Death wish

At what point does life end in a meaningful way? That is as ethically and politically fraught a question as,at what point does life begin? If a patients life has become intolerable,and she freely requests medical assistance to end it,should such intervention be allowed? Or is it tantamount to murder? The extreme circumstances of the Aruna Shanbaug case have made it the definitive one for euthanasia advocates and opponents in India. Formerly a nurse in Mumbais KEM hospital,she has been in a semi-vegetative state since 1973,when she was brutally sodomised and strangled. She has no speech,vision or mobility,but she used to scream for long hours. She has been fed and cared for by KEMs devoted nursing staff for decades now. Her fate had become the point of contention between journalist Pinky Virani and others who fought for Aruna to be delivered from her condition,and the hospital staff that wants to care for her until her last breath by natural process.

The right to die debate rages across the world,and is likely to assume greater force in coming years as medical science advances. Many jurisdictions have sanctioned physician-assisted death under strict conditions. Advocates of euthanasia,or merciful killing,frame it in terms of compassion and autonomy. Those who oppose it point to the inevitable slippery slope would it lead to people being killed even when their severe suffering can be eased with palliative care,would it extend to people who didnt really want to die,how could it be ensured that such permission is not misused,if legalised?

Confronted with the complicated Shanbaug case,the Supreme Court has rejected active euthanasia as an option,but allowed for passive euthanasia the withholding of life-sustaining treatment in exceptional cases. This can be either explicitly allowed by the patient,or in cases like Arunas where the patient is unable to give informed consent,by a panel of doctors,with permission from the high court. In doing so,the court has indicated morally relevant differences in each situation,and opted for case-by-case scrutiny. Yet it is also negotiating uncharted waters,and checks need to be put in place to rule out misuse or trivialisation. It is clear that we require a cogent legal framework on what constitutes a case for passive euthanasia,whose permission is needed in cases when the patient cannot decide,and what procedure should be followed by the court. Parliament needs to weigh in on this debate.