Mayank Singh: The euthanasia debate in India

Mayank_singhThe case of Aruna Ramachandra Shanbaug was a landmark moment for the euthanasia debate in India. Aruna was a nurse working in the King Edward Memorial Hospital (KEM) in Mumbai. On the evening of 27 November 1973, Aruna was brutally raped. She survived, but asphyxiation had cut the blood and oxygen supply to parts of her brain, which resulted in her being in a permanent vegetative state (PVS) ever since. She cannot walk, eat, or even move, and relies on the services of the staff nurses of KEM who have, for more than 40 years, cared for and looked after Aruna.

When journalist, Pinki Virani first raised the issue of euthanasia for Aruna, the KEM nurses were furious. And later, when the Supreme Court of India rejected the mercy killing plea for Aruna in a landmark judgment in 2011, they rejoiced and celebrated the “new birth of Aruna” by distributing sweets. However, in the absence of existing legislation, the Supreme Court allowed passive euthanasia under exceptional circumstances in the same judgment. Aruna’s case didn’t bring relief for her though, and difficult cases continue to reach the courts. Cases where not only the patients suffer, but their near and dear ones too. There is often nothing they can do.

Responding to litigation by a non governmental organization, “Common Cause,” the Supreme Court recently served a notice to all the states and union territories, inviting a debate on legalizing passive euthanasia so that the law’s position is formalised. Passive euthanasia is different from active euthanasia as it does not involve the administration or injection of a lethal drug or substance to the patient; instead, it involves not taking the necessary actions to save a patient’s life. More recently, health minister Harsh Vardhan declared“A consensus should be developed on whether to allow killing of terminally ill people with no chances of revival.”

Euthanasia is a perplexing subject worldwide (a similar debate is ongoing in England), and one with very controversial and strong arguments on both sides of the debate on the grounds of humanity, medicine, bioethics, and legality.

Euthanasia must be considered by actually putting oneself in the shoes of the patient. If one thinks from the point of view of a relative or a loved one of the patient, one may be petrified by the thought of withdrawing life from somebody you love. But would you want yourself to go through the same amount of suffering? There is no straightforward answer to that.

One argument often cited against euthanasia is that science may one day find a cure. While true, this argument is not without its pitfalls. Thanks to medical science, many diseases that used to kill thousands of people have now been beaten. However, it is worth noting that these developments generally span multiple decades. Of the thousands of novel therapies which are studied every year, only a handful may actually reach patients. There is no “guarantee” of a cure, no matter how much money and effort we put in. Development in medical science is a lengthy process and does not follow laws of probability; many patients now suffering will not live to see a cure.

Another pertinent argument is of misuse. Ever since the Netherlands allowed euthanasia in 2002, the numbers have risen from 2331 active euthanasia and assisted suicide deaths (in cases of assisted suicide, a doctor provides the required drugs, but the patient administers them) in 2008, to more than 4188 in 2012. But euthanasia can be regulated by not giving blanket approval to all euthanasia pleas, and instead reviewing each case individually, so that permission is granted only in the most exceptional cases, where the person is terminally ill without any hope of recovery. A “living will” laid down by a person in a healthy state of mind may also be used as a reference of what has to be done should such a question arise. However, this will be a difficult challenge to overcome.

A rather weird argument cited in favor of euthanasia is limited healthcare facilities. I think this is a flawed argument as infrastructure is something that can be overcome by money and effort, and which shouldn’t affect this decision.

The “Hippocratic Oath” every doctor takes dictates them to “do no harm.” The question is, what constitutes doing harm to a terminally ill patient in pain? I follow a simple rule in life: treat others as you would want to be treated. If I apply the same philosophy here, my answer is leaning more in favor of allowing euthanasia in exceptional cases. If we are humane enough to extend the courtesy of painless death to animals, what prevents us from extending the same to fellow humans? But it is also very important to make sure that euthanasia is not misused.

There must be some light at the end of the tunnel for those who have suffered enough. Empathize, not sympathize with such patients. Maybe, depending on the outcome of this consultation, they will someday have a choice to die with dignity. Maybe there is still hope for Aruna Shanbaug and many more like her.

Mayank Singh is a postgraduate in biotechnology, and is currently working as editorial manager at BMJ India. Twitter: @knayam

Competing interests statement: I, Mayank Singh, declare that I have read and understood the BMJ policy on declaration of interests and I have no relevant interests to declare.

Read our News story: India’s Supreme Court consults on right to die for terminally ill people