Who should take the decision on pulling the plug on life support — and when? Much of the serious public discourse on withdrawal of life support to the terminally ill was sharpened around the Aruna Shanbaug case.
In 2011, when the Supreme Court heard author Pinki Virani’s plea on Aruna’s behalf for stoppage of feeding through the Ryles Tube she’d had for a year then, the nurse at Mumbai’s KEM Hospital lying in a permanently vegetative state (PVS) since a brutal sexual assault in 1973 became the face of India’s debate on passive euthanasia.
Media coverage of the Terri Schiavo case in 2005 had already lined up Indians for and against the motion, but in Aruna there was an Indian face, a cultural context Indian families identified with, and dilemmas that went beyond purely medical and legal questions.
With no statutory provisions in India on withdrawing life support to patients in PVS, the Supreme Court said passive euthanasia may be permitted in “certain situations”, defining what will be seen as Aruna’s biggest legacy to Indian medico-legal practice.
In 1996, in Gian Kaur vs State of Punjab, the Supreme Court, considering the criminalisation of suicide, had held that euthanasia and assisted suicide were not lawful in India, and that the right to life under Article 21 did not include the right to die. Only legislation could permit euthanasia, the court said.
Incidentally, the Supreme Court verdict in the Aruna case would also observe that criminalisation of suicide was “anachronistic”, and recommend to Parliament that it therefore consider deleting IPC Section 309. The Bench led by Justice Markandey Katju laid down procedure for High Courts to treat such applications, appoint medical examination panels, etc., until Parliament could enact such legislation.
The judgment itself was limited to medico-legal issues — what precise conditions are to be termed as PVS, what is brain-stem death, when the withdrawal of life support would amount to judicial murder, the issue of agency, etc.
But among KEM Hospital’s nurses who were seriously affronted by Virani’s plea, and among the general public, the issues Aruna’s story threw up were also of just who constitutes Aruna’s family, religious beliefs on natural death, the complicated process of ruling out medical miracles, and more. Much of modern Indian families’ understanding of living wills and “advance notice” is rooted in their understanding of Aruna’s case.
Aruna’s story also has a legacy, by omission, to state accountability for rape victims. Women’s rights lawyer Flavia Agnes calls Aruna’s case the best demonstration of the fact that nobody wants to take responsibility for the victim once the legal system moves on. The verdict executed, the case over for the media, the victim is nobody’s concern. In Aruna’s case, it was a public hospital and its nurses who stepped in.
In the not-so-distant past, the state did not take upon itself the responsibility of providing the best possible medical care, nor did it counter those who stalled demands for better palliative care and transparency on the treatment. Hard-fought interventions by activists in later years have made compensation and rehabilitation for victims of rape, sexual assault or acid attacks now mandatory.
Finally, it goes without saying, Aruna’s case is a reminder of how far we have come in prosecuting rape and sexual assault cases. Her attacker, Sohanlal Walmiki, was convicted of attempted murder and theft — he took her jewellery. He had sodomised the menstruating 25-year-old, but was not tried for rape under a narrow definition of what constitutes rape. Today, insertion of any object into a woman’s or child’s body is prosecuted as rape — under the Protection of Children from Sexual Offences Act if the victim is under 18 years of age.
Much of modern Indian families’ understanding of living wills and “advance notice” is rooted in their understanding of Aruna’s euthanasia case, on which the Supreme Court ruled in 2011.
ROLE OF STATE
State accountability and concern for victims of rape and sexual assault came to be debated more vigorously in the aftermath of Aruna, and activist interventions have since achieved much.
Sohanlal wouldn’t have been prosecuted only for attempted murder and theft if current rape laws — products of evolution along a road signposted prominently by Delhi 2012 — had been in force.