The Supreme Court's verdict on the plea to allow mercy killing in the Aruna Shanbaug case revives the debate on euthanasia, and how it differs from suicide. The court, while ruling that the 63-year-old woman, in a vegetative state since being s*xually assaulted and choked by a hospital ward boy 37 years ago, be allowed to live because of Mumbai's KEM Hospital staff's love for her, expressed approval for 'passive' euthanasia. This entails withdrawing life-support systems or medicines and force-feeding of patients who are brain-dead and in a vegetative condition over a period of time, with no chance of recovery. The court, however, ruled against 'active' euthanasia, which entails injecting a lethal substance to expedite death of such patients. So far as the former is concerned, the court has laid down that an expert panel of doctors, including a neurologist, psychiatrist and physician, would first be required to give its opinion. Once the patient's relatives give their response to the panel's report, the concerned court would proceed. Thus the final decision on mercy-killing would rest on a High Court bench of at least two judges.
In the course of the proceedings, the Supreme Court has observed that it is time to decriminalise suicide and delete section 309 of the Indian Penal Code, which awards punishment for attempted suicide. This is an outdated law, which seeks to punish the survivor of a suicide attempt, who presumably has already suffered enough. There is no justification to enhance that person's torment. Suicide is a tragedy rather than crime. Earlier, the Law Commission in an October 2008 report had also advised repealing this law. Most nations have already decriminalised suicide. But euthanasia has found less easy acceptance. Voluntary euthanasia or assisted suicide, with the patient giving consent, is legal only in a few European countries and American states. When such consent is not available, the act is termed non-voluntary and considered illegal, except under certain conditions in the Netherlands.
Interestingly, nurses at KEM Hospital, where Ms Shanbaug herself worked as a nurse before the assault, are happy that the court has ruled that she should live. They have been taking good care of her, though her kin has abandoned her. They have no reason to put her to sleep as she still seemed to have some responses left. While the apex court's cautious verdict recognises the case for mercy-killing — with medical staff reported to expedite death in acutely painful situations even though the law does not sanction it — the nurses' disapproval of the mercy-killing plea, filed by Mumbai-based journalist Pinky Virani, underlines the need for extreme diligence in such cases. For, putting humans to sleep is not quite the same as putting injured and ailing animals and birds to sleep. Animal rights activists may differ but that is the subject of a different debate. This view hinges on the sanctity of human life, as the most evolved among all species, and the most conducive to spiritual growth and experience. The argument goes further that if property and money is at stake, euthanasia could be a convenient ploy for those who stand to gain with the death of an ailing person.
Distinction also needs to be drawn between ordinary suicide and assisted suicide. The first is usually the outcome of a personal decision, linked to despair; and the second owes to consensus, informed opinion of doctors and others, and the consent of patients suffering from terminal maladies, without a cure. But in an age of internet bonding, the distinction has blurred, with sinister portals that abet suicide making the act a result of consensus. Stringent action is required to block the functioning of these sites, which are reported to have lured many young, vulnerable lives to their doom. In fact, persons, suffering from chronic ailments, have allegedly taken recourse to web portals to be guided step by step towards oblivion. This focuses attention on the ethics and legality of taking an impersonal view of the right to live or die.
Medical and legal opinion may approve of euthanasia but religious sanction for suicide is rare, and is given only in extraordinary circumstances. Human life should ideally be allowed to run its full course. The Jain practice of santhara or sallekhana entails a slow fasting to death by one, who seeks liberation. A couple of hundred Jains every year are reported to give up the breath in this manner. The act is approved by the Jain religion, and not equated with ordinary suicide, resulting from despair. This is because santhara apparently hinges on prolonged introspection, meditation and relinquishing of karmic bondage, and is permitted for those, fit for it. It is considered an exalted ideal though opponents point out that widows, aged dependents and the ailing may be dispensed with via enforced santhara. The recent police crackdown on the practice has led to persons undertaking it in secrecy, without the public excitement, associated formerly with the act.
Among Hindus, there are records of sages and yogis having voluntarily thrown off the body, once it became aged or diseased, or they readied to unite with the infinite. But this is an altogether different act from suicide or euthanasia, which, in some instances, may be difficult to distinguish from medical malpractice. The debate on ethics is thus bound to persist.