is legal* !o-ever( in most co'ntries it is not and man% ma% not -ant it* For s'ch cases( a 8Living Will / Advance Directive+ is 'se/'l* "t is made -hen the person is o/ so'nd mind and gives his/her directive to doctors( 3

relatives and /riends /or s'ch sit'ations* &ssentiall%( it as s them not prolong their death -ith medical intervention or treatment( not to p't them on li/e s'pport s%stems and manage their last ho'rs -ith pain illers onl%( even i/ it shortens their li/e* Cultural and eligious Traditions "n most societies there is a tradition and rit'al o/ meeting death -ith dignit% and peace* "n essence it is similar to the living -ill* !o-ever( here it is not solel% dependent on individ'al -ill ,'t there is a comm'nit% s'pport* The Christian tradition o/ !ospice comes closest to the living -ill( -here medical care is provided to red'ce s'//ering ,'t not to prolong death* $ome !ind's ,'ild a cottage ne9t to a hol% river and spend their last da%s peace/'ll%* Aains have a tradition o/ s%stematic /asting to death -ith religio's rit'als* $ome tri,es in Fi@i ,elieve that a/ter death the% -ill live eternall% at the age at -hich the% died* $o the% pre/er to die in their prime2 "n the polar region some comm'nities send their old on a ,oat -ith provisions* "t is possi,le to ,'ild sec'lar traditions too* "n !%dera,ad( there is an old;age home r'n ,% the Comm'nist Part%2 ADD L!FE T" #"$ #EA % A&D &"T #EA % T" #"$ L!FE' P',lished in Calc'tta( Frontier( A'ne )3( )116 also in Medico Friends Circle Bulletin( Octo,er( )116*

LIVING WILL / ADVANCE DIRECTIVE

TO #G FA#"LG( #G P!G$"C"AN AND ALL OT!&C P&C$ON$ CONC&CN&D T!"$ D"C&CT"D& is made ,% meHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH at a time -hen " am o/ so'nd mind and a/ter care/'l consideration* " D&CLAC& that i/ at an% time the /ollo-ing circ'mstances e9ist( namel%: " s'//er /rom one or more o/ the conditions mentioned in the sched'leI and " have ,ecome 'na,le to participate e//ectivel% in decisions a,o't m% medical careI and T-o independent ph%sicians 4one a cons'ltant5 are o/ the opinion that " am 'nli el% to recover /rom illness or impairment involving severe distress or incapacit% /or rational e9istence* T!&N AND "N T!O$& C"CCF#$TANC&$ m% directions are as /ollo-s: "* ""* """* That " am not to ,e s',@ected to an% medical intervention or treatment aimed at prolonging or s'staining m% li/eI That " am not to ,e p't on an% li/e;s'pport s%stemsI That an% distressing s%mptoms 4incl'ding an% ca'sed ,% lac o/ /ood or /l'id5 are to ,e /'ll% controlled ,% appropriate analgesic or other treatment( even tho'gh that treatment ma% shorten m% li/e* " consent to an%thing proposed to ,e done or omitted in compliance -ith the directions e9pressed a,ove and a,solve m% medical attendants /rom an% civil lia,ilit% arising o't o/ s'ch acts or omissions* " -ish it to ,e 'nderstood that " /ear degeneration and indignit% /ar more than " /ear death* " as m% medical attendants to ,ear this statement in mind -hen considering -hat m% intentions -o'ld ,e in an% 'ncertain sit'ation* " C&$&CD& the right to revo e this D"C&CT"D& at an% time( ,'t 'nless " do so it sho'ld ,e ta en to represent m% contin'ing directions* $C!&DFL& A B C D & Advanced disseminated malignant disease $evere imm'ne de/icienc% Advanced degenerative disease o/ the nervo's s%stem and/or m'sc'lar s%stems -ith severe limitations o/ independent mo,ilit% and 'nsatis/actor% response to treatment $evere and lasting ,rain damage d'e to accident( in@'r%( stro e( disease or other ca'se Other conditions o/ compara,le gravit%*

0LORENCE NIGHTINGALE
On $at'rda% Nora got a call /rom the !ospice centre* Bertha Cascellino -as as ing /or her* Normall% Nora -ent on T'esda%s and Frida%s and that too onl% on night d'ties* The &verest Cesort /or Pain and Palliative Care also -or ed as !ospice 4centre /or care o/ terminall% ill persons5* !er /riends -ere al-a%s ma ing /'n o/ the -ord J&verestJ ? ever;rest or rest /orever2 "t -as sit'ated on the o'ts irts o/ Bilgram and -as close to the Bilgram Ceserve Forest* Nora /o'nd it convenient to visit it on her -a% ,ac /rom the /orest* The &verest Cesort -as headed ,% $r* Cecilia* $he -as a grad'ate in !olistic !ealth /rom the #edical #ission $isters* $he -as also a competent n'rse and a good administrator* Kloria( A'lia and Aosephine helped -ith vario's tas s ? /rom cleaning to coo ing* A'nt $'san( a ,'9om old lad% -as the matron* Aohn Pinto and his dog Conn% loo ed a/ter the garden and sec'rit%* The% moved a,o't and -ere generall% li ed ,% ever%one* The% had a cons'ltant ph%sician ; Dr* A sha% -ho had recentl% come ,ac /rom the F*$*A* -ith all sorts o/ degrees in pain and palliative care* !e also had a h'ge ed'cation loan( nearl% thirt% la h r'pees( to pa% ,ac * !e had long hair( ear rings and -as more interested in -or ing as a D* A* in Bilgram Cl', than -or ing at the Cesort* The &verest Cesort had t-o sections and t-o inds o/ patients* The /irst ind -ere those -ho -ere rich and had all sorts o/ pain d'e to their li/e st%le* The% -ere given a co'rse in Basic !olistic !ealth and had good health% /ood( %oga( -al s in the /orest( -or in the Cesort garden and -ent to listen to #'sic at the Bilgram Cl',* The% lived in the section 's'all% re/erred to as the Cesort* The Cesort had an e<'ita,le scheme /or the /ees* Patients -ere charged according to their income* "/ a person earned Cs*1111/; per da% then he -o'ld ,e charged the same amo'nt per da% at the Cesort* #ost patients approved o/ the scheme and happil% paid* $ome o/ them even paid a higher rate* "t gave a good income to the resort* #an% patients came again and again* The other ind -as the hospice -ard* "t had onl% si9 ,eds* !ere people -ere admitted -ho -ere terminall% ill* There -as no hope /or them to recover* The% came here to die peace/'ll% in compan% o/ spirit'al people* The hospice had a good rep'tation as most patients -ere happ% that the% had an ass'red painless /'t're* Their relatives -ere also happ% as the% -ere relieved o/ the dail% ,'rden* $ome o/ them visited reg'larl%( others sent card and gi/ts to the Cesort* $ometimes this incl'ded a gi/t che<'e too2 The /ee principle -as same* "n addition the patients and their relatives -ere enco'raged to mention the Cesort in their -ill* &ven i/ it -as not mentioned in the -ill man% relatives made genero's donation to the Cesort a/ter the death o/ their old relative at the hospice* 11111 Nora -as ver% pop'lar among all the patients o/ the &verest Cesort ,eca'se o/ her no-ledge o/ /orest( =

environment and nat're* Nora too the sessions on &nvironment A-areness in Basic holistic !ealth Co'rse and led them to /orest -al s* $he ta'ght them that reconnecting -ith nat're has a therape'tic role* $he enco'raged them to -or at the garden -ith AohnJs help and do some home gardening -hen the% -ent ,ac * $he had a tremendo's sense o/ h'mo'r and la'ghed easil% at the @o es people tell her* !er patients loo ed /or-ard to her visits* Nora had also ac<'ired some pro/essional s ills in the /ield* $he has attended a short term co'rse on Keriatric Care r'n ,% !ospice "ndia* $he had also attended a one month co'rse in Pain and Palliative Care -hich -as r'n @ointl% ,% the "ndian and "nternational Association o/ Pain and Palliative Care* Nora visited the /orest one ho'r ,e/ore da-n and came ,ac one ho'r a/ter the s'nrise* On her -a% ,ac she -o'ld visit the Cesort and have her ,rea /ast -ith the inmates* Bet-een = and 11 she -as availa,le /or co'nselling in her o//ice* "n the evening also she -ent to the /orest an ho'r ,e/ore s'nset and ret'rned an ho'r a/ter* "n the evening a/ter dinner she did night d't% at the hospice -ard* Nora charged /or her co'nselling sessions on the same general principle ,'t she did /ree vol'ntar% service /or the night shi/t* $o altho'gh she -or ed onl% t-ice a -ee she had a good income ,eca'se man% patients li ed her and -o'ld prolong their sessions -ith her* Nora live 'pstairs at No* 6 Cavalr% Coad( ho'se o-ned ,% Bertha Cascellino* NoraJs main -orr% -as -here to go a/ter A'nt Bertha died* !ere she -as pa%ing onl% Cs* .11 as rent -hereas a ne- place -o'ld cost her at least Cs* .1112 $econdl% her son( #ichael -as /inishing his #*$c* in &nvironment $ciences in Bangalore and -anted to go a,road /or /'rther st'dies* $he -as 'nhapp% a,o't her response that she cannot a//ord it* 11111 Dr* A sha% normall% -o e 'p aro'nd noon as he spent late ho'rs at the Bilgram Cl', and later -ith his m'sic* !e made a pot o/ ,lac co//ee and leis'rel% got read% and made himsel/ a ,r'nch ? a rich omelette -ith tomatoes( capsic'm( m'shroom and cheese* !e had it -ith ,ro-n ,read -ashing it do-n -ith several c'ps o/ ,lac co//ee* !e reached the Cesort at 7 pm and had a co'nselling session ,et-een 7 to 3 pm* !e charged same as Nora /ollo-ing the same principle* $ince he -or ed dail% he too had a reasona,le pac et* Then he did a ro'nd o/ the hospice -ard* The old people eagerl% a-aited to tell him a,o't their aches and pains( a,o't their ,o-el movement and a,o't their sleep* !e smiled( la'ghed( patted and changed medicine ? mainl% sleeping pills and pain illers* Then he had a small session -ith the $r* Cecilia( revie-ing all the cases* #ost o/ the times these sessions -ere not reall% necessar% since the treatment -as /airl% straight /or-ard* Altho'gh the visiting ho'rs -ere /rom 7 to 3 pm some o'tstation visitor -ill t'rn 'p at an% ho'r( pro/'sel% apologising ,'t nevertheless tal ing to $r* Cecilia* $o o/ten these sessions did not occ'r* Then he -al ed to the Bilgram Cl', aro'nd seven* A sha% -as respected and li ed ,oth ,% the sta// and patients /or his no-ledge and /orthrightness* To the ne- comers at the Cesort he -o'ld sa%( J"/ %o' have come here /or c're o/ speci/ic diseases( longevit% or increase in %o'r se9'al per/ormance then %o' have come to a -rong address* !ere -e help %o' to lead a health% li/e( to remain health% as long as %o' live* JAdd Li/e to %o'r Gears and not Gears to %o'r Li/eJ2 To the relatives o/ people -ho -ere ,ro'ght to the hospice centre( he -o'ld sa%( JO'r aim here is to 11

red'ce s'//ering and not prolong death* We help o'r patients to die in peace and tran<'ill% -itho't s'//ering 'nnecessaril%* O'r g'iding principle is JDo not do an% medical intervention that does not improve the <'alit% o/ li/e o/ the patientJ and o'r motto is JLive Well and Leave WellJ2 !is no-ledge o/ m'sic -as a tremendo's asset* !e co'ld /ind an% m'sic that the patients -anted and cop% them to their ipods* !e also /o'nd some o/ his patients -ere remar a,l% no-ledgea,le in old m'sic and he learnt a lot /rom them* !e also e9plored the therape'tic role o/ m'sic in pain and palliative care* 11111 The hospice -ard -as not one ,ig hall* The ,'ilding had eight small rooms( t-o on each side o/ a s<'are -ith a nice little s<'are la-n in the middle* One o/ the /ront t-o rooms -as $r* CeciliaJs o//ice and the other -as N'rseJs room* The patients lived in separate rooms each -ith an attached ,ath and toilet* The% -ere allo-ed to ,ring co'ple o/ pieces o/ their personal /'rnit're ? 's'all% a c'p,oard -hich contained /anc% items the% treas'red and an eas% chair* O/ten an e9tra chair -o'ld end 'p in the verandah -hich -as in /ront o/ the room and -ent all ro'nd the s<'are* "n -inter the chairs moved to the la-n* Bertha Cascellino -as eight% /o'r* Frail( -ea and -ith lots o/ aches and painsI ,'t still she had a lot o/ li/e and /'n* $he o-ned No* 6 Cavalr% $treet in Bilgram* "t -as a colonial str'ct're and one o/ the last /e- le/t in Bilgram* Cavalr% $treet -as seeing reg'lar demolition o/ old ,'ildings and ne- shin% glass and metal str'ct'res coming 'p* Wido- o/ Colonel Cascellino( Bertha -as <'ite rich* $he had t-o sons and a da'ghter* The eldest son lived in #angalore( the other in D',ai and the da'ghter in the F* $* All o/ them -ere -ell settled and /airl% rich* The% managed to visit the mother once a %ear and ,ro'ght lot o/ gi/ts( most o/ -hich -ent to the hospice* The% also paid 'p d'es reg'larl% and ever% %ear gave a gi/t che<'e* Bertha had NoraJs /amil% as tenants /or decades* No- NoraJs parents -ere dead and the ,rothers have moved o't ,'t Nora sta%ed on* Nora o/ten dropped in /or a /e- min'tes to sa% hello to Bertha A'nt% on her -a% ,ac * And Bertha loved Nora and al-a%s o//ered /ood and drin * Once in a -hile Nora shared a glass o/ -ine in the evening -ith her* $o -hen Bertha t'rned eight% she said eno'gh is eno'gh and moved to the hospice* $he loc ed 'p the ho'se and gave her e%s to Nora* $he moved onl% her ,ar and an eas% chair to the hospice* Colonel Cascellino maintained and e9cellent ,ar and Bertha A'nt% also ept on replacing the ,ottles* $he 'sed to call the manager o/ the ,an across the street o//er him a glass o/ sherr% and cond'ct her ,an ing ,'siness -ith him* The manager( Cecil AlvareB -as al-a%s happ% /or this distraction and the% disc'ssed Koa and /ood and drin s* When she moved to the hospice she still called him and still shared a glass o/ sherr%* And li e in the past she shared a glass o/ -ine -ith Nora* 11111 $at'rda% -as al-a%s ,'s% at the Cesort* Ne- gro'ps arrived in the morning and visitors to the hospice 11

o/ten came on $at'rda%s* Toda% Bertha had also called her ,an er and he had arrive -ith a large #anila envelope and le/t a/ter a chat and his 's'al glass o/ sherr%* Dr* A sha% also had a ,'s% sched'le ,eca'se $at'rda% evenings at the Cl', -as al-a%s demanding* !e /inished his co'nselling sessions and -ent on his ro'nd to the hospice* A'nt Bertha -elcomed him ,'t complained o/ lac o/ sleep* A sha% said O*L* !e -ill change her medicine ,'t on one condition* $he sho'ld not have a drin * Bertha said /ine and po'red the $herr% onl% /or him* A sha% said JKood girlJ patted her on her chee and -as o//* !e peeped in at $r* Cecilia room and sa- she had visitors so he said JB%e2 " -ill see %o' on #onda%J* 11111 $o in the evening -hen Nora got her call she agreed to drop in* Bertha A'nt% -elcomed her said she had a lot to tell her and $r* Cecilia* $he said( JNora dear2 " donJt have long to live* $o toda% " called Cecil /rom the ,an and arranged ever%thing* "n the #anila envelope there are pac ets /or %o'( A sha%( Cecilia( Kloria( A'lia( Aosephine( A'nt $'san and Aohn Pinto* There is also something in m% -ill /or %o'* Changing the -ill ma% ta e too m'ch time so " -ant to tell %o' that share it -ith A sha%* The ,o% has ,een ver% good to me and he has his loan to pa%* " thin %o' -ill ,e a,le to pa% it o//J* Nora a got ,it alarmed and called $r* Cecilia* Cecilia said donJt -orr% she told me all this several times* $he is ver% /ond o/ %o' and she /eels that she m'st do something /or A sha%* Bertha gave the envelope to Cecilia /or sa/e eeping in the o//ice sa/e* Cecilia came ,ac a/ter loc ing the sa/e* Then Bertha said( JAnd no- let 's have a part%2J And as i/ on c'e a tempo trolle% stopped o'tside and in -al ed a co'ple o/ ,earers /rom the Bilgram Cl', carr%ing -hite ,o9es o/ /ood* "t -as mainl% things to go -ith a part% ? pra-ns( /ish ti a( small sa'sages( chic en manch'ria( go,i manch'ria( cheese dip and ,read stic s and so on* Bertha said that the% can have all the drin s in the -ine c'p ,oard* Nora and Bertha st'c to some old French -ine* The girls polished o// red -ine ,ottles( Aohn and $'san -ent /or -his % -hereas Cecilia -as happ% -ith her gin and lime* The% pla%ed some m'sic and sang* Aohn did some pantomime o/ some o/ the rich visitors o/ the Cesort* Nora told @o es* There -as m'ch la'ghter* Conn% -anted to ,e part o/ ever%thing and cats -ere pro-ling /or tit ,its* &ver%,od% had a good time* The part% ended as all god things m'st do* Nora prepared her pillo- on the eas% chair and ,ro'ght o't a vol'me o/ Pro'stJs la recherche du temps perdu 48"n $earch o/ Lost Time+5* The hospice -ent <'ite as night descended* The Cesort people -ere ret'rning /rom the Bilgram Cl',* There -as crescent o/ moon* Nora -o e aro'nd t-o in the morning* A'nt% Bertha appeared to ,e sleeping <'ietl%* Nora got 'p( stretched and decided to cover the A'nt% properl%* $he -ent close and something alarmed her* $he to'ched her hand and /ace* "t -as cold* Bertha had silentl% died* Nora came o't and slo-l% -al ed to-ards CeciliaJs room* A lamp came 'p in her room and Cecilia -hispered( J-hat is it NoraEJ JBertha is goneJ Nora -hispered ,ac -ith a cho e in her voice* Cecilia came o't -ith a sha-l on her sho'lder and said( J" -ill @oin %o' in the -a eJ* 11111 Ne9t morning the% called 'p the son in #angalore and /i9ed 'p the /'neral /or ne9t $'nda% ,% -hich 1)

time the other ,rother and sister -ill ,e a,le to reach* The% ordered the porta,le re/rigerated hearse in -hich the ,od% can ,e preserved* The% -aited till /o'r ,e/ore calling 'p Dr* A sha% ,eca'se the% tho'ght he -o'ld ,e sleeping late* A/ter several rings A sha% replied* Nora as ed( Mcan %o' come to the hospiceEJ JWhat is 'pE " am in Bangalore* #% /riend /rom A'stralia has come and so " too the night ,'s*J JBertha A'nt% passed a-a% earl% this morning* $he sort o/ ne- it -as coming and she prepared /or it* !er ,an er had come d'ring the da%* And in the night she especiall% called me and told Cecilia and me a,o't her last -ishes* Then -e had a part% and -e almost /inished her ,ar2 4la'ghs5* Bertha had several glasses o/ her ,est -hite -ine*J There -as a prolonged silence on the line* JAre %o' still thereEJ JGes2 " am s'rprised and not s'rprised* An%-a% she -ent happil%J* JThat is -hat " eep on telling m%sel/* B't " canJt eep m% tears ,ac * $he has ,een li e a mother to me /or the last so man% %earsJ* J" too am /eeling sad* Ta e care* " -ill come ,ac in a da% or t-o*J Go' can ta e %o'r time* The /'neral is on $'nda%J 11111 "t -as a ver% ,ea'ti/'l /'neral* Bertha -as pop'lar and so man% old people came /rom all over the to-n( some even spea ing Port'g'ese2 The la-%er read the -ill on #onda% at the hospice* The -hole /amil% and Nora and Cecilia -ere present* "t said( J " have onl% one propert%( the ho'se at No* 6 cavalr% Coad* #% children are -ell settled and are genero's o/ heart* For nearl% .1 %ears " have treated Nora as m% da'ghter and she has reciprocated the /eeling* $o " give m% ho'se and all its contents to Nora* #% children( ho-ever( are -elcome to pic 'p an% memento /rom the ho'se*J &ver% one appla'ded* Nora loo ed apprehensivel% at the /amil%* The% -ere all ,eaming and came and h'gged Nora* The% said( JWe are so glad that #'m did -hat she did* We all -anted to help %o' ,'t tho'ght %o' -o'ld ,e o//ended*J Nora co'ld not stop ,a-ling* &ver% one soothed her sa%ing( JNo-2 No-2 Go' sho'ld ,e happ%* All %o'r /inancial -orries are over2J 11111 Nora sold the ho'se /or Cs* One crore since it -as prime propert%* $he gave .. la hs to A sha%* A sha% -as rel'ctant to ta e it ,'t Cecilia prevailed 'pon him sa%ing that she hersel/ -as present -hen Bertha e9pressed her -ish to pa% o// his ed'cational loans* Nora sent her o-n son to &ngland to do a doctoral co'rse in environment sciences* With the remaining mone% she ,o'ght a nice propert% ,et-een the /orest and the hospice*
1)* 11* )111

1.

THE 2LAC3 HOLE

There is but one truly serious philosophical problem, that is suicide !udging whether life is worth living or is not worth living amounts to answering the fundamental "uestion of philosophy #lbert Camus The Myth of $isyphus Art'r Ba aev -as travelling in the West !imala%as in Nepal* !e had heard o/ an area called JThe Blac !oleJ and the legend that no one ret'rns alive /rom it* !e -as c'rio's and as the sa%ing goes( c'riosit% illed the cat* As ing ever% -here he /inall% reached a small hamlet called Pos'ng and there he -as* Ges( The Blac !ole does e9ist and it is across the river ,'t no one /rom the village -as prepared to ta e him there* When as ed i/ an% one ,e/ore him had come( the% readil% ans-ered( %es( %es( several -hite men had gone there ,'t no one ret'rned* Art'r -as reading Cam's and said to himsel/( -hat the hell2 " might as -ell /ind o't i/ li/e is -orth living or not* $o he too a small ,oat and crossed the river* The villagers told him -here to start and -here ,est to land* !e /o'nd a small /oot path leading 'p the hills* With his heart in his hand he slo-l% proceeded* "t -as a sort o/ lane -hich t-isted and t'rned ever% /e- h'ndred meters -ith ,'shes all aro'nd* $<'irrels -ere r'nning 'p and do-n and he heard man% ,irds chirping and even sa- a /e- o/ them* A hare ran across the /ield* Then he heard a -histle and a man @'mped do-n /rom a tree -ith ,inoc'lars in his hands* !e -as dressed /or moving a,o't in the /orest( -ith d'll colo'red clothes and good hi ing shoes* !e said( JWelcome to The Blac !ole2 Follo- me*J The% -al ed thro'gh the /orest and reached a village s<'are* "t had t-o ,'ngalo- ind o/ ,'ildings -ith sign ,oards* One read JThe Last FlingJ and the other J&ver CestJ* There -as also a p', on one side called JThe Watering !oleJ* !is host too him there and ordered cold ,eer* A lot o/ %o'ng &'ropean vol'nteers in /armerJs clothes -ere also drin ing ,eer and chatting a-a% in several di//erent lang'ages* Art'r -as happ% to see the Kerman ,eer JA'g'stinaJ on the men' and ordered and too a deep dra'ght* Then the host said that his name -as Kavriola( -hich is C'ssian /or Ka,riel( and as ed Art'r( J$home %o'r papers and tell me a little a,o't %o'rsel/J* A/ter listening he said( JOh2 Go' are a Kerman Ae-2 " -ill call !annah to ta e %o' aro'nd* #ean-hile( let me ass're %o'( there is no danger and %o' can go ,ac -henever %o' -ant*J Art'r let o't a h'ge sigh o/ relie/ and g'lped the remaining ,eer* !annah t'rned 'p( a st'nningl% ,ea'ti/'l ,r'nette in a long /lo-ing maroon s irt and a /etching canar% %ello- top* A/ter the% -ere introd'ced( Kavriola said he had to go ,ac to his post in the /orest* !annah said let 's move to the lo'nge o/ &ver Cest( here it is too nois%* The &ver Cest lo'nge -as a ,it dar -ith several alcoves and lo- com/orta,le so/as* There -as a men' and e% ,oard on the co//ee ta,le* !annah ordered another A'g'stina /or him and an apple @'ice /or hersel/ ,% pressing the men' n'm,ers on the e% ,oard* A -aiter silentl% appeared and placed their 17

order on their ta,le -itho't 'ttering a -ord* !annah said( JGo' m'st ,e d%ing to as some <'estions so go ahead* B't ,e ass'red %o' -onJt die -itho't %o'r -ish*J Art'rJs /irst <'estion -as 8Wh% do the villagers sa% that no one ret'rns alive /rom here2+ !annah smiled displa%ing -hite even teeth and said( JAl-a%s and al-a%s this is the /irst <'estion* Ges( -hat the villagers sa% is tr'e /rom their e9perience* B't as Kavriola told %o'( %o' are /ree to leave an% min'te* Onl% %o' -ill not go ,ac the same -a%* We ta e %o' thro'gh another ro'te to another village at the other side o/ the valle%*J JWe do this to disco'rage people /rom visiting 's o't o/ sheer c'riosit%*J JB't also some people act'all% do not ret'rn* The% come here to die* We are the Federal !ead<'arters o/ the "nternational $ociet% /or &'thanasia* $ocieties in mem,er co'ntries are o'r mem,ers and the% ann'all% contri,'te to the 'p eep o/ this centre* !o-ever( it is also sel/ s'//icient in terms o/ /ood and energ% and several vol'nteers -or here* " am a vol'nteer*J Wh% do %o' call this place 8The Blac !oleE+ 8The real name o/ o'r place is Freeland* !ere ever%thing is /ree* Go' are /ree to sta% or not to sta%* There is no mone%* Go' can eat and drin -hatever %o' li e and as m'ch as %o' li e* !o-ever( once %o' decide to sta% /or a longer period %o' -ill get to no- the ,asic discipline* We operate on the principle o/ 8a /ree association o/ /ree people*J+ J!o- do people -anting to commit e'thanasia die hereEJ 8When the% come the% are /irst p't 'p in &ver Cest /or as long as the% li e* The hotel has a ,ig li,rar% on e'thanasia and /ilms and case st'dies o/ ho- people came to decide -hen and ho- ; ,oth here and else-here* The% can also go ,ac i/ the% /eel li e* When the% are read% the% as /or a date*J 8Then the% are shi/ted to The Last Fling* #ost people -o'ld alread% have planned their last /ling* The% have a host that the% can choose /rom vol'nteers* A t%pical ro'tine is that the% -ant to see the $'nrise on the mo'ntain in the &ast and the $'nset on the Western mo'ntain* The% have a dinner and m'sic o/ their choice* The medicine is given in their /ood -ith their /'ll consent ,'t the% -onJt /eel it*J 8When the% are read% to retire( the host ta es them to their room and helps them to 'ndress* $ome li e to ,e le/t alone -hereas some -ant to die in the arms o/ their host* All their -ishes are /'l/illed*J 8" have to go no-* The% -ill give %o' a room here /or a da%* Feel /ree to do an%thing %o' li e ? 'se the li,rar%( go /or a -al ( meet other g'ests* " -ill meet %o' tomorro- morning at 11* K'ten tag2J 11111 Art'r -ent 'p to his room* There -as a la'ndr% ,as et -hich said that clothes -ill ,e ret'rned ,% : pm and there -as a p%@ama s'it and a trac s'it* !e <'ic l% got o't o/ his clothes and p't all his clothes in 16

the la'ndr% ,as et( had a ,ath( got into the p%@ama s'it and cra-led ,et-een sheets* !e -o e 'p re/reshed aro'nd 1 pm( got into his trac s'it and -ent do-n to the l'nch area* !e heard someone spea ing Kerman and @oined him /or l'nch* !e st'c to his A'g'stina ,eer altho'gh a lot o/ choice -as availa,le* !e had some /ish( some -hite -ine and apple pie and three varieties o/ cheese* !is companion -as a portl% loo ing e9 ,an er -ith a -alr's mo'stache* Over co//ee he told his stor% o/ coming to the Freeland* !e -as health% ,'t -as <'ite old ? 3= going on to :1( and -anted to die in good health* !e had made a living -ill in -hich he e9pressed his desire not to ,e hospitalised i/ he /ell ill* B't that did not satis/% him so he made another doc'ment called Jlegal deathJ on his 3=th ,irthda%* "n this he settled all his a//airs and converted a million D# in travellerJs che<'e and le/t home* !e -andered aro'nd the -orld /or nearl% a %ear and /inall% came here to die* !e -anted to die on his :1th ,irthda%* Then he as ed Art'rJs stor%* Art'r said he -as a vol'nteer in "ndia /or a %ear and on his -a% ,ac he -as travelling in Nepal* "n Kerman% he -as -ith an anti n'clear organisation called L'rve Westro-* !err Ac ermann as ed <'ite a lot a,o't LW( its -or ( its /'nding etc* Then he loo ed em,arrassed( co'ghed t-ice and as ed i/ it -as alright i/ he made a small donation to LW* !e still had some le/t o't o/ his million D# and he had ver% little time to spend and no-here to spend* O/ co'rse all mone% le/t -ill go to Freeland* Art'r said %es and than ed and as ed ho- m'ch he -ished to give* !e said a <'arter o/ a million( that is )61(111 D#( is all he co'ld spare ,eca'se he did -ant to leave some mone% /or Freeland also* 11111 A/ter l'nch Art'r -ent /or a long -al * !e sa- vol'nteers -or ing in /ields( shepherding mo'ntain sheep( r'nning po'ltr% and piggeries* !e -ent 'p the Western mo'ntain to see the $'nset* On his -a% he sa- micro h%del plants r'nning and prod'cing electricit%* At the $'nset point there -as a glass encased room( a /e- ta,les( -ith a cara/e o/ red -ine on each ta,le and glasses* A,o't 0 people -ere alread% there loo ing o't at the Western s %* The $'n slo-l% t'rned into a h'ge orange and then into a red ,all and slo-l% s'n do-n the mo'ntains* &ver% one -atched ,reathlessl%* The red -ine in the glass glo-ed2 11111 Ne9t morning !annah -as there in ,l'e @eans( ,ottle green top and to'gh shoes* Over A'g'stina and apple @'ice she as ed -hat he tho'ght o/ the place* Art'r said he -as thrilled and told her the stor% o/ the donation to his organisation* Ges she had heard a,o't it and she -as happ% that the mone% -as going to good ca'ses* Then Art'r said that he -o'ld li e to ,e a vol'nteer /or a /e- months and -o'ld li e to ,e a host /or a Last Fling* $he said 8%o' are -elcome to ,e a vol'nteer ,'t to ,e a host to the Last Fling -ill ta e some time* Fs'all% the vol'nteers train /or a,o't . months ,e/ore the% are read% /or it and the organisation is satis/ied a,o't them* Normall%( the% -ill have to sta% in the vol'nteerJs hostel ,'t t-ice a -ee he can @oin /or a meal at the &ver Cest /or getting 'sed to the ideas o/ e'thanasia* !e can 'se the li,rar% ; ,oth ,oo s and /ilms as part o/ his training*+ 11111

13

The ne9t three months -ere ver% ,'s% /or Art'r* !e -or ed /or 6 da%s a -ee /or hal/ the da% in vario's pro@ects o/ Freeland -hich made it sel/ s'//icient in /ood and energ%* !e also spent some time at the Lindergarten* T-ice a -ee he spent st'd%ing e'thanasia and interacting -ith people -ho -ere sta%ing at &ver Cest and -ho in their o-n -a% -ere also st'd%ing e'thanasia* The three months /le- ,%* !e had come in Aan'ar% and no- it -as April* Then one da% C'th( one o/ the residents o/ &ver Cest as ed him i/ he -o'ld ,e the host at her Last Fling on Kood Frida%2 Art'r -as thrilled ,'t he said he had to get the approval /rom Freeland management* $he said she had alread% as ed them and the% said it -as alright* 11111 Frida%( the 1.th April( )11) remained etched in Art'rJs memor% /orever* C'th -as 66 %ears old and she had le' aemia or ,lood cancer* $he -as a ,iochemist and had held a pro/essorJs @o, at the #a9 Planc "nstit'te* At the age o/ 61 -hen she discovered she had cancer she retired /rom her @o, on medical gro'nds and had a good pension* C'th -as a Kerman Ae- o/ C'ssian origin* !o-ever( her parents had ,ecome Christians and she carried a m'lti religio's( m'lti ethnic and m'lti ling'al c'lt're* $he -as active in peace movement( in anti n'clear movement and in !'manist Atheist movements* $he -as th's a c'rio's mi9 o/ rationalism and rich c'lt'ral ,ac gro'nd* C'th had ,een sta%ing longest at &ver Cest* Not ,eca'se she had an% misgivings a,o't e'thanasia* B't all her actions -ere deli,erate* $he -anted to en@o% li/e as long as she co'ld and then decide to end it -hen it -as not -orth living an% more* $he chose her date and her host -ith care and had a reason /or ever%thing* $o on April 1.( )11)( Art'r -as read% earl% morning in a trac s'it to accompan% her to the $'nrise point on the &astern #o'ntain* A/ter the glorio's s'nrise the% ,rea /asted on orange @'ice( ,lac co//ee and C'ssian ,lac ,read and some cheese* $he rested most o/ the da% and had a /r'gal l'nch -ith some /ish so'p and -a/ers and a pint o/ A'g'stina* "n the evening Art'r -as read% in a ,lac s'it to accompan% her to the $'nset point in the Western #o'ntain* The% remained seated <'ietl% /or nearl% hal/ an ho'r sipping red -ine* The% ret'rned and a/ter a small rest she -ent ,ac to the dining room dressed in a /antastic ,lac go-n -ith -hite lace* Art'r complimented her on her dress and as the% marched do-n to the dining ta,le the orchestra ,ro e in -ith the Wedding #arch /rom #id $'mmerJs Night Dream ,% #endelssohn* The men' -as alread% chosen and consisted o/: Borsch A plov -ith l%p%osch a -ith red mello- -ine Tro't Fish -ith -hite -ine A'g'stina $alted cashe- n'ts $even inds o/ cheese 1:

Li<'e'r Co//ee C'th chatted pleasantl% a,o't her child hood in C'ssia and C'ssian Christmas -hen the% -ent to the /orest to c't do-n a Christmas tree and a,o't her dog "l%'sha -ho /ollo-ed her ever%-here* Then she tal ed a,o't her Fniversit% da%s in Berlin( the protest marches against n'clear -eapons and movements /or peace and disarmament* $he said she is d%ing happil% ,eca'se F' 'shima occ'rred and no- at least Kerman% -onJt have an% n'clear plants* Then she tal ed a,o't Freeland and the sel/ s'//icient comm'ne and a,o't agro ecolog%* $he told him the stor% o/ #endelssohn discovering the m'sic scrolls o/ Passion ,% Aohann $e,astian Bach in a ,'tcherJs shop and his s',se<'ent str'ggle to per/orm it* !o- it -as the Kerman Ae-s( -ho resc'ed the greatest m'sic o/ all time ,% the com,ined e//orts o/ #endelssohn( a Ae-ish ,an er and h'ndreds o/ m'sicians -ho practised the m'sic in a ,arn a-a% /rom the cit% -itho't charging an%thing on $'nda%s* $he e9plained her choice o/ m'sic /or the da%* $he chose the Wedding #arch ,eca'se she -as marr%ing Death* Then she chose Passion ,eca'se it -as Kood Frida%* Passion re/erred to the s'//ering o/ Aes's on the Cross* As the dinner progressed the m'sic s-itched over to pieces /rom Passion and then she contin'ed it on a DDD in her room 'pstairs* Art'r -as enchanted and -as moving as i/ in a dream* !e -o e 'p in her ,ed at ) in the morning* "t too some time to realise -here he -as and he tho'ght -h% he -o e* !e ,ecame a-are o/ a silence* There -as no m'sic and C'th -as not ,reathing* !e dressed <'ietl% and ept a -a e till s'nrise* Art'r /o'nd a pac et -aiting /or him in his room* !e tore it open and /o'nd /ive ,oo s -ith a note /rom C'th sa%ing that she al-a%s carried these ,oo s -ith her* The ,oo s -ere: The Kood $oldier $ch-ei ,% Aaroslav !ase To Lill a #oc ing Bird ,% !arper Lee Three #en in a Boat ,% Aerome L* Aerome Alice in Wonderland ,% Le-is Carroll Walden ,% !enr% D* Thorea'

)0* 1.* )11)

10

"bituar(

IN 4E4ORIA4. SITARA4 SHASTRY

$itaram $hastr% died on )7 Oct )11)( -hen he -al ed into a r'nning train ,et-een Adit%ap'r and Kamaria stations near Aamshedp'r* The incident occ'rred at a point -here the train crosses a ,ridge over a river thirt% /eet ,elo-* !is ,od% -as thro-n o// the ,ridge( and la% on the ,an s o/ the calml% /lo-ing river* !e -as a,o't :. %ears old* A -ee earlier( he had ,een diagnosed as having throat cancer* !is da'ghter Lanti Pra,ha 4Chin'5 and her h's,and had come do-n to Aamshedp'r /rom Delhi in order to ta e him ,ac to Delhi /or treatment* On the da% the% -ere s'pposed to /l% o't( he le/t home earl% in the morning and did not ret'rn* When contacted on his mo,ile phone( he replied that he -o'ld not ret'rn and that the% sho'ld not search /or him* Then he s-itched o// his phone* From 1=30 on-ards( till the da% o/ his death( $itaram -as a /'ll;time revol'tionar%/social activist* Till 1=30 he had -or ed /or the L"C in Aamshedp'r and -as a 'nion leader* That %ear( li e man% other places in "ndia( a lot o/ %o'ng people t'rned to-ards the path o/ social revol'tion* "n Aamshedp'r <'ite a /e- T&LCO -or ers resigned( collected their PF( and @oined the revol'tionar% movement* Those -ere head% times* From the ver% ,eginning some o/ his special <'alities -ere visi,le* The /irst and /oremost <'alit% -as that he -as e9traordinaril% co'rageo's* !e never /eared an%one( never /eared having a di//erent opinion and lived his li/e on his o-n terms* !e had great mo,ilit% ? ,oth in space and across societ%( connecting -ith a -ide cross;section o/ people* !e also had a great 'nderstanding o/ the region ? Ahar hand ? -hich onl% improved -ith his -ide travels to ever% noo and corner o/ the region and his interaction -ith ever% section o/ the Ahar hand movement* $itaram -or ed tirelessl% /or the Ahar hand movement( ne- ever% Ahar hand leader and -as respected ,% all o/ them* !e ,ro'ght them together again and again /or the common ca'se* Being a comm'nist he had a great 'nderstanding o/ the -or ing classes o/ the region* Later he developed a similar 'nderstanding o/ the Chhattisgarh region -hen he -or ed -ith Comrade $han ar K'ha Neogi* B't prior to that he -or ed in Dhan,ad district( -ith A* L* Co% o/ BCLF 4Bihar Collier% Lamgar Fnion5* !e helped organise the election campaign o/ A* L* Co% and later he edited the BCLF @o'rnal( %&irawal% 4Dang'ard5 /or the -or ing class* &ver%-here he had a to'gh time( ,eca'se -hile mone% -as /orthcoming /or trade 'nion -or and /or the la-%ers( there -as no mone% /or the @o'rnal or /or his 'p eep* The &mergenc% -as a to'gh period /or all political -or ers and he moved to Bom,a% to help edit Blit' &indi* !e had a /antastic command over !indi ? he -rote the ,est simple !indi /or the -or ing classes( and in later %ears translations ,ecame a stead% so'rce /or his maintenance* !e -rote a ,rilliant ,oo let entitled J#ehnat ashon o Lita,en Chhahi%eJ 4The -or ing class -ants ,oo s5* "n the earl% eighties( he edited Mitan /or Comrade Neogi in Chhattisgarh* &ver%-here he -ent he made good contacts -ith all the activists o/ the region( ,e the% -or ers( peasants or( as happened in Chhattisgarh( -ith doctors( engineers and la-%ers too*

1=

Der% o/ten $itaram came across as a di//ic'lt person* " thin the main reason -as that he -as impatient and 'nhapp% -ith 's /or not ,eing active eno'gh( not 'nderstanding the need to align -ith other movements li e the Ahar hand movement or -ith the %o'th coming o't o/ the AP movement( and lastl% not 'nderstanding the need to s'pport each other( not living in comm'nes* !o-ever he -as respected and loved ,% a ver% large n'm,er o/ people* !'ndreds o/ comrades and /riends received his 4and NaliniJs( his -i/e5 hospitalit%( help and advice* !e -ill ,e missed ,% a large n'm,er o/ people* !ere -e m'st also to'ch 'pon NaliniJs role in his li/e ; she held him -hole thro'gh all the noise and t'rmoil o/ his li/e( despite all their @hagras 4domestic <'arrels5* $he -as also e9tremel% genero's 'nder all inds o/ stress that -ent inevita,l% -ith ,eing married to $itaram* #an% o/ 's /eel saddened that he had to commit s'icide* Those -ho sa- his m'tilated ,od% near the river -ill carr% this ha'nting image -ith them /or a long time to come* #an% o/ 's as ( -h% did it have to ,e li e thisE Kiven the sit'ation he -as /aced -ith( that -as pro,a,l% the onl% valid option* Despite his protests( his /amil% had pers'aded him to go to Delhi /or treatment* Wea and v'lnera,le as he -as( he co'ld not arg'e o't his case /or not going* B't he -as not prepared to /ace a sit'ation -here he -as dependent on others( a li/e o/ hospitalisation and the pain/'l realit% o/ throat cancer* On the other hand the /amil% also /eels -ea and v'lnera,le in s'ch a sit'ation( and it is di//ic'lt /or an% /amil% -here s'ch choices are not openl% disc'ssed to ,e a,le to accept s'ch choices o/ no treatment* $o he too the co'rageo's decision o/ -al ing o't o/ this -orld* "t -as characteristic o/ him and his decision /itted his personalit%* The sad thing is that he had to ,e alone in his last moments* "t is a sad commentar% on o'r progressive movement that it has not s'pported the movement /or legalising e'thanasia( that -e are not prepared to deal -ith sit'ations li e this( and -ere not availa,le to help him /or a hono'ra,le and digni/ied end* No- -e can onl% s'pport the /amil% to cope -ith this tra'matic e9perience* We conve% o'r heart/elt condolences to Nalini 4-i/e5 and to Chin' 4da'ghter5* Octo,er )=( )11)

)1

E5THANASIA6 S5ICIDE AND SANYASA

" tho'ght ,% -riting an o,it'ar% o/ Comrade $itaram $hastr% " had come to term -ith his death* B't it -as not so* $ome correspondence -ith /riends and comrades made me realise that there are iss'es that have never ,een ade<'atel% disc'ssed among 's Jle/tistsJ and JprogressivesJ or other p',lic /ora* This is an attempt to start s'ch a process* $econdl% this is also tr%ing to address m% o-n sit'ation ; o/ a person nearl% sevent% %ear old( -ho lives alone( has some health pro,lems and does not -ant to live -hen he is not in control o/ his sel/* "n m% o,it'ar% note " ended -ith JThe sad thing is that he had to ,e alone in his last moments* "t is a sad commentar% on o'r progressive movement that it has not s'pported the movement /or legalising e'thanasia( that -e are not prepared to deal -ith sit'ations li e this( and -ere not availa,le to help him /or a hono'ra,le and digni/ied end*J E)t!anasia Let 's start -ith 'nderstanding s'icide and e'thanasia* &'thanasia is not s'icide* The -ord e'thanasia means good death* "t re/ers to the practice o/ intentionall% ending a li/e in order to relieve pain and s'//ering* "t is pop'larl% no-n as Jmerc% illingJ* Technicall% it is assisted s'icide and it is s'pposed to ,e a h'mane and digni/ied -a% o/ d%ing -hen li/e is no longer ,eara,le* O/ten it is 'sed in cases o/ terminal illness -hich are ver% pain/'l( -here an% medical intervention -ill not improve the condition o/ the patient( e9pensive to eep the person alive and e9tremel% stress/'l to care giver and the /amil%* &'thanasia is not legal in most co'ntries* "t is legal in a /e- co'ntries in &'rope and in some parts o/ the F* $* and A'stralia* "n "ndia it is not legal and people in s'ch condition have either to s'//er or commit s'icide* Cecentl% passive e'thanasia ,ecame legal in "ndia* The term Npassive e'thanasiaN 'sed ,% the $'preme Co'rt in its verdict on Ar'na $han,a'gJs case is de/ined as the -ithdra-al o/ medical treatment -ith the deli,erate intention to hasten a terminall% ill;patientJs death* #a ing 8passive e'thanasia+ legal ma% appear as some progress* B't it happens ever% da% -ith poor patients -hen the doctor tells the /amil% to ta e the patient home ,eca'se the% cannot do an%thing more /or the patient* "n the case o/ rich patients either the /amil% is not prepared to accept that no more medical care -o'ld help or the medical pro/ession does not comm'nicate clearl% either d'e to /ear or greed or ,oth* S)i%id &ven i/ e'thanasia -ere legal in "ndia( the ma@orit% o/ people -ho commit s'icide -ill not ,e eligi,le /or it* $'icide is committed /or a variet% o/ emotional( social( ps%chological and economic reasons* "n the last decade several la hs o/ "ndian poor peasants and 'r,an poor committed s'icide /or economic reason* $everal st'dies have sho-n that s'icide -as the ,est option /or ma@orit% o/ them* "n a signi/icant n'm,er o/ cases( ho-ever( s'icide can ,e prevented ,% timel% co'nselling* $'icide 8help lines+ tr% to provide this* B't man% do not avail o/ it* B% its ver% nat're s'icide is a lonel% act ,eca'se -hile s'icide is no longer a crime( aiding and a,etting is* $o i/ someone no-s a,o't it he or she is e9pected to prevent it and see help /rom others to prevent it* )1

A ver% large n'm,er o/ old people -ish death ,eca'se li/e is 'n,eara,le* "t ma% ,e d'e to ill health or /inancial reasons or ,oth* The main reason /or it is that in the present societ% individ'alism and n'clear /amil% is the accepted val'e s%stem and inter generational care is vanishing /ast* $ome o/ the old people also commit s'icide ,eca'se the% -ant to die -hen the% are still a,le to move a,o't on their o-n* &ven i/ e'thanasia -ere legal the% ma% not <'ali/% /or it and -ill not get help* #ost pro,a,l% $itaram $hastr% -o'ld not have <'ali/ied /or e'thanasia* &'thanasia la-s -ill have to ,e /ar more li,eral so that people -ho are /ed 'p -ith li/e have a chance to die legall% and -ith dignit%* B't it is not possi,le to have a li,eral e'thanasia la- in the present societ% an%-here in the -orld ,eca'se o/ the possi,ilit% o/ its mis'se* Palliati- Ca* $itaram $hastr% did not -ant to ,e treated /or his cancer* There is some do',t -hether it -as in /act cancer or not* This is not 'n's'al in cancer cases* There is a de,ate on this iss'e and man% re/'se cancer treatment on this co'nt* !o-ever it is in the /ield o/ cancer treatment itsel/ that the concept o/ palliative care has evolved as a /'ll discipline* !ere the person is not treated /or cancer( ,'t is given help to red'ce his s'//ering and die peace/'ll% in a caring atmosphere* This concept is applica,le in man% other diseases also* Basicall% it is in/ormed care and co'nselling co'pled -ith relie/ /rom pain and s'//ering* $o an option /or $itaram $hastr% co'ld have ,een palliative care at his o-n choice o/ place* Fn/ort'natel% palliative care is not ver% -ell developed in "ndia e9cept in Lerala -here ever% district has a palliative care centre* O/ the =10 palliative care centres in "ndia 071 are in Lerala2 Toda% palliative care training co'rses are availa,le even /or para medicals and /or co'nsellors and it is an area that needs to ,e enco'raged* Also -hen it is availa,le( it is not /'ll% 'tilised* For e9ample the C"PLA Pain and Palliative Care centre at P'ne( -hich is completel% /ree( has occ'panc% o/ onl% 31>* The reason seems to ,e the perception that -hen %o' go to s'ch a centre it means there is no hope /or c're* "t is o/ co'rse tr'e( ,'t man% patients are rel'ctant to accept it and doctors ma% not ,e a,le to co'nsel them ade<'atel%* "/ the patients are rich( there is the additional /actor that contin'ing JnormalJ health care is l'crative to the cancer Jind'str%J* 0amily P* ss)* "n m% o,it'ar% " had said JOn the other hand the /amil% also /eels -ea and v'lnera,le in s'ch a sit'ation and it is di//ic'lt /or an% /amil% -here s'ch choices are not openl% disc'ssed to ,e a,le to accept s'ch choices o/ no treatment*J The pro,lem is in/ormed choice* "t is /'rther complicated ,% the /alse l're o/ Jmagic o/ modern medical scienceJ as -ell as the ne- val'e s%stem that li/e m'st ,e saved at all costs* The cost not onl% incl'des the /inancial cost to the /amil% ,'t o/ten at the cost o/ the <'alit% o/ li/e o/ the patient* The medical pro/ession itsel/ o/ten /orgets its o-n golden r'le( JNo medical intervention sho'ld ,e carried o't that does not improve the condition o/ the patient*J There is a legitimate perception that a signi/icant part o/ the medical pro/ession is g'ided primaril% ,% the pro/it motive and not ,% the -el/are o/ the patient* ))

B't there is also a /actor o/ /ear o/ ,eing s'ed ,% the rich patient+s /amil% /or not saving the li/e o/ the patient* D"%t"*7s Dil mma We have at several places a,ove criticised the health pro/ession* B't individ'al doctors do /ace dilemma* The% are a part o/ a societ% and a medical s%stem and their o-n opinions have o/ten needed to ,e modi/ied or compromised d'e to vario's /actors mentioned a,ove* $till there are good hospitals and good doctors -ho gen'inel% help the patients in ever% -a% incl'ding pain and palliative care and passive e'thanasia* Sanyasa and P* pa*ing ,"* D at! The val'e s%stem Jthat li/e m'st ,e saved all costsJ is o,vio'sl% at /a'lt* $everal /actors o/ cons'mer societ% are responsi,le /or it* The perception that mone% can ,'% an%thing( partic'larl% the J,estJ health care( that it can Jsnatch li/e ,ac /rom the @a-s o/ deathJ( the greed o/ the medical pro/ession( 4altho'gh man% good doctors do not s',scri,e to it5 and peer press're* "t has ,ecome sociall% accepted so that even poor /amilies are 'nder press're to accept it and go thro'gh enormo's ps%chological and /inancial stress* This -as not al-a%s so* "n most societies there is a tradition and rit'al o/ meeting death -ith dignit% and peace* "n the Christian tradition o/ !ospice medical care is provided to red'ce s'//ering ,'t not to prolong death* The !ind' tradition ,elieves that a/ter death the so'l has to attain 8#o sha+ 4/reedom5 and /or that it has to c't itsel/ /rom 8#a%a+ 4,ondage to earthl% ties o/ material -ealth and h'man relationships5* To this end some !ind's ,'ild a cottage ne9t to a hol% river and spend their last da%s peace/'ll%* $ome ta e 8san%asa+ 4ren'nciation5( leave /amil% and die among 'n no-n people* Aains have a tradition o/ Jsalla hanaJ ; s%stematic /asting to death -ith religio's rit'als* $ome tri,es in Fi@i ,elieve that a/ter death the% -ill live eternall% at the age at -hich the% died* $o the% pre/er to die in their prime2 "n the polar region some comm'nities send their old on a ,oat -ith provisions* "t is possi,le to ,'ild sec'lar traditions too* "n !%dera,ad( there is an old;age home r'n ,% the Comm'nist Part%2 There are several sec'lar old age homes in the co'ntr%* !o- " -ish $itaram had a choice li e this2 B't that -as not to ,e* S" t! n# What one -o'ld do i/ one /aces a similar sit'ation in oneJs o-n li/eE " thin all choices are open and the person has to choose according to the sit'ation* "/ palliative care is not availa,le or the person -ants to do die -ith a /air command on his/her /ac'lties( does not -ant to ,e ,ed ridden etc* then s'icide ,ecomes a valid choice* The pro,lem -ith s'icide is that it involves violence ? not @'st to-ards onesel/ ,'t to-ards oneJs /amil% and /riends* &ven strangers can ,e a//ected ,% it as in the case o/ s'icide 'nder a r'nning rail-a% train* An engine drive told me that these cases a//ect them /or a %ear at least2 One can opt /or some ind o/ 8san%asa+ pre/era,l% -ith the no-ledge o/ the /amil%( so that /amil% is not stressed* One need not ,e religio's to do it* Then one can -al a-a% and die among 'n no-n people in an% manner one chooses on a date and time o/ oneJs o-n choice* Pre/era,l% it sho'ld not ,e in a violent manner so as not to h'rt even 'n no-n people* $'ch a choice( ho-ever( re<'ires a lot o/ co'rage and a val'e s%stem o/ accepting death -hen li/e is no longer -orth living* Decem,er 11( )11) ).

P)8lis! d. 0 8*)a*y6 9:;< Sangatya Sa!itya 2!anda*

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