INNAMREDIYARPATTI, India — Michael headed for work at a textile mill, leaving his wife, children and infirm mother at home in this impoverished part of southern India. When he returned a few hours later, his mother’s body was propped up in a chair surrounded by villagers and decorated with flowers, poisoned by his wife with a potion in a local form of mercy killing known as thalaikoothal.
Three decades later, he harbors no ill will toward his wife. “My mother had been sick and in pain for 20 days and wasn’t eating properly,” said Michael, 62, who like many southern Indians uses one name. “I was thinking of doing it myself. It was time, and there wasn’t enough food to go around.”
Even as India debates the morality and legality of euthanasia, three districts in the southern state of Tamil Nadu have been quietly carrying out a homegrown version for decades, or centuries, depending on whom you ask.
The practice in one small corner of India has declined under the spotlight after a high-profile 2010 case and growing opposition from elderly rights groups, but dozens, even hundreds, of cases of thalaikoothal, or “head pouring,” occur quietly each year, people say.
“Some call it euthanasia,” said Rajeshwar Devarakonda, social protection head at HelpAge India, a civic group focused on elderly care. “Others call it homicide.”
Although it can take various forms, a common approach is that once an elderly relative becomes seriously ill and the family can’t afford to care for the person, a date is set. Often relatives are called to say goodbye or even participate. The victim is given an oil bath, a head massage perhaps involving cold water and an exceedingly large amount of green coconut milk, leading to death.
Reducing a sick or frail person’s body temperature can bring on heart failure, said Dr. Raja Natrajan, a geriatrician, while drinking excessive liquids can induce renal failure.
In a variation, victims are force-fed cow’s milk and their noses pinched shut — an act called “milk therapy” — resulting in “breathing problems,” said S. Gurusamy, a sociology professor at the Gandhigram Rural Institute.
Thalaikoothal — traditionally for those 50 and older who become incapacitated, although younger people who become very ill are also targeted — is as natural as a birthday or wedding, some say. “It’s just the cycle of life,” said Kalimuthu, 60, a Peraiyur village farmer with a white, receding hairline and a wispy mustache.
Despite community claims that it’s used only in terminal cases, social acceptability has resulted in abuses, care experts said, as impatient family members “hurry things along” to gain control of the estate, sometimes with the help of compliant doctors or quacks who substitute poison-laced alcohol or pills for coconut milk.
“Nowadays, because of their assets, young people sometimes want thalaikoothal done even if it’s just a cold or minor sickness,” said Elango Rajarathinam, Virudhunagar-based director of Elders for Elders Foundation. “Old people are definitely scared of this practice. You can see the stress on their faces.”
Occasionally, those targeted get wind of it and flee.
Others just accept their fate, experts said, even requesting thalaikoothal, less because they’re ready to die than because society makes them feel worthless.
Ponnusamy, 67, a pipe fitter in a green shirt and purple dhoti, a type of sarong, recently suffered two heart attacks, leaving him worried about more than his ticker.
“I trust my wife wouldn’t think like that,” he said, gazing over the infertile landscape at two bullocks with decoratively painted blue horns. “If my family tried thalaikoothal on me, I’d ask why. If they didn’t answer, I might resign myself to it.”
The history of thalaikoothal is hazy, but some say it started before the British Empire when a prince helped his ailing mother-in-law die peacefully. Others suspect it began as recently as the 1950s, a response to a rising population and poor local economy.
“India’s very good at making up stories,” said Devarakonda.
Underpinning thalaikoothal is a society that’s seen extended families gradually replaced by nuclear families, placing less social value on the elderly.
Although women’s status in India is often low, men are more frequently the victims of thalaikoothal, experts said, in part because assets are generally in their names, providing an incentive. Also, daughters-in-law who provide most elder care are reluctant to assist men, given social taboos. In addition, some perceive men’s housekeeping skills as limited in male-dominated India, leaving them seemingly dependent.
“An old man can’t even make his own tea or take care of the grandchildren, while older women remain useful,” said Devarakonda.
Many people feel they’re just relieving someone’s suffering, added Gurusamy, who sees thalaikoothal as more a family decision than a moral concern.
“You can try anything, but it won’t stop thalaikoothal,” said Dhanushkoti, 63, a retiree in Innamrediyarpatti. “In our culture, if there’s a problem in the house, the family, not the government, handles it.”
Rather than fighting entrenched culture directly, activists said, they’re trying to improve underlying social and economic conditions through education and calls for improved palliative care. Elders’ health often deteriorates for very basic reasons, they said, including untreated bedsores that lead to severe infection and, ultimately, thalaikoothal.
The gradual spread of pensions, however modest, is also helping. “If you’re dead, you can’t bring a pension in,” said Rajarathinam. “Now families have an interest in keeping you alive.”
Activists have created about 500 elder-empowerment groups to confront neighbors suspected of planning thalaikoothal and are teaching children to act as community watchdogs, although these measures aren’t always effective.
As several men in their 70s gather in the Innamrediyarpatti community hall for a self-help meeting, most acknowledge that they’ve never prevented thalaikoothal and would be reluctant to do so.
“If I try and stop someone, they’ll just say, ‘Then you take care of the old man yourself,’ ” said Kalimuthu, a group member. “What can I say? I can’t afford to keep him.”
Euthanasia is illegal in India, but right-to-die groups have conducted seminars, launched media campaigns and petitioned courts for changes.
The Supreme Court in a landmark case two years ago — in which a woman remained in a vegetative state for nearly four decades after being raped and asphyxiated — paved the way for families or direct caregivers to withdraw life support.
Police and officials in Tamil Nadu have largely turned a blind eye to thalaikoothal. In 2010, however, the practice hit the headlines when a 60-year-old man died suddenly and his nephew Asokan accused a hospital janitor of offering injections, using skills she’d picked up watching doctors. She was suspected of being involved in several similar cases. Officials ultimately released her, saying there was no evidence because the bodies had been cremated or buried.
“It’s a police coverup to hide this disturbing practice,” said Asokan, a trade union official. “Elderly need better care, and this hideous practice should end.”
As some people justify thalaikoothal on cultural grounds, others are outraged.
“Who has the right to take a life?” said Kannan, 45, a betel nut seller rolling leaves at a small stand. “We don’t need to kill them. This is murder.”
Tanvi Sharma of The Times’ New Delhi bureau contributed to this report.