Back to basics — defining life and health Premium

In The Hindu’s weekly newsletter, Ramya Kannan writes to you on getting to good health, and staying there. This week: India’s hunger index ranking, the state of mental health and the mysterious cancer cells that survive chemotherapy.

This week in health: India’s hunger index ranking, the state of mental health and the mysterious cancer cells that survive chemotherapy.

Oftentimes, the resolution of an intensely medical matter happens outside of medicine, with ethical considerations always queering the pitch. It was one of those occasions. The last few days of this health week were dominated by hectic parleys, not in hospital corridors, but in the courtroom. The Supreme Court finally passed a judgement denying a two-time mother, undergoing postpartum psychosis, her petition to terminate her pregnancy at 26 weeks. She had petitioned the court to terminate on the grounds of her mental health, but also economic and emotional hardships. The court sent her to the All India Institute of Medical Sciences on October 13 to check if her foetus was suffering from anomalies. 

Throughout the entire course of this trial, which ended in the Court deciding to deny her petition for medical termination of pregnancy, it was clear that it had dragged the country through questions not only of science, but also philosophically delving into long-drawn debates on what constitutes life, living and death.

Arguments oscillated between the rights of a living woman and those of her unborn child, as the prosecution pitted the 26-week-old foetus, declared as having no abnormalities, against its 27-year-old mother. A Division Bench of two women judges of the Supreme Court was split in their opinions about the decision of a married woman to abort her 26-week pregnancy and the Centre’s resolve to save the “unborn child”. Unable to reach common ground, Justices Hima Kohli and B.V. Nagarathna finally referred the case to the Chief Justice of India to form a three-judge Bench.

The petitioner’s counsel submitted in court that she was “physically, emotionally, mentally, financially and medically unable to carry, deliver or raise a child”. Additional Solicitor General Aishwarya Bhati who seemed to take this case up like a crusade, argued that while Indian Medical Termination of Pregnancy law was “pro-life” for sure, but stopped short of deliberately extinguishing life. She argued: “This is no longer a case of pro-life [life of the child] or pro-choice [reproductive autonomy of the woman]. This is actually Hobson’s choice for her. She cannot medically terminate the child now. The choice is now between a pre-term or a full-term delivery. Chances of a healthy child reduces with a pre-term delivery. A full-term delivery gives the child a healthy chance to survive.” 

As per the Rules of the amended Medical Termination of Pregnancy Act, (as explained by Sreeparna Chakrabarty), the opinion of a medical board had to be sought before termination of pregnancy beyond 24 weeks. K. Aparna Sharma, a member of the Board, and a doctor at AIIMS, wrote back informing the court that the foetus was ‘viable’ and terminating the pregnancy at this stage would amount to foeticide, seeking the permission of the court to do so. The mother herself came to a rather belated realisation of her pregnancy, as she was still lactating (since her second child in September last) and not menstruating at the time, and sought the intervention of the court as she felt unable to carry this baby to term. 

Though the doctors certified that she indeed had psychosis and was under treatment, their statement that the medicines had not affected the foetus seemed to weigh the scales in favour of the little one. The court did itself between a rock and a hard place, and chose to go with the statute. A three-judge Bench headed by Chief Justice of India D.Y. Chandrachud urged her to reconsider her decision. In the final judgement, Krishnadas Rajagopal reported that the judges made it clear that the woman cannot claim an “absolute, overriding right” to abort, especially when multiple reports from the AIIMS medical board have confirmed that the pregnancy was neither a cause of immediate danger to her life or that of the foetus. The Bench, in this significant judgement, also recorded the willingness of the Centre to undertake the expenses of the delivery, and later arrange for the adoption of the child after it was born.