How Aruna Shanbaug case shaped euthanasia debate
NEW DELHI: In 2011, a 110-page judgment delivered by Supreme Court Justices Markandey Katju and Gyan Sudha Misra began with a couplet by Mirza Ghalib. ‘Marte hain aarzoo mein marne ki, Maut aati hai par nahin aati’ (We die in the vain hope of death/ We die, but death eludes us). They were hearing the case Aruna Ramchandra Shanbaug v. Union of India and Others, and ruled that in cases of irreversible illness, and after a thorough medical evaluation, passive euthanasia should be permitted. The judgment provided strict guidelines for it, which involved clearance by a high court.
Ironically, Aruna Shanbaug, a nurse, and later patient in Mumbai’s King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, could not herself choose to undergo passive euthanasia.
She had been in a permanent vegetative state since 1973 after she was raped by a hospital employee Sohanlal Bhartha Walmiki. He asphyxiated her with a dog chain, and the lack of oxygen damaged her brain stem.
Shanbaug, who was 25 years old at the time of the assault, was admitted and looked after by the state government-run hospital till her demise on May 18, 2015. The nurses, her former colleagues, kept her alive for over four decades—bathing her, turning her to ensure that she wouldn’t get bedsores, and feeding her through a tube. She eventually died of a cardiac arrest brought on by pneumonia.
Pinki Virani wrote about a book on Shanbaug in 1998 titled Aruna’s Story: The True Account of a Rape and its Aftermath. Over the years, she followed her progress.
In 2009, she moved the Supreme Court through a Public Interest Litigation (PIL) seeking to become her ‘next friend’, as Shanbaug’s kin had either died, or were unable to look after her. A next friend is appointed to take essential decisions for a person if they are unable to do so themselves and in the absence of a legal guardian.
Virani pleaded with the court that passive euthanasia be allowed for Shanbaug. The 2011 judgment, an outcome of this litigation, declared the KEM hospital staff, instead of Virani, as next friend.
The nurses, in turn, chose to not stop her treatment. Shanbaug became a symbol for many things—the rape survivor who lived on, the recipient of caregiving of the hospital nurses and doctors, the lightning rod around whom the issue of passive euthanasia was fought and won.
“I am deeply grateful to the Supreme Court for validating its own 2011 judgment and allowing living wills under very specific conditions, keeping in mind that even if there is no living will for passive euthanasia and if the patient is in an irreversible condition and death has already set in, the loved ones, or next friend can go to the doctor and do the needful, because the law allows it. There is so much guilt and societal approbation about taking such a decision,” said Virani regarding Friday’s judgment, which legalized a living will document in cases of passive euthanasia. Euthanasia in the Netherlands is regulated by the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, 2002. It legalises euthanasia and physician-assisted suicide in very specific cases, and very specific circumstances including the patient’s will and suffering, a second opinion, and the absence of alternatives. Belgium legalised euthanasia in September 2002. The Belgian law sets out conditions under which suicide can be practised without giving doctors a licence to kill. Patients wishing to end their lives must be conscious when they make the demand and repeat their request for euthanasia. They have to be under “constant and unbearable physical or psychological pain” resulting from an accident or incurable illness. Italian lawmakers passed a law last year allowing adults to decide, in consultation with their doctors, their end-of-life medical care, including the terms under which they can refuse treatment. The law permits Italians to write living wills and refuse medical treatment, artificial nutrition, and hydration. Active euthanasia is illegal in all US states, but physician-assisted dying is legal in Oregon, Washington, and Montana. The difference between the two lies in who administers the lethal medication. Allows assisted suicide as long as the motive isn’t profit.
If you are in a permanent vegetative state, how are you going to decide how much is enough for you? That is where this becomes a discussion to be had among family and friends. Making a decision like this is difficult for the family, especially when the patient is not conscious. The advance directive gives their thoughts a direction. We don’t want to create a living will, as it will be executed only if we fall ill. We are healthy now, but why should we wait for a terminal illness to strike?