6. What can be done for a terminally ill patient in palliative care?
Every day, families and their doctors around the world have to make the painful decision of whether to intentionally let a loved one die in order to ease their suffering. This is commonly referred to as euthanasia. The laws with regards to euthanasia vary from country to country.
The person is in a coma.
The person is too young (e.g., a very young baby).
The person is mentally challenged to a very severe extent.
The person is severely brain damaged.
The person is mentally disturbed in such a way that they should be protected from themselves (Ref: About.com).
Active Euthanasia: Intentionally causing a person's death by performing an action such as giving a lethal injection.
Passive Euthanasia: Intentionally causing death by not providing necessary and general/ordinary (usual and customary) care or food and water.
In this article we look at euthanasia purely from a spiritual perspective. However, before we try to understand the act of euthanasia from a spiritual perspective, let us familiarise ourselves with a few spiritual concepts.
Destiny is that part of our lives which we have no control over. All major events in our life are usually destined events. For more information on destiny, please refer to our section on destiny.
To complete our destiny and the give-and-take account we have with various people.
To make spiritual progress with the final aim of merging into God and therefore getting out of the cycle of birth and death.
Human birth is very precious. This is because when we are on the Earth plane (Bhūlok), we have the best opportunity for spiritual progress. Refer to the article on the spiritual purpose of life.
All of us have to die at some point and this is decided as per our destiny. In our lives, as per our destiny, there are some pre-destined time periods in which we can die. How a person dies can vary and is not necessarily pre-destined. For example, in a pre-destined time period, if a person is destined to die, he will die. However, the means by which he dies may be through the process of euthanasia, assisted suicide or by normal medical reasons. In cases of Mahamrutyuyoga (definite death), it is rarely euthanasia or assisted suicide or suicide that is the cause of death. God arranges for the death in some natural way. People who have violent deaths generally do as per their destiny.
Refer to the article on 'Time of death'.
In this section we look at a few viewpoints that will give is additional perspective if we are faced with the prospect of euthanasia on ourselves or our loved ones.
Euthanasia is against the word and will of God "Religious people don't argue that we can't kill ourselves, or get others to do it. They know that we can do it because God has given us free will. Their argument is that it would be wrong for us to do so.
"They believe that every human being is the creation of God, and that this imposes certain limits on us. Our lives are not only our lives for us to do with as we see fit.
This is a very superficial and simplistic way of looking at euthanasia. If we look at our lives as per the path of Devotion (Bhaktiyoga), there is nothing that can happen to us without God's will. God has complete right over our lives and there is nothing that we can do to transcend that right.
According to Path of Action (Karmayoga), 65% of our lives are destined and 35% of our lives are due to free will. The decision to commit euthanasia may not always be according to free will and many spiritual factors can influence the outcome of our decision.
In keeping with our spiritual purpose of life, if the patient is able to do spiritual practice, it is recommended that the patient not entertain euthanasia. This is because it is easier to do spiritual practice while in a physical body as opposed to when one is a subtle-body. In the subtle-regions of the Netherworld (Bhuvaloka) and Hell (Pātāl), the experience of suffering is far more than on the Earth plane of existence. In these subtle-regions, subtle-bodies have little to no happiness. This intensity of suffering only increases as one goes to the lower regions of Hell and the ability to do spiritual practice diminishes.
Contrary to popular belief of some major religions, in the current era of Kaliyug, less than one percent of people go to the subtle-region of Heaven (Swarga). In the subtle-region of Heaven since subtle-bodies are completely involved in enjoying the fruit of their merits, subtle-bodies forget about spiritual practice. It is only in the subtle-regions of Maharlok and higher, where less than 0.1% of people go after death, that spiritual practice does happen. Also, a subtle-body in the subtle-regions of the Nether region (Bhuvarlok) and below, faces more attacks from higher level ghosts than a person on the physical Earth plane of existence. Refer to the section 'Which subtle-region are subtle-bodies likely to go after death'.
The bottom-line is that there is no spiritual benefit for an average patient to ask to die by euthanasia. Hastening death does not equate to the ability to do spiritual practice in the subtle-regions of the Universe or for that matter, enduring less pain. However, a person can gain merits depending on the reason he is asking for euthanasia.
For a person in a coma or a permanent vegetative state, the sub-conscious mind is still active and so also is the give-and-take account centre. In the case of a person doing spiritual practice as per the six basic principles of spiritual practice and who has reached the 50-60% spiritual level, spiritual practice continues in the sub-conscious mind. However, if one is not firmly entrenched in spiritual practice prior to getting into a coma, it is impossible for one to begin spiritual practice when in a coma. For a person of average spiritual level who is terminally ill but has their faculties intact, focusing on spiritual practice will benefit them in the afterlife and will also reduce their pain before dying. While this is theoretically possible, it is difficult for a person to start spiritual practice as per the 6 basic principles when one is terminally ill and suffering. Palliative care can help in this situation – Refer to the section on palliative care.
What perspective do we need to keep when a loved one is in a permanent vegetative state with no hope of recovery?
A person (patient) undergoes this kind of a situation as per their destiny. The impact is felt by both the patient and the family members. This depends on the give-and-take account between the patient and the people involved in looking after the patient. If the patient's life is taken prior to the give-and-take account being settled, or the units of unhappiness completed as per their destiny, they will have to face it in the next lifetime. Therefore, while we may end their pain in this lifetime, it will have to be faced in some other lifetime. The change that may occur in the next lifetime is in the longevity or intensity of the problem. For example, in the current lifetime, because of the act of euthanasia, a person and his or her family members may have been spared 10 units of pain spread over five years. In a subsequent lifetime, it could change to 25 units of pain spread over two years.
Also, family members have to reflect upon what is their real reason behind wanting euthanasia for the patient. For example, is it for their own happiness or do they just not have the time and want to move on with their worldly lives, or do they want to devote their time for the spread of Spirituality? Depending on their intent, family members either gain merits or demerits from their action or they even transcend the law of Karma.
Medical decision-makers already face difficult moral dilemmas in choosing between competing demands for their limited funds. What is the point in keeping a person in a vegetative state (with no hope of recovery) when those resources can be used for other people in need?
The primary purpose of our lives is to do spiritual practice and to progress spiritually. If a person is capable of doing spiritual practice or accepting spiritual healing treatment in palliative care, life should be prolonged. Refer to Section 6 – What can be done for a terminally ill patient in palliative care?
If the above is not happening, then it is better to let the person commit euthanasia so that the resources can be used to help others who can do some spiritual practice. This is in keeping with the spiritual principle that looking after society is more important than looking after just one person's needs.
Sometimes family members may consider euthanasia for a person in a permanent vegetative state if looking after the patient is an obstacle in their own spiritual practice. If the intention is purely to use the time and resources to enhance one's spiritual practice, then the proportion of sin incurred is minimal.
Some patients may prefer death to dependency because they hate relying on other people for all their bodily functions, and their consequent loss of privacy and dignity. For a seeker of God, this challenging period can be used as a means to reduce one's ego and body consciousness/attachment to one's body and thereby make spiritual progress. Both ego and body consciousness are obstacles in spiritual progress.
In 2008 Her Holiness Pethe Aji, a Saint doing spiritual practice under the guidance of SSRF, had a stroke which rendered Her semi-paralyzed and dependant on other seekers for Her daily needs till her death four months later. However, in these four months, due to her intense focus on spiritual practice, she was able to increase her spiritual level by 4%, i.e. from 74% to 78% at the time of death. Moreover, the seekers looking after Her would experience spiritual healing just by being in Her service. We quote this example as a testimony to how life's trials can be used to our spiritual advantage. The same rate of spiritual growth has also occurred in the case of other seekers of God during their terminally ill stage.
Many people think that each person has the right to control his or her body and life and so should be able to determine at what time, in what way, and by whose hand, he or she will die.
One needs to understand that as per the spiritual Path of Devotion there is nothing that can happen in this Universe if it is not in accordance with God's wish. It is better if these same people exercised their right to try and progress spiritually which is the reason we were given this life.
There are 14 main planes of existence in the Universe. Seven of them are positive planes of existence and seven are negative planes of existence. The seven negative planes of existence are commonly known as Hell (Pātāl). There are numerous sub-planes within these main planes of existence.
Generally, all our actions give us either merits or demerits or a combination of both. Depending on our merits and demerits and the state of our ego, we go to different subtle-regions of the Universe after death. For example, a person with a lot of merits may go to the subtle-region of Heaven and a person with a lot of demerits would go to one of the subtle 7 regions of Hell. Behind every action the intention is an important aspect in deciding whether a person reaps merits or demerits from it.
The type of person/entity harmed (an average person or a seeker of God or a Saint, a spiritual organisation etc.).
In the case of euthanasia, if a physician with all good intention strives to relieve the person of their intense suffering, then in this act there are both merits and demerits for the physician. Depending on the intention behind committing euthanasia or assisted suicide, the proportion of merits or demerits for the physician changes. The following examples shed light on the intensity of merits and demerits incurred from various meritorious and de-meritorious acts on a scale of 1 to 100.
The reason that there are demerits is because of the act of taking life. A human birth is precious as it gives us an opportunity to do spiritual practice so as to realise our spiritual goal in life. Refer to the section – How often are we reborn?
As discussed earlier, this is the only plane of existence in the Universe (Heaven and below) where people practically can do spiritual practice. When murder of a person not doing any spiritual practice takes place, it robs him of the ability to do spiritual practice and hence the demerits incurred are a lot.
From a seeker of God's perspective, it is important that we are able to transcend both merits and demerits as they both keep us in the cycle of birth and death. This can only be done through spiritual practice. Refer to the concept of akarma-karma.
If a person is conscious and asks to die, here too a sin is incurred if the act of euthanasia is carried out. From a spiritual perspective, even if a person who is in pain (with no hope of recovery) takes his life with the help of someone else, it is considered suicide. The magnitude of the sin however, depends on the intention behind asking for euthanasia. In some cases a person can even get merits depending on their intention on asking for euthanasia.
The attitude of a person terminally ill varies depending on a person's spiritual level.
If a person is above the 50% spiritual level their attitude will be 'let everything happen as per God's wish.' Here, they take more of an observer stance to their pain and adverse situation.
At a lower spiritual level their attitude is mostly as per what they want.
In an earlier section, we discussed the concept of time of death. If a person's time to die has come as per 'Definite Death' (Mahamrutyuyoga), then no amount of legal obstacles can circumvent death. The mode of death can be any such as euthanasia or dying of an illness.
A woman at the centre of the right-to-die debate in Italy has been moved to a clinic where she will be allowed to die after 17 years in a vegetative state since a car crash in 1992. Her father has been battling with the courts in Italy to let her die since 1999, insisting it was her wish. In July, a court in Milan ruled that doctors had proved her coma was irreversible. It also accepted that, before the accident, she had expressed a preference for dying over being kept alive artificially. State prosecutors appealed against the ruling, but the Court of Cassation in Rome ruled the challenge inadmissible in November. The Italian health ministry subsequently issued an order barring all hospitals in the region from withdrawing her support, but this was overruled by a court in Milan on 21 January. A private geriatric clinic in Udine then said it would receive her and allow her to die.
All major events in our life are destined. Meeting with a car crash that put this person in a vegetative state was as per her destiny.
For many years her father battled to let her die but to no avail. The reason is that as per her destiny, it was not time to die.
Now as she approaches the time for 'definite death' (Mahamrutyuyoga) the court decision has moved in favour of her father's request for euthanasia.
For people who are meant to die at a particular time as per the 'definite death' time period in their lives, they will die at that time with or without euthanasia. However, in most cases, the cause of definite death is not because of euthanasia, but other natural causes.
Palliative care is physical, emotional and spiritual care for a dying person when a cure is not possible. It includes compassion and support for family and friends. However, it is not always the case that holistic palliative care is available.
Inability to do spiritual practice: Most people do not do spiritual practice that is in accordance with the 6 basic principles of spiritual practice. If a person has not been doing spiritual practice as per the 6 basic principles prior to becoming terminally ill, it is very difficult to begin spiritual practice at this late stage and under adverse conditions.
Increase in Raja-Tama: Because of the increase in Raja-Tama with the onset of illness and the prospect of death close at hand, a large percentage of terminally ill patients are affected by ghosts (demons, devils, negative energies, etc.). These negative energies then try to take control of the subtle-body of the person after their death.
Importance of spiritual protection: The most important part of palliative care is the spiritual aspect. For the patient, spiritual protection from ghosts (demons, devils, negative energies, etc.) is most important even though spiritual growth is unlikely to happen.
Until the year 2018: It is recommended to play the chants Shrī Gurudev Datta for ancestral problems and the chant Om Namo Bhagavate Vāsudevāya throughout the day for 6 hours and 18 hours respectively.
The person who is undertaking palliative care of a patient should treat the work as satseva wherein one is serving God (the Soul) within that person.
While euthanasia is a hotly debated topic, it is difficult to decide which side to take unless one has an understanding of the spiritual dimension and the laws that govern our life and death. As a rule of thumb, if decisions are aligned with the spiritual purpose of life, it is more than likely to be spiritually correct. Law makers and decision makers unfortunately do not understand the spiritual dimension and hence there are conflicting viewpoints.
Also, we must understand that nothing in the Universe can happen without God's wish. It would be myopic of us to think that if we can cut our lives short through euthanasia that it would be going against His will. Trying to understand and argue about God's ways with our limited mind and intellect is like trying to study the ocean through one drop of sea water. Destiny and the give and take account influence all our major decisions. Do refer to the SSRF Classroom lecture – Why we do the things we do.
Finally, while we do spiritual research and try to understand this universe, we can only begin to scratch the surface of understanding the infinite God Principle. Even though spiritual research is way beyond modern science, research, in its scope, only satisfies the beginning stage of a seeker's spiritual journey. It is for this reason that Saints on Earth urge us to do spiritual practice to make spiritual progress so that we can transcend our little minds and intellects and merge into God. When we do spiritual practice and attain the level of Sainthood, the whole issue about euthanasia becomes a non-issue as one understands and experiences that everything happens as per God's will and that spiritual practice is the only place one's focus should lie.