Dr. Shyam P. Lohani

Originated in Greece, the word ‘euthanasia’ means good death. Euthanasia is usually carried out to a terminally ill patient. Almost everywhere around the globe, the debate on euthanasia is ongoing. Some are for euthanasia while others are against it. Those differences are rooted in cultural backgrounds, religious perspectives, and views on life with local traditions. The term euthanasia refers to deliberately ending someone’s life usually to relieve pain and suffering. Physicians sometimes perform euthanasia when it is requested by a person who has a terminal illness and is in an unbearable pain.

Dimensions
Euthanasia encompasses various dimensions ranging from active (introducing something to cause death) to passive (withholding treatment or supportive measures). It can be voluntary (consent from the patient) to involuntary (consent from the guardian) and physician-assisted where physicians prescribe the medicine and the patient or the third party administers the medication to initiate death. Today, proponents of voluntary euthanasia and/or assisted suicide to express concern for a much wider circle of patients, including those with severely disabling conditions such as quadriplegia (non-progressive) and multiple sclerosis, and Huntington's chorea (both progressive).
Euthanasia is the administration of a lethal agent, usually a cocktail of drugs, to a patient by another person. It is intended for the purpose of relieving the patient’s intolerable and incurable suffering. Despite being tragic, it is understandable that some patients in extreme coercion such as those suffering from a terminal, painful, debilitating illness may come to decide that death is preferable to life.
Proponents of euthanasia argue that it is beneficial to terminally-ill patients and their families. It is cruel to allow a person to die a slow painful death and force their families to watch their beloved live in misery every day. Thus, those who suffer from incurable illnesses should be allowed to decide to die without any pain.
Proponents of euthanasia often argue that the right of a terminally-ill person to avoid unbearable pain and embrace a timely death with dignity should be respected. Besides, the medical costs for terminally-ill patients are often exorbitant to many of them and their families. Particularly in developing economies, families have no money to palliate their terminal illness and have to wait for death painfully. Therefore, it may be humane to let euthanasia help them slide into eternity with dignity, without pain, with their loved ones present.
Terminating someone's life is not an easy decision and task. But it is really hard to witness when someone you love is suffering from agony and pain. At the same time, the patient may want to end his or her life from excruciating pain. But legalising euthanasia is not an easy task. Society will react differently towards the legalisation. Maybe brain death is one of the situations that merit euthanasia.
Assisted suicide is sometimes called physician-assisted suicide (PAS) that involves a physician knowingly helping someone end their life. Such persons are likely to experience persistent and unrelenting suffering. They may have a disease that is diagnosed as terminally-ill. When most people think of euthanasia, they think of a physician directly ending someone’s life. This is known as active euthanasia where purposely giving someone a lethal dose of a drug is considered.
Passive euthanasia is usually withholding or limiting life-sustaining treatments. A physician may also prescribe increasingly high doses of pain-killing medication. Over time, the doses may become toxic. This sometimes creates confusion between passive euthanasia and palliative care. The focus of palliative care is on keeping people as comfortable as possible at the end of their life. A palliative care physician might allow someone approaching death to stop taking a medication that causes unpleasant side effects. In other cases, physicians may allow someone to take a much higher dose of pain medication to treat severe pain.
Law needs to be stringent in order to prevent the manipulation of the system by greedy relatives, business partners, and the state, for example. Furthermore, methods would need to be devised to deal with those who are in a condition that they are unable to make a decision. We can understand why people want to alleviate suffering at the end of life, and why they think voluntary euthanasia might be a compassionate way of achieving that. But with good palliative care, patients may have a good quality of life, and no-one will die in unbearable pain, whether they die at home, hospice, or hospital. Sadly a small number of people do experience pain while dying expected deaths.

Palliative care
There is no denying that painful deaths occur. There are complicated cases, where people have pain that is generated in ways that are very difficult to alleviate. There are cases when people will need a palliative care specialist and a full palliative care team to help support them through. But no one dying an expected death needs to die in extreme, excruciating pain. In such instances, that may be due to poor quality palliative care.
There have been debates over the ethics and legality of euthanasia and PAS for centuries. Today, laws about euthanasia and PAS are different across countries. In the United States, PAS is legal in many states. Outside the United States, PAS is legal in Switzerland, Germany, and Japan. Euthanasia, including PAS, is legal in several countries that include the Netherlands, Belgium, Luxembourg, Colombia and Canada.
There is no legal basis for euthanasia in Nepal and it is often difficult to differentiate between euthanasia and deliberate killing. The current law of Nepal forbids any person to deprive others of their lives. But, it is time for us to initiate extensive debates among healthcare and legal professional, and the general public on euthanasia and assisted suicide.

(A Professor, Lohani is the founder and academic director at Nobel College. lohanis@gamil.com)