For autonomy and dignity, in life and dying

How would one rank the tragedies in Aruna Shanbaug’s life? What are these tragedies?

Undoubtedly, Sohanlal Valmiki’s brutal assault on 27 November 1973, which left her in a permanent vegetative state, is the first. The second is the Supreme Court’s 7 March 2011 ruling in which the judges held passive euthanasia to be a legal right, but denied it to her, although she was the cynosure of that litigation. And I am aware of wading into a bitterly contested domain by naming the third one. It was the “iconic” (the Supreme Court’s words, not mine) dedication with which teams of nurses who worked in KEM Hospital over the years looked after her, nursed her and tended to her. This dedication, it must be said, was without a smidgen of selfishness. But to call it selfless would be a disservice to both facts as well as Shanbaug’s rights to dignity and autonomy.

The very fact Dr Sanjay Oak, then the Dean at KEM, contested Pinki Virani’s plea to be regarded as her “next friend”, that is, legal guardian or representative, shows the possessiveness of the medical community at that hospital. True, this might have well come from sincere concern, bolstered by what the nurses told the court Shanbaug was their role model (for she was one of them, a constant, “living” reminder of their struggles for a safe work environment) as well as their “child”, and hence they had the sole, and exclusive prerogative to decide on her behalf. And what could be a more momentous and critical decision than one of life or death?

Although it wouldn’t be proper to subject this to criticism, or attribute any negativity to this decision, it must be stated that Shanbaug’s dignity and autonomy were never considered - either by the court, or by her loving protectors and care-givers. In fact, only a medical opinion was put forward - that she was very much “alive”, not an appropriate case for “coma” (in strict medical terminology), and there was no need to bring her “vegetative existence” to an end. In his affidavit, Dr Oak stated that every mature society is judged by how its care and commitment towards the invalid, the unfortunate “Children of a Lesser God”, and India shouldn’t abdicate its responsibility. During the hearing, the judges also got to have a look at her, via a video link, and were satisfied that she wasn’t vegetative enough to be granted the right to physician assisted suicide.

In a way, this is indicative of the futility of arguing for the “right to die” or legalisation of euthanasia. Inevitably, one gets entangled in the ‘value of life’ debate, and even the meaning and interpretation of “living” is held hostage to subjectivity, in which those who can speak, and the medical establishment in particular, have the upper hand. One hasn’t even broached the issue of religious sentiments and tenets of different communities, which always queer the pitch in such cases.

Instead, a more worthwhile approach would be to demand the right to execute a “living will”. This has got nothing to do with either euthanasia or assisted suicide; it is just the legal right to refuse in advance any medical treatment or the administration of life support in case one becomes terminally ill. There are cases aplenty where the illness is sudden, and a person is rendered incapable of making a decision, a board of medical experts shall decide on his behalf. The difference between medical opinion in this case and those like Shanbaug’s, is both significant and critical. The latter decides the meaning of “life” for a person, while this has a limited mandate whether a person is deemed capable to exercise his autonomy. In Shanbaug’s case, conspicuous by its absence was whether she was indeed living a life with dignity. Not so here individual autonomy and personal, as well as bodily dignity are non-negotiable components of the right to make a living will.

In July last year, Common Cause, a Delhi-based civil society organisation, approached the Supreme Court with precisely this prayer, and the matter was referred to a Constitution Bench. It is imperative for the court to hear the matter and give a timely ruling. Unless it does, many others, would continue having their autonomy disregarded and violated, especially by those who provide heartfelt care and unstinted support.

Saurav Datta is associated with the Commonwealth Human Rights Initiative, Delhi, which works towards better policing. You can follow him on Twitter @SauravDatta29

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