Last week, there were many who heaved a sigh of relief. The Supreme Court finally decided to legalise both passive euthanasia and the Living Will (http://supremecourtofindia.nic.in/ supremecourt/2005/9123/9123_2005_Judgement_09-Mar-2018.pdf). Many were elated, as was this author because he has been involved with an organisation (Society for the Right to Die with Dignity or SRDD) which was a co-intervenor to the petition that Common Cause, an NGO, had filed before the Supreme Court.
The apex court ruled that the “right to life: including right to live with human dignity” would mean the existence of such right up to the end of natural life, “which also includes the right to a dignified life upto the point of death including a dignified procedure of death. The above right was held to be part of fundamental right enshrined under Article 21 of the Constitution which we also reiterate”.
It differentiated between passive euthanasia and active euthanasia, the latter allows a third party to end the life of a patient. This has been disallowed. But the former allows the stoppage of any form of treatment – a right all individuals already enjoy. This is now legal. For instance, if I have a tumour, and the doctor advises me to undergo a surgical procedure and I refuse, the law permits me that freedom, even if the non-removal of the tumour could result in my death.
By legalising the Living Will, the Supreme Court has allowed individuals to extend this right even to the stage when the person is unable or incapable of spelling out the line of treatment he accepts or rejects. Thus, if the person were to expressly write out a “will” or “advance directive” stating that he would not like to be put on artificial life support systems in case he goes into a coma or is unable to express his decision at that point of time, the advance instructions shall prevail (a sample copy of a Living will can be downloaded from http://www.asiaconverge.com/wp-content/uploads/2017/10/SRDD_ Living-Will_revised.pdf).
But the situation also saddened many policy watchers because it pointed to the utter callousness on the part of India’s legislators, who could not pass laws allowing people this right. The appeal to the government was first made almost 50 years ago. Ironically, even Mahatma Gandhi was in support of euthanasia (http://www.asiaconverge.com/2011/ 03/512/).
The issue was first raised in India during the 1970s by Minoo Masani (November 1905–May 1998) who founded SRDD. But it came under the spotlight when the apex court was compelled to hear the case involving Aruna Shanbag (http://www.asiaconverge.com/2011/03/512/), a nurse who was raped and left in a permanent vegetative state (PVS) inside KEM Hospital where she worked.
Thirty-seven years after she remained in PVS, Pinky Virani a friend and activist, approached the Supreme Court asking it to allow Aruna to die, by taking away her feeding tubes which kept her vegetative body alive. The Court did not grant that appeal, but did mention that as Aruna had not left behind a Living Will, and had no relatives, it was upto the hospital nurses to decide whether she should be allowed to live or die. The KEM staff voted in favour of keeping her alive, till she died in 2015. The courts urged the government to pass the required laws to deal with such vexatious situations where the need for the person to die with dignity was crucial. The government kept silent.
In fact, some of the issues that the Aruna Shanbag case raised have not been dealt with even today.
For instance, is it fair to block a hospital bed (especially in a country which has very few such beds) for a person who cannot be cured, and thus depriving thousands of patients begging for a cure? This was the very issue that cropped up when comatose legislator Priya Ranjan Dasmunsi was kept in a private hospital at public expense till the hospital had to urge the family to take him home.
Then there is the issue whether the government has the right to compel doctors to keep a person alive – and not let him die in peace – even when it had failed to provide the guarantee of medicare. In fact, many of the government’s actions even prevent people of living a decent life.
Consider the following: To date, the government has not bothered to give away grain to the poor free of cost, as ordered by the Supreme Court, instead of letting it rot in the sun and the rain (http://www.asiaconverge.com/2018/03/record-food-grain-production-but-value-destruction-as-well/). It has failed to create laws to take care of termination of malformed foetuses. It was the courts which exhorted the government to decriminalise homosexuality and suicide.
Each time, the legislators have actually compelled the courts to step into the breech and take a stand. It is ironic, therefore, when politicians decry the interference of the courts in legislative matters!
Then there is the sad tale of the government itself allowing government-provided medicate to shrivel up to a point that today it accounts for less than a quarter of health expenditure in the country (see chart). Other countries like Singapore, which levy lower taxes on its citizens to offer a better quality of universal medicare than India does.
India has, instead, not permitted more medical seats in government colleges. But, it has promoted private medical colleges, which have fattened the college managements through the levy of donations and capitation fees. And it has abetted the collapse of medicare by allowing some of the finest equipment for diagnostics (X-ray, MRI, sonograph etc) to lie disused in government hospitals.
According to published WHO data (http://www.asiaconverge.com/2016/07/india-medicare-damns-the-entire-country/), doctors accounted for just 0.7 per 1,000 people in 2012. This is far below the need for 1 per 1,000 recommended by WHO. And if one discounts this WHO number for the quacks who practice medicine, the ratio could tumble to under 0.35. China scores over India (with 1.49 doctors per 1,000 people), though India appears to have more nurses and dentists than China.
Mercifully, the Supreme Court has delivered the incurable and terminally ill from the apathy of the legislators.
The author is consulting editor with FPJ.