‘Life is pleasant, death is peaceful; it’s the transition that’s troublesome.’ (Isaac Asimov)

Death is a stark reality and it’s inevitable. Everybody makes a similar statement rather stoically, but the fact is that nobody is comfortable with the thought of one’s own death. We say that death is a great relief from life’s troubles and tribulations, but do we really mean it? Is there not a tinge of hypocrisy in these statements?

If we really believe that death is a journey to our eternal home, why do we wish for a long life? Even a ninety year old person may ask for another ten years, or if it’s all right, a few more beyond. The Bible says, ‘our days may come to seventy years, or eighty if our strength endures; yet the best of them are but trouble and sorrow, for they quickly pass, and we fly away’. That’s a chilling reminder that the human life-span is limited, and any attempt to prolong it will not succeed, except just marginally.

My mother-in-law passed away recently at the ripe age of 85, but she died an ‘enviable’ death, so to say. She died peacefully in her sleep in the small hours of the day without disturbing anybody. She lived a pleasant and quiet life and left equally pleasantly and quietly. This set me thinking especially when many people consoled us saying how fortunate she was to die without going to a hospital, where she would have been subjected to various desperate measures to prolong her fragile life.

Medical science has progressed remarkably over the years, but it still has its limitations. The problem is that we tend to overlook its limitations and imagine how every illness can be cured magically by medical science. It is true that younger people have a better chance of survival, even in a worst-case scenario. Medical science is able to restore the health of an accident victim or people with tumours, heart problems, multiple fractures, injuries etc. All these are possible when the patient is otherwise young and healthy.

We cannot generalize the power of medicine without reference to the age and health of the individual concerned. When it comes to the old and infirm, the power of medicine faces a big challenge. It’s here that often medicine fights a losing battle.

Taking old people to the hospital and consigning them to the ICU with all tubes attached, poking needles at intervals, multiple tests, visitors barred etc is indeed a very sad situation. The trauma faced by the patient is unspeakably pathetic. The relatives spend sleepless nights, and spend huge amounts of money going through this process of hospitalization, secretly sceptical about the outcome.

I think hospitalizing the old and terminally ill is an act of desperation enacted by the relatives more as a social obligation rather than a real personal option. Relatives, especially children sometimes do all these only for a social approval and to fulfil a visible filial obligation.

Doctors too face a moral dilemma at this point. It is their professional duty not to give up an attempt to save a life. At the same time they are bound by the Hippocrates oath, which enjoins them to inform the immediate family the prognosis. They are expected to avoid “those twin traps of overtreatment and therapeutic nihilism”. . They have to follow the oath in letter and spirit.

Doctors should not mislead the family with all kinds of placebos, and tests to give the impression that some great miracle is in the offing. In fact the time-honoured oath further says: “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”

A line has to be drawn meaningfully about who has to be admitted in the ICU and who has to be on life-support systems. Elderly patients shall be in the ICU only when the doctors are reasonably sure that the patient has a fair chance to improve by being there.

It is also a good idea if every individual in their old age has a chance to tell his immediate family their choice beforehand. Let them spell out if they want to prolong their tenuous life through medical intervention or they want to be left to die peacefully. This is clearly a human rights issue. Once a parent makes his or her decision in this matter, the children will not have to face a moral dilemma.

The freedom to die with dignity should be made a fundamental right. One must be able to make a will to the effect that one doesn’t want the intervention of hospitals or doctors except to alleviate suffering and pain, and to facilitate a smooth passage into the next world.

(The writer is Director, Little Rock Indian School, Brahmavar, Udupi)