By Rimli Bhattacharya
I used to commute in the packed local trains to and fro my house and workplace. One day a little boy got inside the ladies’ compartment to sell books. Being an avid reader, I picked up a book, Aruna’s Story. That was the first time I came to know about the tragic case of Aruna Shanbaug through the pen of her journalist friend Pinki Virani. I had heard about the word ‘Euthanasia’ or mercy killing but this book led me to learn more.
Born in 1948 at Haldipur, Karnataka, Aruna was employed as a nurse at the Kind Edward Memorial Hospital (KEM) in Mumbai. She was well-known in the hospital for her good work and positive attitude towards patients. She was also engaged to a doctor at the same hospital. It was on the fateful night of 27 November, 1973 that Aruna was sexually assaulted by Sohanlal Bhartha Walmiki, a sweeper working on contract, and left to die. She was changing her clothes after her duty hours in the hospital basement when Sohanlal attacked her. She was smothered with a dog chain and was wrenched with it. As she was menstruating, there was no intercourse. Sohanlal tried to rape her anally but by that time Aruna had already collapsed and was in no condition to protect herself. The strangulation by the chain led to asphyxiation which completely cut off the oxygen supply to her brain. In medical terminology the assault resulted in brain stem contusion injury, cortical blindness and cervical cord contusion. She was discovered lying unconscious in a pool of blood the next morning at 7:45 am by a cleaner. To everyone’s bewilderment, the police filed this case under robbery and attempt to murder as the doctors didn’t disclose the anal rape. Sohanlal, who was convicted for the pummel and robbery, served two contemporaneous seven year sentences and was later declared a free man. Aruna permanently went into a vegetative state and remained in that sorry state for 42 years. Though initially her family kept in touch with her, she was later abandoned by her family and her fiancé. She spent her days lying in one of the beds of KEM hospital and was nursed by the KEM staff. It was due to the careful tending of the staff that Aruna did not develop a single bed sore. She breathed her last on 18 May, 2015 at the age of 66. The reason of her death was pneumonia.
It was Aruna’s condition witnessed by her journalist friend Pinki Virani that triggered a discourse on euthanasia in India.
Euthanasia refers to willfully terminating someone’s life. This is a medical term and is practiced by doctors on patients to alleviate the patient’s suffering from either terminal illness or when the patient is in a lot of pain. It is executed only after weighing in several factors like legal recourse, mental and physical health, and personal credence and desideration. Euthanasia is classified under four categories, namely: Active, Passive, Voluntary and Non-Voluntary.
Active vs Passive
When a doctor himself ends someone’s life, it is known as active euthanasia. The physician deliberately assists in death of the patient by injecting a homicidal dose of neuroleptic drugs.
Passive euthanasia is chronicled as restraining or limiting life succor systems, thus enabling the patient to pass more quickly. Sometimes the physician might also increase the dosage of medicines and bring it to a toxic level at which point the patient finally passes away. However, in both the cases the medical team ensures palliative care to keep the patient as comfortable as possible during the last few days of his/her life.
Voluntary vs Non-voluntary
As the name suggests, when the person gives full authorization regarding ending his/her life it is called voluntary euthanasia.
Non-voluntary euthanasia demands someone else to make the decision to end someone’s life. This is normally done when the person goes into a vegetative state, is in coma or is permanently incapacitated. It may also fetch for practices like withdrawing life support system from the patient in absence of brain activity.
Euthanasia should not be confused with suicide
In India euthanasia was never a legal option or even discussed until journalist Pinki Virani filed a writ petition in the Supreme Court. In her appeal Virani mentioned that the hospital authorities should stop force-feeding mashed food to Aruna so that she can die peacefully. This prompted the Supreme Court to study the case comprehensively. As an article in Newslaundry pointed out, the court accepted this petition under Article 32 of the constitution. This is unusual because for any case to be accepted under the article, the petitioner has to show violation of fundamental rights. In view of the importance of the issues involved, the court decided to go deeper into the merits of the case. The court also summoned the then Dean of KEM hospital, Dr. Amar Ramaji, to assess Aruna’s current state. In his written submission to the court’s notice, the doctor mentioned that Aruna could be fed by the normal course and that she also responded to facial expressions. He mentioned that Aruna also responded to commands intermittently by making sounds. His submission was at variance with the submission of the petitioner. Hence, the court decided to appoint a three-member committee comprising of well-known doctors to look into Aruna’s case history, examine her and then submit a report.
The panel of doctors again supervised Aruna’s medical condition through fresh tests and trials. The report submitted by them suggested that Aruna had developed non-progressive and irremediable brain damage. To be considered for euthanasia the patient should lie in that state for four weeks and Aruna was a perfect case of the same. The panel also said that Aruna met most of the criteria under this law and elaborated that her condition matched four conditions: Brain Death, Coma, PVS, MCS (Minimally conscious state).
After several controversies, resistances and upheavals, the Supreme Court furnished a set of comprehensive guidelines on 7 March, 2011 for legalizing passive euthanasia in India. Virani’s plea was disregarded and special leverage was given to the opinion of KEM staff who took care of Aruna. Following the Supreme Court decision rejecting the plea, the nursing staff at the hospital – who had opposed the petition and had been looking after Shanbaug since she had lapsed into a vegetative state – distributed sweets and cut a cake to celebrate what they termed her “rebirth”. A senior nurse at the hospital later said, “We have to tend to her just like a small child at home. She only keeps aging like any of us, does not create any problems for us. We take turns looking after her and we love to care for her. How can anybody think of taking her life?”
Aruna died of pneumonia on 18 May, 2015. However, it was Aruna’s story which provoked the Supreme Court on 9 March, 2018 to legally grant passive euthanasia for terminally ill patients and also issue the instructions and stratagem to be followed by the medical practitioners. Aruna’s story is an enthralling and tragic case which has resulted in the landmark judgment of approval of passive euthanasia in India.
Rimli Bhattacharya completed Mechanical Engineering from National Institute of Technology. After obtaining an MBA, she worked in the corporate sector. Rimli is a trained Indian classical dancer, based out of Mumbai, India. She tweets at: @rimli76
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