Euthanasia: A Social Science Perspective

Author(s): ANEETA A MINOCHA, ARIMA MISHRA and VIVEK R MINOCHA

Source: Economic and Political Weekly, Vol. 46, No. 49 (DECEMBER 3, 2011), pp. 25-28
Published by: Economic and Political Weekly
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 is taken when one feels that life has served its
Euthanasia: A Social Science purpose. While there is hardly any research
on this practice, anecdotal evidence shows
Perspective that it is the old and patients with del^i-
tating illness who opt for santhara.3 Else-
where, in countries like Iceland, issues of
ANEETA A MINOCHA, ARIMA MISHRA, VIVEK R MINOCHA
life and death are discussed with reference
to the almighty, destiny and natural laws
The social sciences, more (Einarsdottir 2009). The decision to end life
ability of euthanasia or death with must then be understood in such cultural
specifically medical sociology/
The ability dignitydignity
social,is of lateis offinding
euthanasia
greater cultural,
space late finding and or greater legal death accept- space with notions about life and death. However the
anthropology have extensively
use of the term euthanasia as a viable
for open public discussions in many coun-
probed issuestries including
relatedIndia.1 The Supreme Court to the body,
medical option to a permanent vegetative
illness and pain.
of India's judgment on the Aruna ShanbaugHowever, state draws its rationale on several other
issues
surrounding case death
opens the doors to a consideration of
and grounds, some
dying, of which are discussed here.
several issues including the right to a digni-
more specifically, euthanasia
Euthanasiaare as 'Death with Dignity9
fied death (suggesting decriminalisation of
relatively conspicuous
attempts to suicide), distinctions between by their
Euthanasia can be traced back to the intel-
absence. Thisactive andarticle
passive euthanasia and more seeks lectual
to developments and medical techno-
importantly facilitates a wider discussion logical innovations in industrially advanced
show up the contexts that define
on the rather sensitive issues of death and countries in the early 20th century that
euthanasia as a "just" option. It
dying.2 Even though the term euthanasia provided human beings greater control
attempts to unravel
is relatively of recent origin, the notion of other issues
over the processes of life. Such control
like the a good death is an oldof
quality helped in framing world views in which
one which is often end-of-life
culturally constructed. In India, for example, life and death found new social meanings
care, familial support, degree of
there has always been a cultural acceptance and interpretations. The human lifespan
dependency, of
agency in death
the idea of self-administered that increased due to the more powerful
decision-making, ethical dilemma
couched in spiritual practices such as and effective ways of managing and pre-
moksha. Such notions of death in
and related discourses the Hindu venting
that help diseases did not however guaran-
us understandand Jain scriptures, for instance, relate it to
euthanasia intee a better quality of life (in whichever
specific notions about the body and purpose way such quality of life is understood).
cross-cultural contexts.
of human life. Howarth and Jefferys (1996) argue that
Swami Prabhananda (2008: 64) notes the irrelevance of the scientific paradigm
that in many eastern cultures the "death of in ascribing meaning to human lives has
a body is not the end of the real entity - triggered a number of popular responses
which is none other than the soul. Man's one of which is to shift the management
life on earth provides an opportunity to do of dying from professionals to the dying
moral exercises..." Hockey (1990) in a persons themselves to control end-of-life
rare anthropological work on experiences decisions including euthanasia.
of death demonstrates that conceptions Such a shift needs to be located in the
of both death and life are expressed and neo-liberal ideology that promotes the idea
generated through culturally specific forms of a rational, active individual/consumer
and/or institutions. Singh (2008) discusses making the right choices and taking re-
the culture sensitive end-of-life care of the sponsibility for himself/herself.4 "Patient
elderly and terminally ill patients through empowerment", "expert patient", "active
a specific case study of Kashi Labh Mukti patients" are the new catch phrases in
Bhawan, Banaras which houses a large healthcare literature. This implies that
The paper was originally
number of such old prepared
and ill people. Here, bytheAneeta
patient, far from being a passive and
Minocha and has been revised posthumously
the rituals of dying are facilitated within the submissive recipient of the doctors' orders,
by the second and third authors.
religio-cultural matrix of Hinduism that is an empowered and informed person
Aneeta A Minocha was with the Delhi School
constructs death as a migration from one endowed with several rights vis-^-vis the
of Economics, University of Delhi, Arima
life to another mediated by the mortal death. doctors to protect his/her own interests.
Mishra (mishraarima@yahoo. co. in) is with the
Institute of PublicThe practice of santhara
Health, that entails the
Bangalore Chief
and among these rights is the patient's
Vivek
R Minocha ( voluntary giving up of one's life through
vr.minocha@yahoo.co.in right
) wasto select a line of treatment, refuse
with
the University College of Medical
fasting is considered among the Jain com-Science,
treatment altogether or seek active inter-
University of Delhi.
munity as the ultimate route to moksha and vention to end life and die with dignity.

Economic & Political weekly 033 December 3, 2011 vol xlvi no 49 25

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 Such perspectives on the rights of the
patient to die with dignity and articulate
death around positive connotations like
"dignified" death, "respectable" and "peace-
ful" death in a manner which upholds that
good death is preferable to a very poor
quality of living. The positive notions of
good death are contrasted with such con-
cepts of life as "good quality of life",
"meaningful, respectable, useful and pro-
ductive life". Consequently the inert, pas-
sive and meaningless vegetative existence
characterised by pain, and suffering
which puts one at the mercy of others is
not considered worth living. The patient
and his family members, therefore, have
an option to put an end to such an exist-
ence and let the person die a dignified and
quick death.
The argument for a poor quality of life
contrasted with dignified death needs to
be read in the context of the declining role
of family as a supportive and caring unit
to manage the sick. This responsibility of
the family in many places has passed on
to governmental and private agencies
and trained medical personnel. In India,
however, there is hardly any organised
effort towards end-of-life care and hence
patients with debilitating illness are
forced to depend on family members with
or without willing support. Such a degree
of dependency, studies have shown, is
closely linked to the desire for euthanasia
(Seale and Addington-Hall 1994, 1995a, b;
Howarth and Jeffeiys 1996). Howarth and
Jeffeiys (1996) rightly argue that euthana-
sia as an end-of-life decision reflects
changes as much with professional-pa-
tients relationships as inter-general kin re-
lationships. Discourses on death and dy-
ing hence need to be situated within the
discourses on ageing.
The rationale for euthanasia also draws
from a utilitarian logic. The terminally ill
and those who are in a vegetative state of
existence require more care as they are
dependent on others for even the simple
tasks of daily life. Such a state of existence
has potentially extensive financial impli-
cations for the medical establishment, the
State as well as the family. The rising cost
is an important consideration in the medi-
cal management of terminally ill and non-
salvageable patients. It covers not only the
monetary expenditure but also the financial
26 DECEMBER 3, 2011 vol XLVI NO 49 EHZ3 Economic & Political weekly
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and social opportunities lost, the time,would not have wanted to live in this con-
effort, and emotional energy expended by dition and would have opted for euthana-
the family on the patient and the diversion sia but Terry had not left any written
of hospital resources and efforts of the living will. On 31 March 2005, Terry died
care-givers from caring for the curable sick a slow death by starvation.
to keeping alive (often artificially) non- In a contrasting outcome, Aruna Shan-
salvageable patients in hospital wards.5 baug in India who has been bedridden in
the kem hospital in Mumbai in a permanent
Unpacking Pertinent Issues vegetative state for the last 38 years after a
Euthanasia though argued to be a viablebrutal sexual assault was allowed to live
option on medical, economic, moral and through a landmark Supreme Court judg-
ethical grounds, nevertheless has always ment in March 2011. The Supreme Court
been shrouded by debates and controver- rejected the plea for euthanasia filed by an
sies all over the world. The case of Terri
author-friend of Aruna on the grounds
Schiavo in the us brings some of these that (a) Aruna's medical conditions do
controversies to the surface. This case led not qualify as "brain dead" and that she
to long drawn legal battles over the issue breathes on her own, and (b) only the kem
of switching off the life support systems hospital staff who have been the sole care-
that were keeping alive the unconscious, givers for so long are entitled to plead for
non-salvageable Terry Schiavo for 14 years euthanasia on her behalf (in the absence of
(bbc News 2005). This legal battle led the a living will and involvement of any family
then President George Bush with his "care member). Hence, unlike Terry Schiavo,
of life" advocacy to intervene to get the Aruna Shanbaug has been allowed to live
feeding tubes reinserted though briefly. with the help of the emotional and medical
On 18 March 2005 the feeding tubes sup- nurturing of the hospital staff till her natural
plying nutrition and fluids to the body of death and it is assumed that such a death
the 41-year old Terry, were removed. Terry's would qualify for a dignified death.
parents fought to keep her alive by retain- These episodes give us an opportunity
ing the tube in a feeding position because to raise and understand several issues that
they saw signs of consciousness in her. are at stake on aspects of life, death and
Michaels Schiavo, Terry's husband and dying. Euthanasia, passive or active, raises
legal guardian, fought for removal of the the key issue of agency - "who does and
tubes so that she could die peacefully and who should control the decisions to hasten or
naturally. He contended that his wife procure death" (Howarth and Jeffeiys 1996).
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NEW DELHI - 110067
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 = COMMENTARY

can evaluate
Both the Terry Schiavo and Aruna Shanbaug the husband is in a coma, the woman is con-
his life situation objectively
cases discussed above highlighted sidered married and not denied the status,
the as the advocates of eutha-
and rationally
contentious issue of agency raising ques-
nasia prefer privileges and favours extended to mar-
it to be? Is it indeed possible
to makeof
tions on who constitutes a "family" decisions
the on one's life and death, ried women till the husband's last breath.
patient exercising the right toboth
let of
herwhich
live are emotionally charged
In such cases, the wife would never easily
issues, against
or die. One of the major arguments without the involvement of one'sopt for euthanasia for her husband.
own
euthanasia is precisely that "the and others' sentiments and emotions? Further, exercising the right to a digni-
philosophy
Should
and respectability can be mutilated andemotions
used be of lesser validity fied
as death could also be problematic in
to suit anyone but the subject compared situations of marginality based on ethni-
to strict medical and economic
in question"
(Duttagupta 2008: 254).6 grounds? Einarsdottir (2009) succinctly
city, class and gender. Duttagupta (2008)
In active euthanasia it is important to perplexed role of parents by
brings out the as offering two contrasting cases of deaths
ask - how much do we knowemotional
about experts of women in India and the us respectively
why in end-of-life decisions
patients seek euthanasia? While more
of pre-term raises precisely this issue to ask "how many
infants in Iceland. This aspect
research is needed on the social contexts
of emotion brings back the issue of agencyIndian women know when and where to
- who should
of end-of-life care and decisions, a fewtake the decisions for termi-
exercise their rights and dignity"? Consider-
studies in the uk do talk about nation
how offactors ing the gender bias faced by many Indian
life? While medical professionals
like loss of autonomy, and the and degree
bioethicists
ofuse emotional involvementwomen in their daily lives, can a right to a
dependency along with severityas an of
argument
irre- against the rights of par-dignified death be asserted? Discourses
ents to be involved in such end-of-life deci-
versible suffering have been significantly on death with dignity hence need to be
linked to demands for end of life
sions,decisions situated within processes of living with
parents strongly feel that the child
(Seale and Addington-Hall 1994, 1995a
belongs to them and they have the right dignity
to in everyday contexts.
and 1995b; Van den Block et decide the future
al 2009) and of their children (ibid).
Even when euthanasia is understood inConclusion
how conversely patients have accepted the
natural course of death despite This article makes an attempt to focus on
severeof the right of the patient
the framework
to illnesses
physical discomfort in terminal a dignified issues surrounding euthanasia from a
indeath, it is important to
understand
situations of strong family and physicianthat rights of persons do notsocial science perspective. While the social
support (Duttagupta 2008). exist in a vacuum, but are exercised sciences and more specifically sociology/
within
The desire for euthanasia isthe context of social roles - one's own and
associated anthropology have contributed extensively
thosedoes
with terminally ill patients but of others,
the which dovetail into eachon health, illness and suffering, contribu-
other.
patient always know that he/she is aThis also means that till the tion on issues around death is relatively
moment
terminal case? Who informs him or aher
of death, scarce. While euthanasia is being dis-
person, even if on his/her death
bed, is aaccept
of this? Does every such patient cussed of late more openly in countries
social being that carries meaning
this terminal status for him/herself? including India, it has largely remained
for others and is vested with social obliga-
tions
Zimmermann (2004) in a review of and privileges towards them. A few
hospice a medical and legal issue. This article
anthropological
and palliative care literature discusses theliteratures thus link the attempted to situate this in a social and
issueterminal
discourse on patients' denial of of end-of-life decisions and construc-
cultural context to ask what kind of ques-
illness and impending death. tions of life and death to the notion of
Patients' tions and issues are at stake. It sought to
denial in this literature has been looked
personhood argue that euthanasia needs to be situated
(Kaufman 2000; Einarsdottir
upon in a number of ways - as2009; Kaufman and Morgan 2005).
a conscious in related discourses on everyday life and
In many
or unconscious defence mechanism, cultures, such as India, inliving, personhood, constructions of death,
which
which
might be healthy and denial as the rituals and symbolic aspects of dying and
autonomous individual is slowly
a non-
emerging,
compliant behaviour as it obstructs ageing in cross-cultural contexts. Euthanasia
the processes of life and death
certain
kinds of care. In the latter,are carried
such out in social contexts in which
non- is deeply embedded in cultural traditions
compliance is linked to the discourses and it is important to study these to be
on social obligations, mutual
religion, morality,
support, which
dying particularly in western society effectively able to contribute to the current
etc, are the determining factors
in any
invites patients to participate in thedecision-making.
plan- debates about legalisation of euthanasia.
The well-being of
ning of death. Anecdotal evidence the larger units of family and kinship
from The discussion establishes that euthanasia
other contexts like India shows that even when seen in the framework of a right
might be at stake in the individual's living
or dying. Therefore, others may or may
patients do not expect to be told about their to dignified death becomes an emotive
terminal illness by the "good doctors". issue full of contradictions and irreconcil-
not endorse the person's decision to termi-
nate his life, even though he may be inable
Also, issues of life and death (in addition a ideological stances. The hierarchy of
to the doctors) are also assumed to be vegetative state of existence. To take anhuman and civil rights, the ranking of
managed by superior forces leaving roomexample, in Hindu society there is a hugesocial positions occupied by the patient and
for expectations of a miraculous cure. difference in the social and ritual status,
the significant others in his reference group,
rights and privileges of a married woman
Further, is the severely ill patient in an the degree of the individual's domination
appropriate mental state in which he/she as compared to a widow. Therefore, even and
if assertiveness in decision-making on

Economic & Political weekly E3223 December 3, 2011 vol xlvi no 49 ^

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important events become contentious issues Arima Mishra (2010): "Deconstructing Self-care Kaufman, Sharon R (2000): "In the Shadow of 'Death
in Biomedical and Public Health Discourses" in with Dignity': Medicine and Cultural Quandaries
in giving a uniform practical shape to the Arima Mishra (ed.), Health , Illness and Medicine: of the Vegetative Stat e", American Anthropologist,
concept of euthanasia. The analysis also Ethnographic Readings (Delhi: Orient Blackswan). 102(1): 69-84.
establishes the need for more social sci- 5 The role of KEM hospital in Mumbai in taking Kaufman, Sharon R and Lynn M Morgan (2005): "The
care of Aruna Shanbaug for 38 years is an excep- Anthropology of the Beginnings and Ends of
ence research to understand issues of life tional case of healthcare practice in India. Life", Annual Review of Anthropology, 34: 317-41.
6 Similar arguments were put forward in the recent Prabhananda, Swami (2008): "The Art of Dying with
and death including end-of-life decisions
mercy killing plea by the 70-year old Karibasamma Dignity" in S Chatteijee, Priyadarshan Patnaik
like euthanasia. from Devenagre, Karnataka. For more details see and Vijayaraghavan M Chariar (ed.), Discourses
www.dnaindia.com/bangalore/report_bangalore. on Ageing and Dying (Delhi: Sage).
Seale, Clive and Julia Addington-Hall (1994): "Eutha-
NOTES nasia: Why Do People Want to Die Earlier", Social
REFERENCES Science and Medicine, 39(5): 647-54.
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Social Science and Medicine, 40 (5): 581-87.
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Terri Schiavo Dies", 31 March.
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Duttagupta, Chadralekha (2008) "Dying with Dignity"
and Medicine, 40 (5): 589-95.
Guzaarish indicate this phenomenon. in S Chatteijee, Priyadarshan Patnaik and
2 See The Times of India, 8, 9 and 28 March Vijayaraghavan
2011 Singh, Umesh (2008): "Culture Sensitive and Culture
M Chariar (ed.), Discourses on
(Bangalore edition) for the reporting of the judg-
Specific End of Life Care: A Case Study Based
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Einarsdottir, Jonina (2009): "Emotional Experts:
Priyadarshan Patnaik and Vijayaraghavan M Chariar
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Passive euthanasia is letting a person die by with- Pre-
(ed.), Discourses on Ageing and Dying (Delhi: Sage) .
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Van den Block, L, R Deschepper and J Bilsen et al
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Quarterly , 23(1): 34-51.
(2009): "Euthanasia and Other End of Life
nasia (AVE) is intentional intervention to end life Jennifer L (1990): Experiences of Death: An
Hockey Decisions and Care Provided in Final Three
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Months of Life: Nationwide Retrospective Study in
3 "The Fast Road to Moksha", The Times of University
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(Bangalore edition), 12 January 2011, p 19. Howarth, Glennys and Margot Jefferys (1996):
Zimmermann, Camilla (2004): "Denial of Impending
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4 For more details on this ideology and its implica- Death: A Discourse Analysis of Palliative Litera-
Medical Bulletin, 52(2): 376-85.
tions on individual responsibility and healthcare, ture", Social Science and Medicine, 54: 1769-80.

Reading the Signs at

and sometimes contradictory strands that
are visible; from extreme libertarian

the Occupy Movement

demands ("End the Fed") to old school so-
cialist credos ("Free School for All"), to
more specific grievances ("Destroy the
Incarceral State").
ARJUN JAYADEV Faced with the burgeoning movement,
and the realisation that a wide variety
The 1 A
Occupy Revolutio
of Americansmoveme
had broad sympathy with
The Beginning
the group, commentators is
have tried to and Ne
myriad signs sl
- Sign at
create their Occupy
own narratives about the
appears to be an inc
movement. The two dominant strategies,
movement
seemingly small act of protest in railing
given the rightward slant of the media in a
economic
The seemingly early
earlyOccupy September
September smalltomovement,
as a response a inequality,
as act a response of begun protest as to in a a the country are:
viral campaign by the magazine Adbusters
capitalism • To categorise it as a its
and left-wing version of m
has spread across the us and indeed the
the Tea Party, albeit without the nous St
institution - Wall
world with astonishing speed. At last or the coherence, and without adequate
United States. But it
count there were over 2,000 cities and clarity about its demands.
insistence
towns worldwide that had joined in the on
• To portray taking
it as a deeply anti-social bar-
protests. In initial responses, the media
established barian horde seeking to stir up hatred,
political
and commentators struggled to make a always at the edge of violent action, with-
including the Demo
coherent analysis of these developments out purpose, and only seeking handouts
radical democratic f
and the implications for the us polity. from the public purse.
organisation
Much like the only other previous move- suggest
These narratives, ranging from sympa-
ment with this flavour (the anti-globalisa-
ambitious thetically concerned to virulently hostile
grass-roots
tion movement that peaked around 2000) in their tones, speak more to the knee-jerk
the potential to mat
there are a large and disparate set of impulse to classify the movement into
issues and engagements which have something recognisable and mouldable
coalesced together in a seemingly inchoate within the frame of the two-party system -
but potentially powerful movement. Visit- primarily as a potential grass-roots advo-
Arjun Jayadev
ing the sites (my own engagement has been (arjunjayad
cacy group for the Democrats. These read-
at the economics departmen
in Boston and only a litde in New York), ings are narrow and miss the point. In
Massachusetts Boston.
one is struck by the multiple overlapping fact, the movement may eventually be
DECEMBER 3, 2011 vol xlvi no 49 ESS Economic & Political weekly

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