The Euthanasia Debate: Should rabies patients be given the right to die with dignity?

The case of the Aruna Shaunbagh is a classic example of how many Indian laws need strong amendments. Aruna was a 25-year-old nurse in King Edward Memorial Hospital, Mumbai who was raped and strangled brutally with a dog chain by a floor cleaner. She survived the attack but her brain suffered severe damage due to the lack of oxygen. She remained in a vegetative state for 42 years before she died in the year 2015.   [caption id=“attachment_795429” align=“alignleft” width=“380”]  Representational image. Reuters.[/caption] In the year 2011, Pinky Virani, activist and journalist, filed a euthanasia petition in the court to free her from her pain. Though the court rejected the plea at the time, it sparked a debate about Indian euthanasia laws. Later in the year 2018, India’s Supreme Court permitted passive euthanasia under certain guidelines.

What is euthanasia?

Euthanasia is the act of ending the life of an extremely sick person to relieve their suffering. Euthanasia is only performed on people who are completely bedridden, terminally ill and show no signs of health improvement. Euthanasia can be categorized into two: active euthanasia and passive euthanasia. In the case of active euthanasia, life is terminated with the help of a physician who gives a lethal dose of a toxic drug to end the agony of a terminally-ill patient. Passive euthanasia involves the omission of treatment or daily care which is required for survival. It involves both withdrawing the current treatment (like turning off the ventilator) and withholding the treatment (like not performing any required surgeries).

Is rabies a death sentence?

Rabies is an infectious viral disease that is usually transmitted from a dog bite.   If bitten by an animal, whose medical history you’re unaware of, you should seek medical help and get all the vaccinations your doctor recommends. This is the only treatment option available - and is specifically for people who don’t show any symptoms of rabies. This article does not deal with those patients.   Once the symptoms start to appear, rabies has a 95% fatality rate. There is no cure for it once the symptoms show up. The initial symptoms of rabies include a fever with pain and abnormal tingling or burning sensation at the wound site. If not treated, the virus spreads to the central nervous system which progressively causes inflammation of the brain and spinal cord. A person with full-blown rabies would present with hyperactivity and excitability and extreme fear of water (hydrophobia) and fresh air (aerophobia). Once the virus invades the brain, the condition of the person deteriorates rapidly. Death usually occurs either due to painful cardiorespiratory arrest (simultaneous shut down of lungs and heart) or after slow paralysis followed by a comatose state.

Euthanasia for people suffering from rabies

Recently an NGO filed a PIL (Public Interest Litigation) questioning a judgement passed by the Apex Court in 2018: while the judgement by the five-judge Constitution bench allowed passive euthanasia, it excluded rabies patients from their judgement. According to a senior advocate, Sonia Mathur, the jury legalised passive euthanasia for those who have been suffering for a long time due to an incurable illness and to the ones who happen to be in a persistent vegetative state with no hope of recovery. She further added that the law does not give the right to die with dignity to the people suffering from rabies. The advocate pointed out the fact that rabies has a nearly 100% fatality rate despite all the medical assistance, unlike other diseases like cancer where almost all forms carry a certain amount of survival rate. The petitioner asserted that due to the violent nature of rabies and the absence of a cure for it, the victims shouldn’t be made to suffer throughout their painful cycle of death.   This petition has spiked the debate on whether we should have the right to die with dignity or not, once again.   For more on this topic, please read our article on   Rabies: Causes, Symptoms, Prevention and Treatment_._ Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.