The legal and medical arguments that surround euthanasia have made the subject rather controversial in some parts of the world, especially in the United States, and to a great extent here in India too. The subject often evokes emotional and angry outbursts from both sides, but for those suffering from debilitating and painful conditions from which there is no hope of recovery, the question is simply one of human dignity. It is notable that the staunchest opponents of euthanasia are not just those from the religious right, but also from the health care sector.
Euthanasia In India
“It would appear that we are born without choice and must also endure life without any choice, no matter how hellish it might be!”
In India, euthanasia or physician-assisted suicide is illegal, but what’s troubling is that the authorities have not even considered autonomy and death with dignity, which can simply involve withholding or withdrawing life-sustaining treatments. It would appear that we are born without choice and must also endure life without any choice, no matter how hellish it might be! According to the Supreme Court of India, withholding or withdrawing life support may be permissible for a terminally ill patient, but this requires prior approval from the High Court, which is impractical in light of the lengthy judicial process and high costs in the ICU setting.
What’s At Stake For The Health Care Sector?
“For many doctors, objections to euthanasia stem from ethical concerns, but there can be little doubt that for the entire medical and pharmaceuticals industry there is also a huge profit motive”
To avoid the legal ramifications of seeking euthanasia, many patients and families of terminally ill patients in India leave against medical advice, moving out of ICU care. This allows the patient to die of natural causes, without prolonging the suffering. So, why is it that the ISCCM and Indian Association of Palliative Care strongly discourage even ‘left against medical advice’ (LAMA)? For many doctors, objections to euthanasia stem from ethical concerns, but there can be little doubt that for the entire medical and pharmaceutical industry there is also a huge profit motive. But how do they stand to profit from blocking euthanasia and withholding life support you ask? To understand, let’s take a look at the costs of palliative and end of life care.
Profit From Suffering
“Resources that are used on futile cases could be better used on patients who still have hope for recovery, and money wasted on such treatments could be better spent on preventive or future care by the patient’s surviving family”
As stated in a study that appeared in the Indian Journal of Critical Care Medicine, “In the Indian context, prolonged and futile life support has undoubtedly imposed enormous economic and human cost on patients and their families that is avoidable; scarce resources in terms of material and manpower can be optimally utilized for salvageable patients when released from futile applications.” In other words, resources that are used on futile cases could be better used on patients who still have hope for recovery, and money wasted on such treatments could be better spent on preventive or future treatments for the patient’s surviving family.
Statistics on end of life care costs are hard to come by for India, but looking at costs in other countries can help give us a clue. In the United States, medical insurance through Medicare alone paid USD 55 billion solely on medical bills for the last 2 months of patients’ lives. This means that it costs USD 55 billion to prolong suffering for 2 months and make hospitals a lot richer. In India, the financial burden is even greater although medical costs are lower, as the bulk of ICU facilities are in private hospitals, with just 10 percent of critical care facilities being in public hospitals. Moreover, a large segment of India’s population has no real health insurance, which means that bills are footed directly by patients.
How This Affects The Quality Of Health Care
“Supply drives its own demand. If you’re running a hospital, you have to keep that hospital full of paying patients.” – Dr. Elliot Fisher
There is growing discontent with modern medicine because of its lack of focus on preventive health care, which is sustainable, while instead excelling in prolonging the lives of those who are terminally ill by treating complications from the disease, simply delaying death without any improvement in quality of life. According to doctors like Dartmouth’s Dr. Elliot Fisher, “Supply drives its own demand. If you’re running a hospital, you have to keep that hospital full of paying patients.” As a result, doctors and specialists have little time to spend with patients who need help, but instead find it easiest to recommend hospitalization, increasing costs for patients. Moreover, in addition to the high costs of treatments for terminally ill patients, they are visited by a plethora of specialists who will conduct tests and provide consultation, whether or not this helps.
In hindsight, it is strange how those who moralize about the sanctity of life and oppose euthanasia and abortion are also often the most vehement supporters of capital punishment, ‘patriotic’ wars, and LGBT discrimination. In reality, there can be no dignity in life, if one does not have the right to also leave the world with some shred of dignity.
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