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Stop the posturing. Let Aruna Shanbaug #RIP

Stop the posturing. Let Aruna Shanbaug rest in peace
Shanbaug’s life and death should make us think about the urgent need for palliative care facilities for the terminally ill.

They argued over her body while she lived; they continue to argue now that she is gone. The death of nurse Aruna Shanbaug on Monday, after 42 years of being in a “vegetative” state, has only increased the volume of debate. Shanbaug has become almost incidental; the discussions revolve around eternal issues of life and death and who decides how long a person should live.

The debate over euthanasia and whether to make it legal will not end soo. But what can be settled are the other issues that the life and death of Aruna Shanbaug raise.

In November 1973, when Shanbaug was throttled by a dog chain and sodomised by Sohanlal B. Walmiki, a contract sweeper, in the King Edward Memorial hospital, the incident did not make front-page news. The hospital authorities were silent. They reported the attack on Shanbaug and the theft of her jewellery to the police, but not the sodomy. Walmiki was caught and tried. He was convicted of theft and attempt to murder. He served out two seven-year concurrent sentences and since then has not been seen.

Why was the sodomy not reported to the police? We are told now that it was done to protect Shanbaug, who was engaged to be married to a doctor. Besides, in 1973, sodomy did not constitute rape: it was only considered an “unnatural” act that invited a maximum punishment of 10 years.

Changed circumstances

It is inconceivable that in this day and age such an attack would have escaped media scrutiny or public outrage. The amended rape law would also have ensured that Walmiki was tried for rape.

Yet, even though the law has changed, we also know that away from the big cities and the media spotlight, even today there are other Aruna Shanbaugs who are brutalised, who cannot even reach a hospital, and even if they do, there is little chance that they will get the kind of care the nurse did for 42 years.

So let us not forget that Shanbaug’s story is essentially one of a woman who was criminally and sexually assaulted and barely survived.

The other story is that of the care given to her by KEM hospital and particularly the nurses who identified with her. No one can argue that this was truly exceptional. These women who cajoled Shanbaug to eat, who washed her, changed her clothes, played music for her, took note of every partial response, did not understand the talk about euthanasia.

They were angry with writer Pinki Virani who filed a plea in the Supreme Court in 2011 asking that Shanbaug be allowed to die. Virani did this under the provision of “next friend”. As far as the nurses were concerned, they were her friends, and her family. The court noted their commitment to Shanbaug and did not allow Virani’s plea. However, it did rule that passive euthanasia was permissible with certain legal safeguards.

Passive euthanasia

In Shanbaug’s case, this would have meant stopping food and other medications. As the nurses had decided they were her family, they chose not to stop these interventions. Thus, 13 days short of her 67th birthday, Shanbaug died without any active or passive assistance.

But what is passive euthanasia? Does it not occur all the time, without it being given that label? When poor families bring a terminally ill person to the hospital, or someone who is brain dead because of an accident, what are their choices? Medical interventions to keep such patients alive need money. Even public hospitals are not entirely free. It is these costs that inevitably determine whether the patient’s life will be prolonged. Put another way, the inability to afford medical care is a form of passive euthanasia.

We also need to remember, that costs contribute to unnecessary deaths even when the patient is not in a terminal or hopeless condition. The reality is that women and men, and even children, are discharged from medical facilities because no one can pay for their care.

On the other side, we must also acknowledge that our hospital system is not geared for palliative care. Even if such facilities exist, costs again decide whether a patient can be cared for. Doctors are not always sensitive as they try and persuade families to put patients through expensive, invasive interventions that at best can lead to a marginal improvement.

Many families, even those who can afford medical costs, have to make tough decisions to stop treatment because they cannot afford to spend beyond a point. Perhaps that is for the best as most of these interventions go to line the pockets of doctors, hospitals and the pharmaceutical industry and contribute little to the quality of life of the patient.

Shanbaug’s life and death should make us think about the urgent need for separate palliative care facilities. If we believe people should be allowed a dignified death, then surely facilities that ensure that patients can live out their last years with minimum pain and maximum care are needed. Kerala is one state that has pioneered such facilities. They are affordable and provide much needed relief for families who bear the burden of care-giving.

Reality check

Finally, let me put forward another reality check. The talk of “caring” has bounced around television studios following Aruna Shanbaug’s death. Virani refers to her as “my Aruna”; the KEM nurses lay claim to her; and family members who had virtually forgotten her have also decided that she is their Aruna.

It is clear that we care for those who are ours. But what about those who are not? A few days before Shanbaug died, a 22-year-old woman was knocked down while crossing the Western Express highway in Mumbai. The person who knocked her down, moved her bleeding body to the pavement and sped away. People saw her lying there but did nothing. The police station was across the road. It took 20 minutes before she was taken to a hospital. By the time she got there, she had bled to death.

Aruna Shanbaug is dead. Let us let her rest in peace. But in the meantime, let us stop fooling ourselves about how much we really care for the ailing, the injured, the disabled, people not in a condition to help themselves.

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