Mitali Saran: Sentenced to life

When Aruna Shanbaug died in a Mumbai hospital earlier this week, we remembered again what that meant and what had happened to her. We all remembered that she was raped in the hospital basement by a staff sweeper, sodomised and strangled with a dog chain until her brain stem was more or less destroyed. Many of us remembered that the rape that all but killed her was the beginning of a life that she lived for over four decades.

But in those intervening four decades, very few of us thought about Shanbaug at all, because chronic tragedy too becomes the quotidian. Her fiance and family fell away. There was a brief spurt of attention when journalist Pinky Virani petitioned a court to allow doctors to euthanise her, but for the most part of 42 years, the teams of doctors and nurses at King Edward Memorial (KEM) Hospital who fed, bathed, cleaned, changed and monitored Shanbaug were among the only people to interact with her - and Ms Virani is critical of their motives and competence.

What does it mean to be alive in that permanent vegetative state? Ms Virani thought of it as pain-filled torture. The staff at KEM seemed to think of it as preserving a vestigial splinter of personhood. The court judgment of Ms Virani's petition declined to allow Shanbaug's life to be ended, but it did allow for what it calls "passive euthanasia", that is, withholding life-preserving treatment, as opposed to administering life-ending treatment, under certain circumstances.

Even if you think of Shanbaug's case as a tricky one, with no clear consensus on how much meaningful consciousness was left in that vegetative body, or what the terms "meaningful" and "consciousness" entail, India has to squarely confront the question of how to interpret the terms "freedom" and "right to life". Even as we are obliged to protect the individual, we cannot blindly keep assuming the sanctity of life for its own sake, especially if that individual would rather die. Freedom and choice are intertwined. If freedom is about the right to life and the right to make life choices, it should also be about the right to die and the right to make death choices (as far as choice is possible, obviously).

India has longstanding, and greatly respected, life-ending traditions. When a Jain elder decides that her time is up and starts to starve herself to death, nobody throws her in the clink for attempted suicide. We generally accept that she is the ultimate authority over her own body, and philosophical and spiritual outlook. When a committed protester embarks upon a fast unto death, we generally agree that this is a valid and noble form of protest, and political plates are often shifted to persuade him to change his mind. (This breaks down if the protester is an inconvenient woman like Irom Sharmila, in which case criminal law is invoked and she is arrested and force-fed through a nasal pipe.) In either case, the protagonist perceives death as the greater good.

An individual should have the right not just to life, but to a self-determined quality of life. One person might cleave so much to life that it is worth any amount of discomfort or suffering; and another might be so loathe to live with diminished faculties, or an evacuation of meaning, that death is the only humane release. Each is the best judge of his or her quality of life. In cases where individual choice is unknowable, the law is right to err on the side of caution, since death is (thus far) an irreversible choice, but shouldn't we, as a society, be paying greater attention to the rights of those who willingly choose to curtail their lives? Shouldn't we, at the very least, ditch the pious homilies about god and let people determine how they feel, without moral judgement? And, surely, a state that retains the power to end a life on the grounds of justice can empathise with ending a life on the grounds of compassion?

Should we not decriminalise attempted suicide, and allow the terminally ill and the psychically tortured to end their suffering? Should we not consider the living will to be a legally binding document, setting down a person's medical directives in advance, in the event that he or she is permanently incapacitated or no longer able to make or communicate healthcare decisions? Nobody can appreciate the full force of biologically hard-wired self-preservation until they are themselves eyeball to eyeball with death. The best we can do is guess in advance, based on what we know of ourselves. If I were locked-in or vegetative, or able to eat but unable to communicate, if I were irrecoverable, would I choose death? Isn't life more than a sinus rhythm?

I don't know, but if I did know, I wouldn't want the state to have the power to overrule me.