The Death Debate

While we debate the merits of euthanasia, Aruna Shanbag languishes in her vegetative state in a hospital bed. It’s been 40 years. Get your head around it.

In December 2004, when 25-year-old K Venkatesh realised that he had just a couple of days left to live, he took a decision. He was bedridden with the terminal stages of muscular dystrophy (medspeak for an irreversible weakening of muscles). By the time he was admitted to a hospital, Venkatesh needed help to drink water; there was a tube running through his throat to feed him and, having lost the ability to speak, he was communicating on pieces of paper. “‘Amma’, he wrote to me,” says Sujatha, his mother, “‘Once my kidneys get affected, my body will be useless. I want to donate my kidneys and liver while I still can’.” He wanted to die.

Sujatha did not agree for two days, then she relented. But that was not enough. The Human Organ Transplant Act specifies that only organs of brain dead patients can be transplanted. Venkatesh was alive. Sujatha moved court for an exemption from the Act. The court expressed sympathy, but refused to accept the plea. Venkatesh passed away in ten days, his kidneys and liver of no use to anyone.

The President of India receives an unknown number of mercy petitions in which the petitioner seeks permission to die. Many of them are from muscular dystrophy patients. In one poignant case, all four children of a poverty-stricken couple in Orissa had the ailment and they just couldn’t afford the treatment. When their writ petition in Orissa High Court was rejected, they petitioned the President’s help, though the President does not have the power to grant death. Section 309 of the Indian Penal Code makes attempted suicide a punishable offence.

Five Decembers later in 2009, when Pinki Virani, a writer, moved a writ petition in the Supreme Court asking that feeding be stopped to Aruna Shanbag, a nurse living in a vegetative state at KEM Hospital, Mumbai, it didn’t get any sympathy from Venkatesh’s mother Sujatha. “Even as a mother I had no right to decide his death. It was his conscious decision,” she says. If the Venkatesh case had raised one question, the Aruna case was an ethical blackhole. The main question was: no one knew whether Aruna wanted to die and, since the only relationship that Pinki Virani had with Aruna was that she had written a book about her, how could a third person, no matter how noble the intention, ask for a stranger’s death?

The Aruna case has been making headlines once every couple of years for the past 37 years. She slipped into her vegetative stage after being strangled with a dog chain while being raped by a ward boy. Aruna was 25 years old then and working at KEM. The blood supply to her brain was cut off, and for close to four decades, she has been confined to bed, force-fed by nurses and doctors at the hospital. When the crime happened, Dr Sunil Pandya was an assistant to the head of department in KEM’s neurology department. “She was admitted under our care for some time because there was the problem of brain damage. It was a horrific case even when it happened. She was engaged to a medical student and suddenly turned into a vegetable. The boy spent all his free time at her bedside. He did it day and night for months till her relatives told him to go lead his own life,” he says.

Dr Pandya, a former editor of the Indian Journal of Medical Ethics, is an authority on medical ethics in India. This is his analysis on the application seeking Aruna’s death. “The difficulty here is who is one person to judge whether another’s life is meaningful or not—that is the crux of the problem. If I am a vegetable, who are you to decide whether my life is worth living or not. The nurses who look after her say that if she is given something that she likes, she smiles. [A Times of India report has quoted the KEM dean as saying that she smiles at nurses and they had deduced she likes non-vegetarian food from her gestures]. Which means there is some awareness but not enough to be able to communicate. So, there is feeling, there is sensitivity, there is also an ability to express pleasure or displeasure but not beyond that. Under such a condition, does anyone have a right to say that enough is enough, her life must be put to an end?”

One way out of this conundrum would have been if Aruna had left a note or document or voiced a sentiment saying that if she was ever reduced to this state, she did not want to be kept alive. That is called an advanced directive or a living will, which has legal validity in some countries like the Netherlands and Switzerland. However, Aruna’s living will would only have solved the ethical dilemma because in India such a will has no legal status.

The Society for the Right to Die with Dignity (SRDD) is a Mumbai-based body lobbying for enlightened laws on euthanasia. “Our society wants living wills to be given legal sanction and a person to have the right to appoint another person to take decisions,” says Surendra Dhelia, secretary of SRDD. Justice VM Mohta, a former chief justice of the Orissa High Court who now practices in the Supreme Court, has, on behalf of SRDD, filed a writ in the Supreme Court asking for living wills to be made legal. He says, “This is recognised by way of Law Commission recommendations also.”

The Government is, however, wary of enacting it because it could be misused. For example, a doctor could be bribed by a relative to legally kill a person in order to inherit his property. “But there is nothing that is not capable of misuse and you don’t hold back something that is essential,” says Mohta. The other reason that makes the Government tread with caution is its uncertainty about public opinion. Mohta says that some years ago he had talked with the law commissioner and the law minister, both of whom felt living wills should be permitted, but public opinion has to be generated in their favour.

The main argument against euthanasia has been religious: that God created humans and thus has the sole right to take it away. The most vehement voice against euthanasia is also the Catholic Church’s. But there is also one non-religious argument. There have been studies conducted in the West in which terminally ill patients, who wanted to die, changed their minds after being admitted to a hospice where they are kept pain-free till death using painkillers like high doses of oral morphine. “Pro-life people point to these cases. They say the reason why a person wants to die is that there’s no support system for him. This is a strong argument against euthanasia,” says Dr Pandya. On the other hand, there is the liberal position that a person has the right to decide whether he or she wants to live. There are also other arguments for euthanasia. Sharmila Ghuge is a lecturer at KC College, Mumbai. She is currently working on a thesis on euthanasia. She says, “The law allows termination of pregnancy in exceptional cases where the foetus is abnormal, beyond recovery and harmful to the mother’s health. The death penalty is also applied in rare cases. So, if the law has exceptions [to take lives] then why can’t an exception be made for terminally ill patients?”

There is another point. In Switzerland, the right to die is extended to tourists. In fact, a group called Dignitas organises suicides for foreigners for a fee. “The Indian Constitution speaks about the right to equality. If you are rich, you can go to Switzerland and get a dignified death. But a poor person cannot, and so isn’t his right to equality violated?” asks Ghuge.

But, even in Switzerland, a case like Aruna Shanbag’s would not be considered. In fact, even euthanasia advocates are hard put to make a compelling case for Aruna’s death. Surendra Dhelia says, “What are the options before us? One, lengthening the dying process because of human intervention and medical technology. Second is a lingering, slow natural death. The third option is to help give her a quicker exit. On humanitarian grounds, I would be with Pinki Virani.”

It might be humanitarian but it is not convincing. By that logic, every severely mentally challenged person could be put to death, and that too by a stranger. “The difficulty the law faces is that everything becomes a precedent,” explains Dr Pandya. “The moment you allow one case, people will twist other cases to fit this precedent. That is why the law is so careful. They can’t establish a precedent which at some point could become a disaster.”

Aruna Shanbagethicseuthanasiamercy killingSupreme Court