NEW DELHI // A landmark Supreme Court decision has sparked a wider debate about euthanasia in India - but it will do nothing to change the condition of the patient at the centre of the controversy.
On Monday, the Supreme Court ruled that passive euthanasia is legal. The procedure allows life support for a patient otherwise likely to die to be withdrawn. A heart-lung machine keeping a comatose patient alive, for instance, can be switched off if the patient or someone with the authority to represent him has consented.
But the two-judge bench drew a distinction between passive and active euthanasia, declaring the latter to be illegal. Active euthanasia involves a lethal step - such as administering a high dose of morphine - intended to end a patient's life.
Pinki Virani, a writer and journalist, had sought active euthanasia for Aruna Shanbaug when she filed a writ petition in 1999. But Ms Shanbaug will continue to remain in her "persistent vegetative state", as she has been since November 1973.
Ms Virani's petition had pleaded that Ms Shanbaug's "vegetative existence devoid of any human dignity is not life at all and putting mashed food in her mouth only amounts to violation of human dignity."
In turning down Ms Virani's petition, the court commended her activism, although it also questioned her right to represent Ms Shanbaug, whom she never personally knew.
After the decision was announced, Ms Virani told the Hindustan Times newspaper, in an e-mail: "Because of this woman [Ms Shanbaug], who has never received justice, no other person in a similar position will have to suffer for more than three and a half-decades."
In 1998, Ms Virani wrote Aruna's Story, a book that detailed Ms Shanbaug's ordeal. When she was a 25-year-old nurse at the King Edward Memorial Hospital in Mumbai, Ms Shanbaug was raped, assaulted and robbed by Sohan Lal Walmiki, a ward orderly who bore a grudge against her.
After raping her, Walmiki choked Ms Shanbaug with a chain, cutting off oxygen to parts of her brain. Ms Shanbaug has since been unable to speak; she also cannot move her limbs or see, and her memory and other mental faculties have been destroyed.
Walmiki was sentenced to seven years in prison, which he has served.
For 37 years now, Ms Shanbaug has been tended to by her hospital's nurses, force-fed via a tube through her nose. Her parents have died, the rest of her family has melted away, and her fiancé - then a medical student - now lives overseas with his wife. In Aruna's Story, Ms Virani described Ms Shanbaug's state as "pathetic … Her bones were brittle. Her skin was like papier-mâché, stretched over her skeleton."
The hospital's stance on euthanasia has been consistently against the practice. Ms Shanbaug's nurses have claimed that she still responds to some stimuli. A hospital affidavit states that Ms Shanbaug is "haemodynamically stable" and that her "blood pressure, pulse rate are normal".
The day after the court's decision, religious leaders spoke out against it. "No man has the right to decide when to pull the plug," said Dr John Dayal, the secretary of the All India Christian Council.
"Science and doctors are called upon to fight till the very end."
Dr Dayal referred to the arguments made by Ms Virani and others about the quality of life of terminally ill patients. "Who are we to decide about their quality of life?" he said. "Many people who live below the poverty line lead lives that may be considered worse than death. What happens there?"
A K Madrasi, a vice-rector of an Islamic school, was quoted in the Hindustan Times as protesting the decision, considering life to be "God's property".
But Surendra Dhelia, the secretary of the Mumbai-based Society for the Right to Die with Dignity, called the decision a progressive step.
"This is going to be legal sanction to something that - let's admit it - has been already happening all over the place," he said. He compared it to the turbulent debates about abortion in India in the early 1970s, and pointed out that after legalisation, abortion moved "from behind closed doors and unhygienic conditions" to being performed by qualified doctors.
Mr Dhelia's society, affiliated to the World Federation of the Right to Die Societies, favours voluntary euthanasia, including the active sort. A patient can indicate, either during their illness or prior to it, via a living will or a power of attorney, that they will forgo further treatment if it cannot help them, and that a physician can administer a lethal injection to end terminal illness.
Such euthanasia options are legal only in Belgium, the Netherlands, Switzerland, Luxembourg and the US states of Oregon and Washington.
This is, Mr Dhelia says, a humane solution, and he cites Mahatma Gandhi for support. In the late 1920s, recalling a maimed suffering calf in his ashram, Gandhi wrote: "I felt that humanity demanded that the agony should be ended by ending life itself."
Would the principle apply to human beings, and indeed to Gandhi himself?
"My reply is 'Yes'," Gandhi wrote. "[S]upposing that in the case of an ailing friend, I am unable to render any aid and recovery is out of the question and the patient is lying in an unconscious state in the throes of agony, then I would not see any himsa [violence] in putting an end to his suffering by death."
Mr Dhelia sees as inevitable India's move towards a practical euthanasia regime. "The only question is when."