Monday, 14 March 2011

The "Wrong" To Die

Anil Dharker
Columnist

The case of Aruna Shanbaug in the Supreme Court, which has brought the subject of euthanasia into public debate, is in one way typical of such cases and in another way, not typical at all. It's not typical because her family is not involved in any decision-making process on her behalf; apparently members of her family (sister; niece and so on) stopped visiting her four years after she was admitted to hospital in a vegetative state; since then none of them have been to see her any time. In a sense, therefore, she has been dead to them for the past 33 years.

Who can blame them? Her closest relative seems to be an older sister who ekes out a meagre living her for herself. Would she be in a position to pay for Aruna's hospitalization? The answer is no. So if KEM Hospital--and the Brihanmumbai Municipal Corporation--weren't willing to foot the bill, how would Aruna be kept alive? The particular circumstances of her tragedy--she was a nurse at the hospital, the criminal assault on her was by a KEM staffer, she was assaulted in the hospital premises--has compelled KEM to continue paying for her treatment. There is another special feature in the case, which is the extraordinary dedication of the nursing staff at the hospital that ministers to her every need day and night and has done so selflessly for the past 37 years.

But is this particular combination always possible? Discussions on euthanasia seldom take into account the people around the patient. Are they in a position to pay for life-long care? If they are not, which would be true of most families, does the debate on euthanasia then centre around only on well-off patients, or those under State care?

Apart from the financial aspect, there is the even more important emotional question to be considered: When the patient is in a vegetative state, he or she does not feel any kind of emotional trauma; it's only those taking care of the patient who feel the daily emotional burden of watching a loved one reduced to a vegetable. What happens to their quality of life? And remember, we are not talking of a trauma lasting a few weeks, but one that can go for years and years, without any interruption or let up. Yet, these important questions, questions which affect whole families engaged full-time in the business of survival are considered irrelevant.

So, what is considered as relevant? The most often invoked sentiment from doctors and others involved in such cases is that they do not want to play God and decide who lives and who doesn't. Yet, are they not playing God in keeping alive someone unable to look after themselves by feeding them through tubes and by constant medication? As medicine evolves and newer and more effective treatments become available, would doctors say they are not playing God by extending the vegetative state of a patient even longer?

Pending legislation on the subject--which the government has now promised to look into--the Supreme Court has formulated an important guideline: "passive" euthanasia is permissible. The court has elaborated that this means that keeping alive a brain-dead patient by artificial feeding is no longer necessary; doctors can simply stop the treatment and feeds and the already comatose patient will quickly fade away. But this applies only to brain-dead patients. Therefore, euthanasia in the case of Aruna Shanbaug was ruled out: she was not considered brain-dead. (Apparently she responds to physical stimuli, reacts to sound and even to changes in her feeds).

This ruling of the court has been hailed as a ground-breaking but on reflection seems to be only a small tentative step in resolving the question of euthanasia. If a patient's brain has stopped functioning, but his or her heart and other bodily organs still work, that patient is incapable of living in any real sense: the body is a mere shell ticking away to no purpose. Euthanasia in cases like this raises no ethical questions at all.

But they do in cases like Aruna Shanbaug's whose brain shows a flicker of life, though her body is completely immobile and incapable of supporting itself. The court has shirked dealing with these questions completely by decreeing that she should be kept alive. Why? At whose cost? Most important of all, to what purpose? If a patient--and here I speak in general, not of Aruna--had a brain which were functioning like a normal human brain, even say, a brain with reduced IQ, you could make out a case for keeping the patient alive in the hope that advances in medicine would enable the patient's physical state to improve at a future date. But if the brain is functioning only in the most rudimentary way, how different is that entity from a low life form, say a crustacean?

These are uncomfortable questions and which, if we are lucky, we will never have to personally deal with. But someone, somewhere, will have to face them. It's the duty of the courts and our law-makers, to think of them.

No comments: