Journalist Pinki Virani petitioned the Supreme Court in India.
MUMBAI, INDIA – For the past 37 years, Aruna Shanbaug, 62, has been lying in a vegetative state in Ward No. 4 of government-run King Edward Memorial Hospital, KEM, in Mumbai, India’s most populous city, according to court records recapping a petition by journalist Pinki Virani for Shanbaug’s euthanasia, which judges recently denied.
Shanbaug used to work as a nurse in the same hospital until a hospital janitor strangled her with a dog chain then sodomized her in 1973. The event caused brain damage, according to a hospital neurologist, and Shanbaug has been in a coma ever since.
She doesn’t weigh much, and her brittle bones could break if her hands or legs get caught under her body the wrong way, according to Virani’s petition. Her skin has become like papier-mâché stretched over a skeleton.
Because she can’t move, she is prone to bed sores. Her teeth have decayed, causing her immense pain, according to the petition.
Her family abandoned her so the hospital staff takes care of her. Because of the controversy surrounding her case, the door to her ward remains locked.
One of her other few visitors has been Virani, who wrote a book on Shanbaug called “Aruna’s Story: The True Account of a Rape and its Aftermath.” In the book, Virani writes that Shanbaug was a pretty and ambitious small-town girl who was engaged to a doctor before the rape at age 25 silenced her forever.
Although the Supreme Court here rejected Virani’s petition, the case has sparked a nationwide debate: Should a person living in a persistent vegetative state be allowed to die?
Although the court rejected Virani’s petition, it did allow for passive euthanasia and has prompted much public debate. Similar to the debates that occur around the world, some people in India say terminally ill people deserve to be put out of their pain, while others see it as a solution to unbearable financial circumstances. But many maintain that euthanasia is murder.
Euthanasia is considered illegal in India. Although there is no specific law on euthanasia, the Indian Penal Code says that culpable homicide is murder when done with the intention of killing someone.
More than 80 percent of Indians, some 830 million people, are practicing Hindus, a religion which prohibits suicide and assisted suicide. But up until a few decades ago, the self-immolation of widows after their spouses’ deaths was prevalent among Hindus, according to various sources. Still, experts say that although opinions of euthanasia among Hindus may vary, concerns about karma, reincarnation and ahimsa, or non-violence, are cited as primary concerns.
When the Supreme Court rejected Virani’s plea seeking the mercy killing of Shanbaug in March 2011, its judgment was nuanced, allowing passive euthanasia – withdrawal of life support to a patient – in exceptional cases to cut short the agony of patients in permanent vegetative states. The legal parameters fixed by the judgment to govern passive euthanasia will remain in force until Parliament enacts a suitable law, the bench said.
Dismissing Virani’s plea, the justices said that Shanbaug couldn’t be considered dead.
“It appears that she has some brain activity, though very little,” the judges wrote in their verdict.
Moreover, the judges said that petitions for passive euthanasia must be filed by the patient’s parents, spouse, doctors or “next friend,” which for Shanbaug would be the hospital staff, who wanted to keep her alive, not Virani.
Although the court has handed down its verdict, public opinion here is still divided among those who say that it's better to die with dignity than to live a painful existence, those who believe that legalizing euthanasia would set a dangerous precedent, and those who waver back and forth.
Dr. Surendra Dhelia, a general physician and secretary of the Society for Right to Die with Dignity, an organization that campaigns for the legalization of mercy killing in India, says that he made up his mind in 1996 to end the life of his father, who was suffering from multiple illnesses.
“I could no longer bear to see him suffer,” Dhelia says. “It was so bad that I made up my mind that he had to go.”
He informed family members of his plan, and everyone agreed. But he says his friend, a psychiatrist, cautioned him.
“My friend told me that while he understood my pain, I would not be able to handle the guilt,” he says. “It was then that I changed my mind, but I stopped all the active treatment, which was legally permissible, and within months he passed away.”
But Dhelia says that even though euthanasia is illegal, it is still done in India and other countries, calling it any society's worst-kept secret.
“There are scores of families deciding to end the medical treatment of their beloved,” says Dhelia, who’s also the managing committee member of the Mumbai branch of the Indian Medical Association. “It is illegal to end the life of a terminally ill person, but families find loopholes around the legal technicalities to put their love[d] ones out of pain and despair.”
Dhelia says that some families and doctors terminate the life of an ill person by creative means like “adjusting the ventilator” or by giving them medicine that hastens the end.
Others say it’s not just a matter of dignity but also a financial issue. For many years, euthanasia pleas were common among economically distressed Indians, who said they would kill themselves if the government didn’t help them, such as cases in 2006 and 2009, according to various media reports. Others cited the financial burden of keeping a loved one with costly medical conditions alive.
One father, Mukesh Kumar, says he contemplated the mercy killing of his two sons, Nitish Kumar, 15, and Anshul Kumar, 13, who suffer from a rare muscular disorder in which the muscle cells die, reducing the body to a skeleton, curving the spine and creating respiratory difficulties.
Nitish and Anshul can’t talk or stand on their feet. They are also paralyzed below their chest and are unable to eat or move without assistance.
Some doctors have told them that treatment is possible, but it is only available in the United States and will costs tens of thousands of dollars. Kumar, a poor farmer from a small village in India's poorest state, Bihar, has already sold his little piece of land and other valuables to buy their medicine. He also runs a small shop, but manages to earn just $90 to $100 USD a month.
“Our sons are in pain, and we are helpless,” he says.
Activist and lawyer Flavia Agnes says that the court’s approval of passive euthanasia in Shanbaug’s case may relieve some families from financial burdens without feeling guilty.
“The court's judgment will bring respite to families who lack the crucial financial resources to meet the prohibitive costs of privatized medical care and save the terminally ill from a tortuous and lingering death,” she says.
But courts have rejected Kumar’s pleas. After ruling out euthanasia, Kumar says his new plan is to petition the prime minister to help cover the cost of keeping them alive.
“If mercy killing is not [possible], then the government should provide financial help for their medical treatment,” Kumar says.
Agnes agrees that more needs to be done to help people in cases like Kumar’s.
“Unless the state provides free medical aid to the poor and marginalized, mere moral pontification from the pulpit about the divinity enshrined in the right to life is of little solace to families of the terminally ill,” Agnes says.
But many say that euthanasia is never the answer.
Dr. Rita Bakshi, a gynecologist and in vitro fertilization specialist in New Delhi, says that although she sympathizes with Shanbaug, she believes that doctors take an oath to save life – not to assist patients in committing suicide.
“It goes against the oath,” she says.
She says that a court ruling in favor of letting Shanbaug die would set a dangerous precedent.
“If euthanasia becomes a law, it may become an easy way to get rid of the old and disable[d], which may be seen as a liability,” she says.
She says that passive euthanasia is also inhuman and could lead to corrupt practices.
“[How] can you stop food and water to a person and plan to kill him?” she asks. “There are corrupt people in every profession. I see it more as a matter of conscience than law and more so for a doctor.”
Lawyer Brijesh Kumar agrees that euthanasia defies the laws of nature.
“All the world religions have been preaching the value of life, from its beginning to its natural end,” he says. “How can we claim that a patient is never going to recover? There is always a hope.”
Citing rampant corruption and widespread commercialization, the judges said euthanasia was an extremely important question in India because of the “unfortunate low level” of ethical standards to which the society has descended.
“The Court has to be very cautious that unscrupulous persons who wish to inherit the property of someone may not get him eliminated by some crooked method,” the judges wrote in their 141-page verdict.
The judges said they didn’t think Virani was trying to be unethical.
“We regard her as a public spirited person who filed the petition for a cause she bona fide regarded as correct and ethical,” the court said. “We hold her in high esteem.”
But it said the decision was ultimately up to the hospital staff, who by caring for her day and night for so many long years qualified as her next friend, not Virani, who only visited her a few times and wrote a book on her.
“Hence it is for the KEM hospital staff to take that decision,” the judges wrote. “The KEM hospital staff has clearly expressed their wish that Aruna Shanbaug should be allowed to live.”
