Sujoy Dhar

MUMBAI, May 27 2011 (IPS) – In a secluded hospital bed in this bustling Indian metropolis, a woman who has lain brain dead for 37 years after a brutal sexual assault is at the centre of a national debate on mercy killing.
India s Supreme Court has ruled that Aruna Shanbaug should live, while at the same time supporting passive euthanasia or the withholding of medical treatments that are keeping her alive.

The court s decision to rule out euthanasia of any kind for Shanbaug gladdened her former colleagues nurses at the King Edward Memorial (KEM) Hospital who have taken care of her since the day in 1973 when she was sodomised and strangled with a dog chain by a hospital custodian whose advances she had spurned.

The decision saddened Pinki Virani, the journalist who petitioned the court to allow euthanasia for her.

Virani also recognised the importance of the landmark decision in a country where euthanasia of any kind had previously been unlawful. This did not stop Virani from criticising Shanbaug s fellow nurses who want to keep her alive. Because of Aruna Shanbaug this tragic woman who has been denied the choice because of those who profess to love her by touting her bedsore-less life no Indian hereinafter need suffer the way she does, Virani said.

The Supreme Court verdict came as a first step toward the passage of a law in India on euthanasia allowing passive euthanasia in certain cases, based on merit.
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According to the judges, since there is no statutory provision in our country as to the legal procedure for withdrawing life support to a person in PVS [permanent vegetative state] passive euthanasia should be permitted in our country in certain situations.

According to court euthanasia should not be permitted to Shanbaug because her caregivers are ready to tend to her medical needs. The hospital is taking care of her and as such the court decided that unless they want it, it will not be granted. Shanbaug s family has shunned her since the incident. Virani s petition was also rejected, as she is neither Shanbaug s kin nor caregiver.

The court said it disagreed with the government s legal advisor, the attorney general, that euthanasia should never be permitted.

A decision has to be taken to discontinue life support either by the parents or the spouse or other close relatives, or in the absence of any of them, such a decision can be taken even by a person or a body of persons acting as a next friend, the court said.

India s Law Minister Veerappa Moily immediately said, There is a need for a serious debate regarding the matter. It has to be examined, it has to be debated upon.

Proponents of voluntary euthanasia in India hailed the court s decision. This court verdict is path- breaking and it has legalised something which is actually already in practice in many hospitals by the doctors. We need a law making voluntary euthanasia both active and passive an option, said Surendra Dhelia, a medical doctor who is also joint secretary of the Mumbai-based Society for Right to Die with Dignity, which is affiliated with The World Federation of Right to Die Societies.

Dhelia said a person should make a living will or give someone a power of attorney under which he or she can be denied treatment in case of terminal illness or vegetative state.

As an individual, I support euthanasia for Aruna since [she has been] in a vegetative state for 37 years. But since she does not have a living will we cannot support it legally, said Dhelia.

Virani said the Indian Parliament must add to the Supreme Court guidelines to further protect individual rights. Meanwhile, individuals could examine the possibility of writing their living will and also talk to those they trust about the DNR or do not resuscitate , said Virani.

Harmala Gupta, founder of CanSupport, India s first cancer support group, said it is premature to talk of euthanasia in a country which has yet to make basic health care available to its citizens.

It is not fair to ask someone who does not have reliable and affordable access to proper symptom control for unrelenting pain and other distressing problems, including mental depression, whether they want to take their life, said Gupta.

The wishes of the family, if the patient is unable to communicate, will also have to be considered, said Gupta, who also believes that allowing death to take its natural course either by not intervening to interrupt it (euthanasia) or by prolonging it (using a ventilator) when it is clear that a patient is dying is the right way forward.

For this we need to make palliative care a part of basic health care in this country, Gupta said.

With too few support groups like CanSupport in India, and the healthcare system in dire straits, euthanasia is often a heartless choice for the poor, according to Gupta.

In a village in eastern India s Bihar, shopkeepers Mukesh Kumar and Asha Devi had once asked the court to allow the mercy killing of their two terminally ill children. When the courts refused them, they appealed to the prime minister and the state s chief minister for help to bear the cost of treatment.

Their two sons, 15-year-old Nitin and 13-year-old Anshu, suffer from muscular dystrophy, a hereditary disease that weakens the muscles. The brothers are unable to do anything on their own since they are paralysed from the chest downwards.

Either the law should allow us to practice euthanasia or assist us in treating them, said the parents who have made the rounds of courts and government hospitals with their plight and prayers.