Government policies and interventions for development in various sectors and issues
Issues relating to development and management of Social Sector or Services relating to Health
Right to Die with Dignity
Passive Euthanasia: To forgo treatment or life-prolonging medical support
Supreme Court had (in the Aruna Shanbaug case) rejected the euthanasia petition filed by journalist Pinki Virani but established the legal framework for allowing passive euthanasia
Active euthanasia: Entails the doctor administering drugs to end the patient’s life
Medical Treatment of Terminally-Ill Patients (Protection of Patients and Medical Practitioners) Bill regarding passive euthanasia—
Euthanasia is difficult to regulate
Exertion of moral pressure on the patient to exercise it with malicious intention—major loophole
Clause 9– “relatives, medical personnel and the like can apply to the relevant high court for “withholding or withdrawing medical treatment of… a competent patient who has not taken an informed decision”
As long as the individual is competent, it must not be left to anyone else to judge the merit of their understanding in something as fundamental as their life—has the potential for misuse and is antithetical to an individual’s fundamental rights, and should therefore, be removed
Eg: Recently promulgated laws which penalise children for not looking after their parents was inconsistent with this ruling which seeks to legalise passive euthanasia
However, the evolution of democratic thought and the limits of state power cannot override understanding of an individual’s right to decide on their life.
BUT— It should be a private affair and the decision should be respected only when there exists no hope of recovery and is suffering greatly, or is in a vegetative state and kept alive by medical apparatus
Issue of public good—In the case of Aruna Shanbag, one hospital bed was reserved for her for 42 years, which could have been used by thousands of patients, all legitimately claiming the right to live
A hospital bed is meant for patients who have a reasonable chance for recovery. For the rest, there are palliative care homes, hospices and residences.
No person should be allowed to use taxpayers’ funds on the one hand, and on the other deny hospital beds to more deserving patients
Campaign for the Right to Die with Dignity in India
The campaign for the right to die with dignity in India actually begins with Minoo (Minocher) Masani (1905-1998) who formed the Society for the Right to Die with Dignity (SRDD) during the 1960s.
Put in his own money to premier the screening of the film, ‘Whose life is it anyway?’ which deals with the above-mentioned subject
Brought out the first draft of the Living Will (Icchha Maran) in this country
Aruna Shanbag (1 June 1948 – 18 May 2015) case:
Aruna was a junior nurse working at KEM Hospital, when in 1973 she was sexually assaulted by a ward boy. She slipped into a coma and remained in a persistent vegetative state for 42 years thereafter.
“If the doctors treating Aruna Shanbaug and the dean of the KEM Hospital, together acting in the best interest of the patient, feel that life sustaining treatments should continue, their decision should be respected. If the doctors treating Aruna Shanbaug and the dean of the KEM Hospital, together acting in the best interest of the patient, feel that withholding or withdrawing life-sustaining treatments is the appropriate course of action, they should be allowed to do so, and their actions should not be considered unlawful.”
Humanisation and decriminalisation of the attempt to suicide
Justice VA Mohta, former chief justice of Orissa High Court once remarked, “Suicide is a criminal offence only when the person attempting it does not succeed.”
Law Commission of India (in its Report No 210 delivered on 17 October, 2008) stated that there is an urgent need for “Humanisation and decriminalisation of the attempt to suicide”
Dr. Christian Barnard, on a doctor’s role: “It is not true that we become doctors in order to prolong life, We become doctors in order to improve the quality of life, to give the patient a more enjoyable life . . . And the same is true when we are dealing with terminally ill patients: what we should ask ourselves is whether there is still any quality of life left. The doctor who is unconcerned about the quality of life is inhumane; and the real enemy is not death but inhumanity.”
Article 21 of the Indian Constitution does make the right to life a fundamental right, it also allows for death subject to judicial process
Order a soldier to the battlefield, even if it means death
Allows a court to condemn to death a convicted criminal
Thus, the right to live is not an unlimited or an absolute right—is subject to legal caveats and conventions.
Historically in India—opting to die is often an act of honour, of salvation
Cultural practices like santhara among the Jain community—practised with the full knowledge and often consent of the entire community
Hinduism- Hindu saints are known to take sanyas and even opt for Samadhi. even the vanaprastha stage advocated by Hinduism allows for a person to leave the material world and wander into the forest, where he is no longer distracted by the world of attachments. How the person eventually dies, remains unknown. It is another practice that is both voluntary and immensely venerated.
The Living Will
Allows a person to state in advance that he should not be put on life support systems should the need ever arise
Based on the simple logic that any person has the right to decide whether he wants to be operated upon or not, even to be treated or not. The living will can even specify the types of treatment that the patient would be willing to permit for himself.
The patient is fully within his rights to refuse the treatment, even if this refusal can result in death.
“A man who is suffering from an incurable disease and is living thanks to the service rendered to him by others without himself doing anything useful in return has the right to end his life. To fast unto death would be much better for him than to drown himself, for it tests his firmness and leaves room for him to change his mind.”
“A calf, having been maimed, lay in agony in the ashram and despite all possible treatment and nursing, the surgeon declared the case to be past help and hope. The animal’s suffering was very acute. In the circumstances, I felt that humanity demanded that the agony should be ended by ending life itself. The matter was placed before the whole ashram. Finally, in all humility but with the cleanest of convictions I got in my presence a doctor to administer the calf a quietus by means of a poison injection, and the whole thing was over in less than two minutes.
Would I apply to human beings the principle that I have enunciated in connection with the calf? Would I like it to be applied in my own case? My reply is yes. Just as a surgeon does not commit himsa when he wields his knife on his patient’s body for the latter’s benefit, similarly one may find it necessary under certain imperative circumstances to go a step further and sever life from the body in the interest of the sufferer.”
How other countries dealt with ‘Right to Die’—
A. One of the first countries that decided to promote the cause euthanasia was Switzerland
Penalizes assistance in suicide out of selfish motives—If no ulterior are given, no offence is done.
Most developed countries accept the legal sanctity of an Advance Directive, or the Living Will or both. But they have yet to be given legal status in India. However, the Supreme Court is currently hearing petitions which seek to give the Living Will a legal status in this country.
Netherland- The legislation passed regulates the ending of life on explicit request by the individual (voluntary euthanasia) as well as accompanied suicide.
Belgium- permits and regulates the ending of life by physicians on request by the individual who wishes to end life
The first state to introduce such a law was the State of Oregon- regulates physician-assisted suicide for terminally ill patients who have a life-expectancy of not more than 6 months
Other champions for assisted suicide- the State of Washington, the State of Vermont, California, the State of Montana, New Mexico
Connecting the Dots:
What are the moral dilemmas raised by ‘Euthanasia’? How does Hindu philosophy place atman, karma and dharma in the context of Euthanasia? Elaborate
TOPIC: General Studies 3
Economic Development – Indian Economy and Issues relating to growth and development – Different indicators used to measure growth
Social Progress Index: A work in progress
(We have tried to cover this article comprehensively)
Genesis of measuring growth:
It was in early 1930s a need was felt to capture all economic transactions by individuals, companies, and the government in a single measure.
It was essential for this measure to reflect an increase in it in good times and a decrease in adverse conditions.
Towards this end, today we have many different methods of measurements such as –
Gross Domestic Product (GDP)
HDI (Human Development Index)
GNH (Gross National Happiness)
Millennium Development Goals and Sustainable Development Goals
Social Progress Index (SPI)
Gross Domestic Product (GDP)
In January 1934, Simon Kuznets prepared a report titled ‘National Income, 1929-32’ and presented it to the U.S. government.
It laid the foundation of how we judge the economic success of countries today.
In it was elucidated the concept and measurement of Gross Domestic Product (GDP).
GDP since then has been used to measure the economic performance of a nation, and has been shaping the debate on the performance of countries for the past 80 years or so. Today, almost every country maintains GDP statistics.
What is Gross Domestic Product (GDP) and what is the difference between GDP and GNP (Gross Nation Product)?
Gross Domestic Product
Gross National Product
An estimated value of the total worth of a country’s production and services, within its boundary, by its nationals and foreigners, calculated over the course on one year.
An estimated value of the total worth of production and services, by citizens of a country, on its land or on foreign land, calculated over the course on one year.
GNP = GDP + NR (Net income inflow from assets abroad or Net Income Receipts) – NP (Net payment outflow to foreign assets).
To see the strength of a country’s local economy.
To see how the nationals of a country are doing economically.
Total value of products & Services produced within the territorial boundary of a country.
GDP is essentially about where production takes place.
Total value of Goods and Services produced by all nationals of a country (whether within or outside the country).
GNP is about who produces.
GDP is a better measure than GNP
Analysts say that GDP is a better measure than GNP and is accepted by all the major industrial countries.
The reason is that GDP is domestic production where employment is created; inflation is moderated; tax revenues are more and so on.
GNP also has its advantages and India is a big beneficiary of it – remittances from abroad; acquisition of foreign companies; invest abroad to tap on foreign opportunities etc. But the consensus is that former is of greater value than the latter.
What are the relative merits and demerits of GDP and has it outgrown its utility? Is there a need for alternative measures?
Merits of GDP –
GDP growth over time enables central banks and policymakers to evaluate whether the economy is in recession or inflation. In that sense it is still required.
GDP has also held significance as a universal metric over the years, to measure the economic performance of a nation.
However, with rapid globalization and technology-oriented integration among countries, this metric has become outdated and does not accurately take into consideration other aspects like the wellbeing of the residents of a country.
Weaknesses/demerits of GDP –
GDP excludes voluntary market transactions: GDP fails to account for productive non-market activities, like a mother taking care of her child, a homemaker doing household chores, a homeowner doing maintenance of his house, leisure (paid vacation, holidays, leave time), improvement in product quality, etc.
GDP also ignores important factors like environment, happiness, community, fairness and justice.
But these are important aspects of development. Thus, there is a need for alternative measures which can take into consideration other key factors like hunger and malnutrition, safety parameters, literacy rate and tolerance.
What are the alternative measures other than GDP? Can they track the apparent progress of countries by considering all the key factors? Can they find a composite measure of well-being to date?
There are many recent approaches which go beyond GDP and incorporate most of the above factors (like environment, happiness, hunger and malnutrition, safety parameters, literacy rate and tolerance etc) into the measurement of the well-being within the society.
Some of these include GINI coefficient, HDI (Human Development Index), and GNH (Gross National Happiness).
It was introduced in 1912 by Corrado Gini and adopted by World Bank
It measures the income inequality among a country’s citizens
But it fails to measure social benefits or interventions that reduce the gap or inequality between rich and poor
GNH (Gross National Happiness)
GNH was introduced in the 1970s by the king of Bhutan
GNH measures the happiness levels of the citizens in a country
But it ignores other important elements like gender equality, quality education and good infrastructure
HDI (Human Development Index)
HDI was devised and launched in 1990 by Pakistani economist Mahbub ul Haq
It is computed and published by the United Nations Development Programme and overcomes most of the shortcomings of the Gini coefficient and GNH.
However, HDI, as a measure, falls short in its capture of the unequal distribution of wealth within the country and the level of infrastructural development.
Many prospects of a healthy society, such as environmental sustainability and personal rights, are not included in HDI.
Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs)
After HDI, Millennium Development Goals and Sustainable Development Goals were also built along various dimensions based on the work done in understanding human development.
From the above different measurement approaches we can conclude that they are not successful in tracking the apparent progress of countries.
These are some of the limitations of the approaches in finding a composite measure of well-being to date.
SPI as complementary index: The way ahead
The next stage in the measurement of well-being went into creating what is termed as the Social Progress Index (SPI). It goes beyond the traditional measure of GDP and has most parameters that are required to fulfil SDGs.
About Social Progress Index (SPI)
The Social Progress Index measures the extent to which countries provide for the social and environmental needs of their citizens.
Fifty-four indicators in the areas of basic human needs, foundations of wellbeing, and opportunity to progress show the relative performance of nations.
SPI is based on three fundamental pillars: basic needs for survival; access to the building blocks to improve living conditions, and access to opportunity to pursue goals and ambitions.
What is the difference between GDP and SPI?
SPI focuses on outcomes rather than inputs that are used in GDP.
For example, the quality of life and longevity are measured instead of spending on health care, and people’s experience of discrimination is looked at instead of focusing on whether there is a law against discrimination.
SPI takes into consideration not just GDP but also inclusive, sustainable growth that will lead to a significant improvement in people’s lives.
SPI can best be described as a complementary index to GDP and can be used along with GDP to achieve social progress.
Findings of SPI 2015
If the world is considered as one country, it would score 61.00 on the SPI on a population-weighted basis.
India ranks 101 with a social progress score of 53.06 among 133 countries, according to SPI 2015.
One significant find is that all countries doing well in GDP/capita are not always the ones at the top of SPI.
For example, New Zealand has GDP per capita almost half that of the top performing nations, according to GDP per capita figures, but performs better than most nations on SPI.
The U.S., which has significantly higher GDP than New Zealand, ranks lower than New Zealand on SPI.
West Asian economies like Kuwait, the United Arab Emirates and Saudi Arabia have high GDP per capita, but secure significantly inferior positions in SPI.
Will SPI replace GDP?
As said earlier, SPI takes into consideration not just GDP but also inclusive, sustainable growth that will lead to a significant improvement in people’s lives.
It can best be described as a complementary index to GDP and can be used along with GDP to achieve social progress.
In conclusion, SPI can bring substantial betterment in the policy discourse on development.
With the move to getting it introduced at a sub-national level, the index is expected to help development practitioners and other stakeholders in analysing well-being in a better manner.
SPI, to be introduced in India soon — this can lead to a better understanding of well-being and prosperity within the country.