Aruna Shanbaug: Between life and death

May 18th , 2015  came as a disappointment to the country when Aruna Shanbaug, the woman who led a life of pain and suffering, was declared dead. Aruna, who had been in a coma for more than four decades, succumbed to pneumonia. Debates around Indian law’s treatment of rape and euthanasia continue, even as the woman who sparked them is no more.

Born and brought up in Karnataka, Aruna migrated to Mumbai after completing her SSLC in search of a job owing to the poverty of her family.  In 1973, she was working as a nurse in King Edward Memorial (KEM) Hospital in Mumbai. She was full of hopes and ambitions, and was planning to get married soon. All her desires fell into oblivion when she was raped and strangulated by a co-worker. The extensive brain damage she suffered consequently put her in Persistent Vegetative State (PVS) from which she never recovered, and also left her blind. For 42 years Aruna had been in a coma, where she could neither live nor die. The perpetrator, Sohanlal Bartha Walmiki, was arrested and tried for rape and robbery. He served two consecutive sentences for seven years each and was released later. Aruna’s family abandoned her after her mishap, claiming that they could not afford her treatment. After her death, her elder sister Shyamala was quoted as saying “I never visited her after the rape” and “I am saddened by her death, but at the same time happy that her 42-year ordeal has ended”. Shyamala also revealed that her family was not aware of the fact that Aruna was the centre of controversy over euthanasia legalisation. Over these years, she was taken care of by the KEM medical staff who stood resolutely by her. Pinki Virani, a journalist and Aruna’s friend, authored a book on her life, titled ‘Aruna’s Story : The True Account of a Rape and its Aftermath’. Here is an excerpt from the book:

 

“…At times she appears to understand but this is difficult to confirm as there is hardly any meaningful response from her. She is unable to attend to any of her needs. She has to be clothed, fed and changed. No communication is possible; she cannot make any need understood. She cries aloud and in a protracted manner when disturbed. Occasional spontaneous and, apparently irrational outbursts of laughter are also noted. She has severe limb and trunk weakness and incoordination. She cannot sit on her own…”

Aruna’s story has since then sparked widespread debates on euthanasia and the freedom of life. Should a person enduring so much pain and suffering be given the right to terminate his/her life? Does freedom of life include freedom of death?  How will this right operate when the person is incapable of giving consent? In 2009, Pinki Virani filed a petition for Aruna’s mercy killing to the Supreme Court. In 2011, the court rejected the plea but made a landmark judgement legalising passive euthanasia in India. With this judgement, India became one of the select countries where passive euthanasia is legal. Passive euthanasia involves withdrawing life support and food to the patient to cause death. Simply put, it is the refusal of life-sustaining aid to the patient, as opposed to active euthanasia, where physicians inject lethal substances into the patient to cause death. The Supreme Court judgement made it clear that passive euthanasia is legal only when the person is brain-dead and the ventilator can be switched off, and/or the person is in Persistent Vegetative State and aid and food can be withdrawn.  While passive euthanasia is legal under “exceptional circumstances” — decided by the judiciary on a case-by-case basis active euthanasia is still illegal in India.

The court also ruled that the petition for mercy killing should be given by the parents or spouse of the patient. In the absence of these relations, a ‘next friend’ can petition. In Aruna’s case, court ruled out the petition by refusing to recognize Pinki Virani as her ‘next friend’, and instead granting the status to the KEM Hospital, where the staff refused to end the life of a former nurse.

Credits: yournewswire.com
Credits: yournewswire.com

Euthanasia, as defined by many governments, is the termination of life under the patient’s consent to end suffering and pain. Voluntary euthanasia, conducted with the patient’s consent, is legal in Luxembourg, Belgium, the Netherlands, Switzerland and the states of Oregon and Washington in USA. When a person is unable to give his/her consent to perform euthanasia, it is known as non-voluntary euthanasia or mercy killing. Many people refuse to consider mercy killing as euthanasia since it contradicts with the notion of consent which is viewed as a prerequisite to perform euthanasia.  The plea for Aruna Shanbaug’s mercy killing is an instance of non-voluntary euthanasia.

There are manifold arguments relating to the idea of euthanasia. One ethical argument put forward by many who support the cause is that people should be given the freedom of choice over their lives and that the government should not interfere in these choices through legal constraints. This is related to the notion of ‘quality of life, that a person should live only when they feel that their life is worth living. Others claim that euthanasia is already widespread but inconspicuous, and that legalising it would enable better regulation of the practice.

On the other hand, those who oppose euthanasia refer to religious and ethical arguments. Some claim that life is a  God-given gift — only God has the right to take it back and hence, euthanasia cannot be justified. Besides, requesting medical practitioners to terminate a patient’s life is against the basic medical ethics of saving lives. Many others  point to the possibility of unintended consequences in the healthcare system. Legalisation of passive euthanasia might make it a ‘common solution’ in case of complications — medical or otherwise. For instance, a severely ill person may be forced to opt for voluntary euthanasia by his/her family, which might not have resources to continue the treatment.

Although Pinki Virani’s plea was rejected, it gave cause for hope to supporters, with passive euthanasia being legalised in India. Moreover, the case led to euthanasia and mercy killing becoming widely debated topics in India for the first time. Aruna’s death has once again initiated discussions on the subject. With all the arguments, supporting as well as opposing the legalisation of euthanasia, it is now for the reader to decide whether a person in unmitigable distress should be left to live or let to die.

A few interesting reads on Euthanasia from around the globe:

CNN on pro-euthanasia views

New-York Times on the pros and cons of Euthanasia

The Mirror article supporting the ban on Euthanasia

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