Three ways of dying


This is about three women and death: one is
Indian, one is Rwandan, and one is American. They come from very different
cultures and they are dealing with the end of life in very different ways. One of
them is particularly sorrowful -- but it is the shame that hurts, not the pain. 

Let’s take the Indian woman first. Her name
is Aruna Shanbaug. She was a nurse in King Edward Memorial hospital in Mumbai. In
1973 she was strangled and sexually assaulted in a ward. Now she lives in a
twilight zone of her own where she can barely move. She cannot speak. She cannot
feed herself or clean herself. Her family and her fiancé abandoned her long ago.

But for 38 years the hospital nursing staff
have been caring for her. They fiercely resisted an attempt by an activist to remove
Aruna’s feeding tube so that she can starve to death. The case went all the way
to the Supreme Court of
India, which released its judgement
yesterday. This denied the request to
end Aruna’s life.

“The whole country must learn the meaning
of dedication and sacrifice from the KEM hospital staff. In 38 years Aruna has
not developed one bed sore,” the judges said. They praised “their noble spirit
and outstanding, exemplary and unprecedented dedication in taking care of Aruna
for so many long years. Every Indian is proud of them.”

This was the best-ever present for
International Women’s Day, the nurses
. "Aruna was ours, and will always remain so," said Agnes
, a nurse who has been working in the hospital for the last 35
years. "Her family stopped visiting her some years ago. She belongs to our
family. We are not under any obligation to care for her but we do it because we
feel a kinship towards her."

And Dr Sanjay Oak, dean of the hospital, told the
: "It was not a matter of victory or defeat. I am happy
that humanity has won."

Next, there is the Rwandan woman. Her name
is Rachel Nyirahabiyambere and she is a 58-year-old legal immigrant to the United States.
She spent years as a refugee in the jungles of the Democratic Republic of the Congo before
following two of her sons to the United States.  When her eldest son moved to Virginia, she quit her job, lost
her healthcare benefits and followed him to help care for his children. She was
also ineligible for Medicaid because she has not lived in the US for five

Last April, she had a stroke which left her
in a permanent vegetative state. She was being cared for at Georgetown University Hospital,
a Catholic hospital in Washington DC. After seven weeks, the hospital tried to
discharge her, as caring for her was very costly. According to the New York
, the hospital set down three options for her sons: to find a nursing
home, to take her into their own homes or to repatriate her to Rwanda.

The sons responded that they could not
afford any of the options. In December, the stalemate was broken. At the
request of the hospital, Alexandria Circuit Court in Virginia appointed a
guardian. The guardian acted quickly. Ms Nyirahabiyambere was transferred to a
nursing home and in mid-February, despite anguished protests from her sons, her
feeding tubes were removed.  

So at this very minute Rachel
Nyirahabiyambere is starving to death in Millersville, Maryland. The hospital
which organised this barbarity declares on its website that its mission is to “provide physical and spiritual comfort to our patients and families in
the Jesuit tradition of cura personalis, caring for the whole person."

Doesn’t care of the whole person include food
and water? The nurses at King Edward Memorial, which is not one of the world’s
leading hospitals, gave Aruna palliative care for 38 years without complaint. But
for one of America’s finest, palliative care evidently means a slow
death by starvation.

“In our culture, we would never sentence a
person to die from hunger,” says one of her sons, Jerome Ndayishimiye.

The third woman is an American, Andrea J. Sloan.
She is a nurse and a lawyer and also the court-appointed guardian for Rachel
Nyirahabiyambere. It was she who ordered the feeding tubes to be removed.
Deborah Sontag, the New York Times reporter, obtained copies of her communications
with Rachel’s sons. They do not make pleasant reading.

cannot afford to allow families the time to work through their grieving process
by allowing the relatives to remain hospitalized until the family reaches the
acceptance stage, if that ever happens… Generically speaking, what gives any
one family or person the right to control so many scarce health care resources
in a situation where the prognosis is poor, and to the detriment of others who
may actually benefit from them?”

Ms Nyirahabiyambere left no “living will”
but it seems clear that she would have preferred to remain hooked up to her
feeding tubes. Ms Sloan ignored this. According to the Times, she told her sons
that she would disconnect their mother unless they could demonstrate that she
wished to live out her life “with a feeding tube, in diapers, with no
communication with anyone and in a nursing home.”

“Ending someone’s life by hunger is morally
wrong and unrecognized in the culture of the people of Rwanda,” one son wrote
to the guardian. Ms
Sloan emailed back
: “You have asked for understanding about your culture
and that is exactly what I am trying to do. Feeding tubes are not part of your
culture, are they?”

Three women. Three countries, two poor and
one rich. But what good is living in the rich country if you are treated so
heartlessly when you die?

Cook is editor of MercatorNet.


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