Euthanasia, a concept relatively new and highly controvertible, is accepted and functional in some states of the United States of America and Australia as well as some European nations.

These nations have identified its need and devised plans, rules and regulations, and embraced it after community participation and consensus. So it is imperative for everybody to become familiar with the notion of euthanasia. This word originated from the Greek words meaning 'good death'.

If it's about death, then what's controversial in it? Contention arises in the manner of occurrence not death itself. Death is a natural phenomenon whereas euthanasia is an assisted procedure. This concept singly has the strength to shake the basic foundation of ethics, law, human rights, family structure and basic understanding of right and wrong with extensive abuse potential.

Hence, this topic needs to be treaded slowly with community participation.

The decision to embrace or reject it needs to be an informed one. The obvious resemblance between euthanasia and suicide cannot be ignored. Both are measures of untimely embrace of death. Suicide is voluntary whereas euthanasia is physician assisted.

Suicide is a manifestation of the emotional uphill irrespective of age, health and pre-existing diseases whereas euthanasia is a preplanned physician- assisted product of informed decision of both family and the patient.

Question arises about the need of such a procedure.

The need arises in individuals afflicted with incurable diseases, cancers or bed-ridden elderly, who are disgruntled with life and looking for a graceful end to their pain and suffering, where any medical intervention appears to be a mere prolongation of their life and pain.

Among malignant cancer patients, there is a growing voice among them for a painless exit. Euthanasia holds true for this very population. As the incidence of malignant cancers is gaining momentum in Nepal, where awareness, familiarisation and acceptance are a time-consuming process, this concept needs to be introduced in the Nepali society.

Euthanasia can be both active and passive – active when something is introduced and passive when no intervention is done to resuscitate. In Western countries, such patients have access to what is called a Do Not Resuscitate (DNR) form, which is an informed choice. Here patients are responsible for all their medical decisions, and they can make their decision for future medical treatment as well when they may lack the ability to make a choice as the disease progresses. They can also appoint a person who can make such a decision on their behalf.

In Nepal, a person's treatment decision is not entirely his or her own, it is a collective effort of the family.

Hence, the whole population needs to be aware of such a procedure. It can be considered the right choice, choice for a well planned painless death.

The procedure gives a choice for an informed individual to embrace the inevitable after proper execution and necessary requirements in a painless way.

It is a dignified exit for those individuals who are undergoing painful and expensive treatment with no avail. Debate can arise about their choice against the norms of the society for a natural death. To start this very debate, the concept needs to be introduced, and the community needs to be made aware. When the community is involved in all aspects of decision-making and all measures are initiated to remove all doubts and obtain total consensus, a legally binding procedure can be introduced, which is least likely to be exploited.

This concept is decisive, and introduction at any time is likely to cause a furour.

But awareness is the key and opens the door for a healthy discussion. The initiation of the procedure is a long way through, but talks can be initiated. Even the developed countries with freedom for almost everything are not quick to accept it. Those countries which already have a functional system have done so after a decade of deliberation. Australia has introduced it with temporary approval, as the community still debates on its acceptance.

Nepal needs to make the community aware, and if and when community consensus is available, it should make laws pertaining and relevant to the local customs and beliefs. The concept poses an ethical dilemma of right and wrong, so it requires a long tedious process of discussion and deliberation.

It must be understood that resourceful individuals with informed choice might venture into countries where it is legal, which would result in loss of revenue.

Suffering people may opt for illegal means to attain euthanasia, which could leave painful memories for the relatives. Medical personnel on compassionate grounds might want to help these patients but do so under threat of persecution. Doctors risk their lives in alleviating others' pain. Hence, this concept needs to be introduced to see whether the community is open for such a concept and procedure and if the community perceives its need.

Reprisal can be expected when the concept is introduced, but it is necessary to do so. Advancements in medicine and technology have enhanced the diagnosis of incurable diseases and led to a long life. But once inflicted with these diseases, painful and expensive treatment as well as a poor quality of life is inevitable. These measures only prolong the painful life of patients and economic repercussion for the families. Euthanasia can provide a well-informed exit by understanding the hopelessness of the case. It gives the family to prepare, plan and bid for a dignified farewell.

As these measures have massive exploitive potential, well formatted criteria need to be established.

There should be legal provisions to prevent persecution of the providers by relatives.

As this is a long tedious journey, awareness needs to start now.

A version of this article appears in the print on April 7, 2022, of The Himalayan Times.