Why talk of euthanasia is pointless in India

Those talking about euthanasia using Aruna Shanbaug as leverage had better cry out for an actively functioning, effective and affordable healthcare regime. That would be a better service rendered to those who need it, says Mahesh Vijapurkar.

In the wake of the recent Supreme Court ruling rejecting mercy killing and allowing passive euthanasia, I have a few questions and a few points of view.

Would, say, if a woman from a family of a bank clerk, or a small store keeper, or a college teacher and such like, was a victim of the kind of dastardly attack which laid waste Aruna Shanbaug, have received the same consideration in the KEM Hospital in Mumbai as did poor Aruna? Or in any other hospital where people go with hope?

My heart, of course, bleeds for her. No one must suffer the hell she is going through, known on unbeknown to herself. I do not grudge Aruna the loving care she has had from her colleagues for 37 years. I bemoan that others have no such possibilities, should such need ever arise. Because millions could not afford the bills to survive like that. Or even get such loving care.

My bet is that Aruna has been kept alive because she has members of her profession who feel deeply about their patient-colleague. My bet is that the authorities let her be because she was a member of the staff and though the hospital is run by the city civic body, no petty clerk raised an issue of payment of bills.

Anybody else in Aruna's place would have been long gone because no hospital likes to keep a bed occupied, especially if it is not generating revenue. Civic hospitals, on the other hand, are perpetually short of beds; patients overflow to the ward floors and corridors. In her case, the KEM showed remarkable sensitivity which is rare for other patients. Wonder if others get the same humane treatment. Had she been in a private hospital, or even a hospital owned or run by a trust, a patient like Aruna would have been out in the cold in quick time.

The hypothetical woman from the family of a bank clerk, or a small store keeper, or a college teacher and such like, I bet would not have had the resources to meet the demands of the private hospitals that the bills be settled every day. Nor would they have any resources to sustain a patient for 37 years as the kind KEM has allowed. In no media report have I heard the costs of keeping her alive, or the bills that would have added up if she had been hospitalised in a private hospital.

There are millions who have the economic status of Aruna Shanbaug, for whom simple, effective and useful medicare is out of reach for two reasons: one, it does not exist widely, and where it does, it is not affordable. I have known cases -- maids, plumbers, drivers and shop assistants who have decided not to see a doctor because they just could not afford it.

They let nature take its course after a couple trips to the dispensary of a quack, who administers intravenously saline, makes them feel good, charges some Rs 500 per day and then lets them off with a few vitamin tablets that a medical representative has left behind as samples.  By then, they are bleeding white.

That is why all this talk about mercy killing and active and passive euthanasia seems so meaningless in this country. Even passive care is beyond the reach of people who are not just well-heeled but have oodles of cash. A single x-ray showing a blob in the lungs and a scribble by the consulting radiologist of a hospital run by a trust in Mumbai led to any number of tests and more tests till the bills toted up to a hefty Rs 60,000. That was in the year 2002 and it started because the scribble said, "carcinoma of the lungs not ruled out." It turned out to be nothing. I know the patient.  It was traumatic for the family because fear of cancer can unsettle anybody.

But then, a question would arise: but one can surely be insured?

But there are issues here as well.

What is the penetration of the insurance sector, what is the rate of rejection of applications for securing insurance? Especially of the elderly who have had one hospitalisation or have a knee problem which deters the insurer from accepting the proposal for insurance? No one has studied that. It is well known that the insurance helps the hospitals who overcharge insured patients routinely.

By the time the treatment is halfway through, the insurance limits are reached and the patient is in limbo. These are realities apart from the shambles in which healthcare is outside the metros, and for the poorer sections.

These are the people, unable to cope with expenses, opt for poor treatment or unwittingly, opt for passive euthanasia. They just let it be and face their fate. The Indian ability to blame things on karma is their best antidote to ill-luck.

In this context, one needs to look at a remarkably candid and realistic report written by a panel set up by the Planning Commission and headed by cardiologist Dr K Srinath Reddy, which unfortunately did not receive the media attention it deserved. This doctor who worked in AIIMS, New Delhi and was a cardiologist to presidents and prime ministers has asked for universal, fully-funded healthcare in which even the private sector could be involved but with a strict regulatory mechanisms and contracting frame work to keep costs in check and safeguarding the consumer interest. 

This has to cover primary -- vaccinations and basic checks-ups; secondary healthcare involving diagnosis and treatment of simple diseases; and tertiary healthcare which required complex treatment in speciality hospitals.

They said that 28 per cent of ailments in rural areas and 20 per cent in urban areas went untreated due to financial reasons of the patients. Only 10 per cent of the households in the country had one individual among them insured. It described as 'catastrophic failure' the insurance for the poor by the government -- it also is 'financially unviable'. The private sector insurance is 'imperfect'.

The pointed reference to a public health insurance agency to collect funds and disburse costs is significant for the group has recommended cashless treatment even for tertiary healthcare which appears to be due to misgivings about the private sector insurance companies and their morals.

In short, the group wanted a complete reinvention of medical care in the country where everyone, regardless of economic status, gets his or her due. If that were to happen, then the question of passive or even active euthanasia to relieve the ill person of his or her misery could be raised. It is futile to talk of it otherwise because, in effect, passive euthanasia is already in vogue, driven by circumstances of the hapless people.

So, those who are talking about euthanasia using Aruna Shanbaug as leverage had better cry out for an actively functioning, effective and affordable healthcare regime. That would be a better service rendered to those who need it but don't get any medical care worth the name.

Mahesh Vijapurkar is a Thane-based journalist and commentator on public affairs