Health

Time to Reopen the Euthanasia Debate

The sad demise of Aruna Shanbaug after 42 years of ordeal in a permanent vegetative state is inevitably linked with the rekindling of the euthanasia debate in India. She had been lying in the same bed of ward no.4 all these years. She is possibly the only patient in the world to have survived in a vegetative condition for so long a period.

The term euthanasia which is also identified as physician assisted-suicide in contemporary times gained significant attention only with her case. Demands for euthanasia were made prior to this case as well, through petitions submitted to the various Presidents of India and in different courts. This was however the first case that had been heard by any Indian court on the subject of euthanasia.

Aruna Ramachandra Shanbaug was a 24-year-old junior nurse from Uttar Kannada, Karnataka, who worked in King Edward Memorial Hospital, Parel in Mumbai. On the evening of November 27, 1973 while Aruna was on duty, a sweeper of the hospital attacked her and made an attempt to rape her. Having found that she was menstruating, the sweeper sodomised her in the canine experiment room of KEM hospital. He wrapped a dog chain around her neck and strangulated her.  The next morning she was found unconscious on the floor with blood all over by a cleaner. It was suspected that the strangulation stopped the blood supply to the brain and caused its damage. She had experienced serious injuries associated with the brain stem and the cervical cord.

The Aruna Shanbaug case was a writ petition under Article 32 of the Indian Constitution. Pinki Virani, who claimed to be the next friend of Aruna and had written  a book on her case, had filed the petition. The Supreme Court subsequently turned down the plea for euthanasia in this case, but laid down guidelines for passive euthanasia, which involves withdrawal of life-continuing treatment or food, under the ‘rarest of rare’ circumstance. It also set out a proper guideline that could be followed in cases that were similar in the future.

The role of the state

The debates on euthanasia have been generally premised on the role of the state and its conflict with the rights and interests of the individual. It has been noted that the paternalistic role of the state may stand in opposition to an individual’s rights and interest as it does not allow him the authority over his own life and body. For instance, an individual who suffers from some terminal illness or is in a vegetative state does not have the right to die with assistance from the other. In such cases the ‘individual’ needs to seek the permission of the ‘state’ which may go against his wish and respect its very own ideals of being a protector of lives of the citizens. The distinction between active and passive euthanasia also requires a special mention in this context. While the former practically involves injecting lethal drug into the patient’s body, the latter on the contrary deals with discontinuing of treatment. Therefore morally speaking, active euthanasia would amount to ‘killing’ someone by means of drugs and the passive form would entail ‘letting someone die’.

The Indian Supreme Court by making passive euthanasia permissible under ‘rarest of rare’ circumstance seemed to respect the very ideals of liberal democracy and a modern state, which places the individual at the Centre stage and aims at fostering and administering the lives. The lawmakers, however, in India have remained silent with respect to issue due to the fear of its misuse. This fear of the legislature to some extent seems justified. The Indian stand does not appear to deliberately downplay the rights of the patients who ask for euthanasia. Conversely it may not want to come up with a law which legalizes euthanasia.

However, the lawmakers, taking their cue from the Supreme Court Verdict of Aruna Shanbaug in 2011, need to realize, that a law which sets guidelines and makes room for passive euthanasia in certain cases does not necessarily violate the state’s role as an entity that fosters and administers life.  Such a law would rather prevent the misuse of euthanasia in cases where it should not be carried out, where the patient still believes to be enjoying a dignified life. Furthermore many, like the proponents of palliative care who position themselves against euthanasia do not regard passive euthanasia as a form of euthanasia. They believe that removal of artificial life support which accounts for passive euthanasia is indeed a noble act and the physicians must resort to it if the treatment is of no benefit for the patient.

The Indian context

Legalising active euthanasia in India, where majority of the population still lies below the poverty line, could have fatal consequences for society. In the absence of proper healthcare delivery mechanisms such an action could have a severe impact. It would only lead to cases of involuntary euthanasia, which essentially amounts to taking lives of persons without obtaining their consent. This might result in the ‘doing away’ with the terminally ill well in advance of treatment for personal gains like property inheritance.

The debate that the Aruna Shanbaug case ignited in 2011 should be reopened up for further analysis and a legislative move for passive euthanasia should be considered. India, where the longest surviving patient remained in a permanent vegetative state can no longer afford to ignore the issue of euthanasia. Her death, therefore, serves to give a clarion call to lawmakers to come up with a conscious decision on the issue that could be acceptable to the Indian society at large.

Minakshi Biswas is a Research Scholar at the Centre for Political Studies, JNU.