In the wake of the acrimonious debate let loose around the globe by the circumstances surrounding the death of Terri Schiavo in the U S, there is a need to stop and think with a cool head. Most of all, we need to understand what we mean when we use the term 'euthanasia'. Perhaps, in keeping with Indian tradition, it is best defined by describing what it is not.
Removal of artificial devices or means by themselves does not constitute euthanasia. Their insertion may be necessary for a patient at a particular stage of treatment in order to ease and comfort, to facilitate healing and even to preserve life. When it becomes clear that these devices are no longer serving their intended purpose or goal, they should be removed. This is not euthanasia, but good medical practice. It is the prolonged use of devices, even when it is clear that they have no further role to play and will only prolong life artificially with no benefit to the patient, that is undesirable. This is when the question of the right of the individual to die naturally and with dignity arises and is to be contrasted with the demand for an early termination of life.
The latter does not allow death to follow its natural course but seeks to pre-empt it.
This is euthanasia.
There is still another misconception that we need to address: That not forcing food and fluids on a dying patient deprives them of nourishment and is a covert form of euthanasia. This, in fact, may be the kindest thing that one could do for a person whose organs are no longer capable of performing their functions properly. In the case of end stage cancer, for example, physical changes occur in the body, which studies have shown do not cause any discomfort even when the person is no longer eating or drinking. Contrary to public belief, which families share, suffering caused by starvation and dehydration is therefore, not an issue any more. In light of the above, professionals have a duty to educate patients and their families. They need to share information and encourage them to ask questions.
From our experience at CanSupport in running a home care programme and caring for more than a thousand people with terminal cancer, we have found that much of suffering is avoidable if one communicates properly.
Patients had questions that they were never able to ask or to which they never received answers, or had fears that they could not share with their physicians; leaving them to imagine the worst. This is why learning how, when and what to communicate forms such an integral part of palliative care training. It also means being honest enough to admit that much as you would like to, you cannot, and perhaps should not, remove all suffering.
Dame Cicely Saunders, the founder of the modern hospice care movement, summed up the philosophy of hospice beautifully in a wonderful little essay titled, 'Watch With Me'. She took the title from the words that Jesus of Nazareth had uttered in the Garden of Gethsemane just before his crucifixion. They were the words of a man who knew he was to die. For her, his words demanded a recognition that while at times as caretakers, we may feel helpless and not fully understand what is happening we can still provide comfort -not by flexing our skills and using interventions that serve no purpose - but by just being there; to "watch with me".

Harmala Gupta is the president of CanSupport, a registered charity that has been running home care services for people with terminal cancer. The telephone helpline for cancer, which is manned by volunteers specially trained to give information and empathetic support, is 91-11-26711212.

Some Opinions
Sandhya Srinivasan, Health Writer
Euthanasia is a very complex issue. The term is used very flippantly. I recognise the right of people to end their lives, or even to let it be known in advance, that if they were ever in a situation like that, they wouldn't want to suffer. And while I also understand it when families support this because they can't see their loved one suffer, there are more complexities to think about. You cannot imagine a person's will to fight death and live until you are in that particular situation. In India, in the absence of a set system, people (even doctors) are pretty much doing what they want and as a result, lots
of dubious decisions are taken.

Urvashi Butalia, Publisher (Zuban) and Writer
Euthanasia is a tricky issue but on balance, I would say removing the pipes (as in Terry Schiavo's case) was the right decision. We went through this with my dad, though not for a long stretch. However, there was a time when he was not there and the machines were keeping him alive. It could have gone on for a long time, which it didn't, but I remember battling with the doctors who wouldn't allow it. See, in the end, we'd have gone back to our busy lives and he would have been lying there, uncared for. Life and consciousness are clearly linked. I know euthanasia is difficult and each case has to be decided on merit and that it can even be misused, but at some point, it is necessary to take the decision on behalf of someone who can't do so. That would be more sympathetic.

Flavia Agnes, Legal Advocate
On one hand, I feel that in the rare cases where nothing can be done to help the patient, the practice of euthanasia should be allowed to end the suffering of the patient, and of the family. But on the other hand, if the patient is not in a position to give consent, the freedom to end a life can be misused, especially where there are issues regarding money. In India, where literacy levels are still low, ignorance can lead to misuse of this practice.

Dr Madhumita Puri, Child Psychologist
I firmly believe that the right to life or death is truly mine. However, if I should reach a state where I'm not in a position to express my position and if, somewhere on the way, I've expressed an opinion, that must be honoured. But if one is in a conscious state, it is a gross violation of one's right to self for people to believe that one is not in the frame to live.

We went through this with my dad. To me life and consciousness is clearly linked. I know euthanasia is difficult and each case has to be decided on merit and can even be misused but at some point, it is necessary to take the decision on behalf of someone who can't do so.
Urvashi Butalia, Publisher (Zuban) and Writer

Euthanasia is a very complex issue. The term is used very flippantly. I recognise the right of people to end their lives, or even let it be known in advance, that if they were ever in a situation like that, they wouldn't want to suffer.
In India, in the absence of a set system, people (even doctors) are pretty much doing what they want and as a result, lots of doubtful decisions are taken.
Sandhya Srinivasan, Health Writer