#dnaEdit: End to suffering

In her life, Aruna Shanbaug reminded the Indian nation of the terrible sexual crimes that are inflicted on women on a daily basis and the tragedy of living for over four decades in a vegetative state that medical science is yet to conquer. The circumstances of her difficult life and the exemplary efforts undertaken by the nurses of KEM Hospital to keep her alive and physically healthy triggered a heated debate after writer Pinki Virani approached the Supreme Court pleading that Shanbaug be subjected to euthanasia. At stake were questions about whether this would violate the constitutionally guaranteed fundamental right to life and the moral quandary over human beings sitting in judgment over another person’s life. Arguments about the financial burden on families — incurred in keeping a critically-ill or vegetative patient alive — and whether terminally-ill or comatose patients must have to put up with unbearable pain were also raised to counter those opposed to euthanasia.

While the plea for Shanbaug was rejected, the Supreme Court, in a path-breaking judgment, legalised “passive euthanasia” — a term denoting the withdrawal of life support systems to patients which are necessary for the continuance of life. The two-judge bench of Markandey Katju and Gyan Sudha Mishra allowed near relatives or doctors of such patients to approach high courts with passive euthanasia requests and prescribed norms for high courts to follow until Parliament enacted a legislation. To authorise passive euthanasia, the bench had relied on the 1996 Gian Kaur case judgment, which had said the “right to live with dignity included the right to die with dignity”. However, the same judgment also stressed that “right to life does not include the right to die”, to criminalise suicide. But in February 2014, a five-judge Constitutional Bench observed that the Gian Kaur judgment had “not approved” of passive euthanasia and termed the 2011 judgment’s reliance on Gian Kaur to be “factually incorrect”. Nothing more was heard of the matter after the Constitutional Bench issued notice to all the states seeking their response on legalising passive euthanasia.

But the central government had a change of heart last December and dropped its earlier objections equating passive euthanasia to suicide. Health minister JP Nadda stated in Parliament that the guidelines laid down by the 2011 judgment would be followed and “treated as law”. But Nadda was quick to add that there was no proposal to enact a legislation to this effect. This testifies to a weak-kneed political response and a general disinterest towards an important social and public health issue. In the absence of legislative cover, there does not appear to have been even a single plea before the high courts by relatives or others seeking approval for passive euthanasia. The stigma of being seen as neglecting a loved one and the hesitation among doctors in view of the nebulous statutory position could also be reasons for this. Such an important decision cannot be left to the judiciary and Parliament must exercise its lawmaking powers. The Law Commission had prepared a draft Medical Treatment of Terminally-ill Patients Bill in 2006, which can supplement the 2011 judgment’s guidelines. But the previous UPA and the present NDA government appear to be in denial of this Law Commission report. While Shanbaug’s case highlighted the need for passive euthanasia, it must be remembered that the KEM Hospital nurses took exceedingly good care of her. But very few families in India have the financial, physical or mental wherewithal to cope with their loved ones suffering over a long period. In the absence of community-based palliative care movements, those denouncing passive euthanasia as assisted suicide must open their eyes to social realities.