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Our bodies

Medical science cannot detect all deficiencies of the fetus or their extent. Can a fetus be destroyed based on conjecture or preponderance of probability? No, medical ethics do not permit that. Only detectable major deficiencies in the fetus that in all probability will cause the baby to die if allowed to be born, are important in decision-making.

Gautam Bhattacharya | New Delhi |

When we criticize one’s physical appearance in front of others, it is body shaming. Though it was always there in all cultures, the use of the term has increased after the social-media revolution. Body shaming reduces one’s self-esteem, may create psychological disorders, and is claimed to be the fourth important cause of suicide amongst those between 15 and 19.

Body shaming may be of different forms. In the past, many believed that fat shaming made people conscious of the need to have healthy food habits. However, subsequent studies confirmed that fat shaming doesn’t motivate people to adopt healthier food habits, rather it makes them feel depressed and they tend to eat more. One feels more helpless in case of height shaming.

Shaming of body shape or complexion as one has hardly any control over them. Why is body shaming so harmful?

Our body is our primary identity and that makes us love it the most. We all are possessive of our identities: our nationality, our race, our language, our profession, and our alma mater. We are possessive about our family culture, our names, and everything that shapes our identity. It is, therefore, instinctive for a person to be possessive of his/ her body.

Amnesty International in its campaign “My Body My Rights”, propagates “the right to make decisions about our own health, body, sexuality and reproductive life, without fear, coercion, violence or discrimination”. But the conflict comes when societal norms, family beliefs, and laws of the State infringe on our intrinsic rights.

The incident during the pandemic in Australia over tennis star Novak Djokovic is a classic example where laws of the State came in conflict with an individual’s rights over his body. The 20-time Grand Slam winner was deported from Australia when the government cancelled his visa on the issue of Covid vaccination. Djokovic made it clear on many occasions that he “supported the freedom to choose what you put in your body”. He never took Covid vaccines and tested positive in December 2021. The world’s number one men’s tennis player was initially provided an exemption to enter Australia as he had Covid just weeks before the tournament. But his visa was cancelled by the immigration department on the ground that Djokovic’s presence in Australia “could incite civil unrest and encourage anti-vaccine sentiment”.

Ever since Covid vaccines came, restrictions on the entry of foreigners were imposed by countries if one was not vaccinated. Governments imposing such restrictions are not wrong as they must look after public health. My right over my body can never belittle the health security of millions of others. While respecting Djokovic’s stand, perhaps most will agree that the immigration department of Australia did what any other country would have done.

However, there are examples when the rules of the State undermine the safety of an individual. One may recall the tragic death of an Indian-origin woman, Savita Halappanavar, who was admitted to a hospital in Ireland with complications when she was 17 weeks into her pregnancy. That was in October 2012. The pregnancy failed; fetal water broke but the fetus was not expelled. Savita was a dentist. When the pregnancy failed, she and her husband requested the doctor to induce abortion. The doctor ruled out that possibility as the law in Ireland did not permit abortion. After a couple of days, the fetal heartbeat ceased. Savita was then operated upon, and the contents of her womb were removed. But sepsis had set in. On the seventh day, she died at the age of 31.

Perhaps Savita’s life could have been saved if she was not refused the induced abortion at the right time. There was a nationwide outcry after Savita’s death, and it took six years for Ireland to legislate for abortion under certain conditions through the Health (Regulation of Termination of Pregnancy) Act of December 2018.

Even in Ireland, where four-fifths of the population is Roman Catholic, people endorsed the legislation for induced abortion if refusal to do so could create a “health risk to the mother” or in the case of a “fatal fetal abnormality”.

The issues are more complicated when it comes to the rights of the unborn vis-à-vis fetal abnormality. Medical science cannot detect all deficiencies of the fetus or their extent. Can a fetus be destroyed based on conjecture or preponderance of probability? No, medical ethics do not permit that. Only detectable major deficiencies in the fetus that in all probability will cause the baby to die if allowed to be born, are important in decision-making.

In a landmark judgement, Calcutta High Court in February 2022 allowed a woman to medically terminate her pregnancy at 34 weeks when an incurable disorder was detected in the fetus and the court was satisfied that a baby born with this condition would never be able to carry out bodily functions and likely die within weeks.

The Medical Termination of Pregnancy (Amendment) Act (2021) allows abortion even after 24 weeks when a Medical Board diagnoses that “there is a substantial risk that if the child were born, it would suffer from any serious physical or mental abnormality”. Thus, serious abnormality and non-compatibility with life appear to be the benchmark for the rights of the unborn.

If my body is most important to me, should terminally ill patients not have the right to end their life for a “death with dignity”? Should not a person, suffering an irreversible physical ailment have the right to request a physician to end life in a peaceful, humane and dignified manner? Should it not come under my rights over my body?

Euthanasia talks about “the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma”. In countries like Germany, Netherlands, Belgium, Switzerland, etc. active euthanasia or physician-assisted suicide was legalized under certain conditions.

Jean Luc Godard, the legend of French New Wave cinema, recently died at the age of 91 in Switzerland reportedly by assisted suicide. The great filmmaker was suffering from multiple invalidating illnesses. If the patient is can take a call on the issue, that is voluntary euthanasia. But what happens when one cannot take a call ~ a baby or a person in a coma? For children or for patients who are in a persistent vegetative state, there is no question of getting the patient’s consent. In such cases, non-voluntary passive euthanasia in the form of withdrawal of life-support has been legalized by a few countries under certain conditions.

However, mercy killing without explicit consent of the patient who is mentally alive (involuntary active euthanasia) is not lawful anywhere. In India, there are no rules for euthanasia. But the concept of passive euthanasia prevailed from time immemorial in Indic religions. King Parikshit, who was in his mother’s womb (Uttara) when his father Abhimanyu died in the war of Kurukshetra, came to know that his death was imminent because of the curse of the son of a sage for disrespecting his father. He then decided to go for “Prayopabesan” ~ a state when one resolves to die in fasting. His last wish was fulfilled by Sukhdev, the son of Vyasdev, who narrated to him Bhagavat (the stories of Lord Krishna), while the King was waiting for death.

The great Gandhian leader, Acharya Vinoba Bhave ended his life in November 1982 by gradually refusing to intake food (including medicines) and liquid for a few days.

What is referred to as “Prayopavesan” or “Samadhi-Maran” in Indian tradition, is nothing but passive euthanasia. One may criticize Prayopavesan as a form of passive suicide or atmahatya. Prayopavesan, or what Jains referred to as Santhara, was declared illegal under Section 306 (abetment of suicide) and 309 (attempt to commit suicide) of the Indian Penal Code by the Rajasthan High Court in 2015 but the Supreme Court had stayed that order.

Hindu Mahasabha leader V D Savarkar referred to Prayopavesan as atmaarpan as opposed to atmahatya. He held that when one’s ability to serve society was no longer there and one’s life mission was over, it was better to end the life at will rather than wait for death. Incidentally, Savarkar also renounced food, water, and medicines before his death in February 1966.

Passive Euthanasia (non-voluntary) in a limited form, by means of withdrawal of life support to patients who are braindead or in an irreversible vegetative state, was legalized by the Supreme Court of India in March 2018. The Apex Court also spelled out the guidelines for “living will” by terminally ill patients who know well the chances of slipping into an irreversible vegetative state. In the same judgement, the apex court advised the government to scrap article 309 of the IPC which penalizes those who survive suicide attempts.

Though Section 309 has not been repealed, Mental Health Care Act, enacted in July 2018, has restricted its application and says that “any person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished under the said code”. Attempt to commit suicide under severe stress have, therefore, been decriminalized in India. Thus, our rights over our bodies are to be seen in context.

Today we are more conscious of the detrimental effects of Body-shaming. Maybe in the future, such shaming will be categorized as a criminal offence. But if my body under certain conditions is a threat to the health security of others in the society, the State can impose restrictions on my free will. The unborn has the right to life but if that right jeopardizes the health of the mother, then the life of the mother should get priority. One should have the right to end one’s life with dignity. But ‘dignity’ being a relative term, one should be allowed to exercise such rights only under well-defined conditions. Different nations through different processes of trial and error are trying to arrive at those conditions.

(The writer is a former civil servant who retired in the grade of Additional Secretary to the Government of India)