The problem with never-say-die

Some are condemned to a creeping death through dementia, slow cancer, or some debilitating progressive disorder that will rob them of dignity and self-respect but not let them go. Illustration by C Y Gopinath using AI

My father, an air-conditioning engineer, worried about the details of his demise, like a cat with a cockroach, for a decade before he died. He once wrote cryptically to a friend in Hyderabad: "What should be the temperature of a vehicle in which a person could travel from one world into another?"

We all have a ticket for that journey. Some depart sooner than others, while some go quickly, dispatched by a car with a drunk driver or a truck out of nowhere. They are fortunate. However, our hearts belong to those condemned to a creeping death through dementia, slow cancer, or some debilitating progressive disorder that will rob them of dignity and self-respect but not let them go.

The most plaintive cry for help I have read came from a beloved friend whose body was riddled with cancers, decay and breakdowns, such pain that he desperately blasted himself with loud music all day to distract himself. He was convinced that death would be the supreme agony. His end-of-life directive screamed just one message: Please don't let me die.

I am OK with interventions including a voice box, feeding tube, life in a wheelchair with someone having to lift me up to use the bathroom, amputation and artificial limbs, intubation, and revival after cardiac arrest. Blindness is acceptable. Deafness is acceptable. Both together, blind and deaf, are not acceptable. Sustained unmanageable extreme pain is not acceptable. Interventions that make sudden death situations likely after hospitalisation but leave me with communication, use of arms, sight or hearing are ok. Life in diapers is acceptable. Loss of dignity is acceptable.

However, in today's battered, brutal, dangerous world, enough would just like to quietly leave the party. It's called assisted suicide.

The Sarco, or the suicide pod, was made for them.

My father would have loved it. The Sarco is 3D-printed and looks like spacecraft from interplanetary travel. It sits at an angle, pointing skyward, as though about to take off. Last month the Sarco, invented by the provocative Australian right-to-die activist Philip Nitschke, was used for the first time in a forest near Merishausen on the Swiss-German border by a company called The Last Resort. Switzerland, with its liberal euthanasia laws, has long been a magnet for people seeking doctor-
assisted suicides.

The client, an anonymous 64-year-old American woman with a severely compromised immune system, pressed a button inside the pod, releasing deadly nitrogen gas. In seven or so minutes, the oxygen level inside the pod fell from about 20 per cent to near 0.5 per cent. The woman floated away into oblivion.

Indian law allows the withdrawal or withholding of life support only under limited conditions, such as when the patient is terminally ill or in a vegetative state or has opted for it through a "living will", also known as an advance directive (AD).

Alas, just as birth was not by your choice, neither is the end of your life. Quite without warning, the biological bundle you lived in, washed, dressed up and cared for (or perhaps abused) all your life, is no longer yours to terminate as you would like. Never mind that life may have dealt that body the worst inhumanities from rape and war to penury and abandonment, but religion will piously scold you, saying your life is a sacred gift.

The law will nod along, adding that self-murder is as much a crime as homicide. Ironically, they're on the losing side here; the law's worst punishment is a death sentence.

Meanwhile, the corporate hospital, with an eye to billing, would love to keep you going as a vegetable. The law lays down layers of bureaucracy even in interpreting your stated AD, which is only valid if notarised before a magistrate. Each AD is subject to the opinion of two medical boards, whose decision can be challenged through a writ petition under Article 226. The case can drag on for ages while the nearly-dead patient hovers between two worlds, wanting neither.

You cannot live in peace, but the world will not let you die in peace.

In July, I had a near-death experience that left me smiling. I was to undergo a fairly basic internal examination that required me to be under total anaesthesia, which felt like a good idea to me as well. I didn't want to be around while someone pokes and prods me with catheters.

As I lay on the gurney, a soft and pleasant voice told me I would feel the slightest pinprick on my arm. That was the last thing I (barely) felt. I have no recollection of slipping into a silky-satiny blackness without dreams or sensations. There were no thoughts, no painful memories, no anxious expectations, no unanswered questions, no unfulfilled obligations, nothing but seamless silk and senselessness. I imagine that's what a perfect death would feel like.

Alas, it was not my curtain call yet. When I awoke, I was in a pleasant room, feeling inexplicably fresh and alert. A pretty nurse was waving her hand in front of my face.

"How many fingers, sir?" she said.

You can reach C Y Gopinath at cygopi@gmail.com

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The views expressed in this column are the individual's and don't represent those of the paper