In the end, it was a cardiac arrest brought on by pneumonia that caused her death on Monday, more than four decades after she slipped into a vegetative state after a brutal rape.

Having aroused the conscience of the nation, stirred a debate on euthanasia, or the right to die, and inspired a historic judgement, Aruna Ramchandra Shanbaug passed away quietly at 8.30am on Monday in the hospital where she once worked as a nurse.

Fittingly, the room in ward No. 4 at King Edward Memorial (KEM) Hospital in Parel, Mumbai, was padlocked on Monday.

It was where Shanbaug had lain for 42 years, its longest resident.

Shanbaug, 66, died after suffering from a serious bout of pneumonia last week. She was diagnosed with a pneumatic patch and was put on ventilator support five days ago. She was rushed to the intensive care unit on Thursday and put on antibiotics after nurses noticed she was having trouble breathing.

“She appeared to be improving, but suddenly slipped into cardiac arrest even though we tried to revive her" said KEM Hospital dean Avinash Supe.

Shanbaug was left in a persistent vegetative state (PVS) after a ward boy, Sohanlal Bhartha Walmiki, raped her on the night of 27 November 1973, while strangulating her with a dog chain. The asphyxiation cut off the oxygen supply to her brain, leaving her blind, deaf, and immobile.

She was engaged to be married to a resident doctor at KEM Hospital.

Walmiki was convicted, and served two concurrent seven-year sentences for assault and robbery, but not for rape or sexual molestation, as sodomy was not covered by the law on rape in 1973.

Over the years, Shanbaug became a symbol for many things—she was the gutsy rape survivor who ‘stuck on’, she was the recipient of unquestioning caregiving by KEM nurses and doctors, and she was the lightning rod around which the debate on passive euthanasia raged.

Pinki Virani, a journalist who wrote a 1998 book about Shanbaug called Aruna’s Story, filed a public interest litigation in the Supreme Court in 2009 pleading for euthanasia for Shanbaug.

Two years later, justices Markandey Katju and Gyan Sudha Misra delivered a 110-page judgement ruling that in cases of irreversible illness, and after a thorough medical evaluation, passive euthanasia should be permitted.

For the first time in India, a distinction was made between passive and active euthanasia.

Passive euthanasia entails a patient being allowed to die by limiting medical intervention, not escalating already aggressive treatment, withholding or withdrawing artificial life support in cases that are judged to be medically futile.

Active euthanasia involves administering lethal substances to end life.

The apex court found that there appeared little possibility of Shanbaug coming out of PVS. “In all probability, she will continue to be in the state in which she is in till her death. The question now is whether her life support system (which is done by feeding her) should be withdrawn, and at whose instance?" the judges said.

The decision, they ruled, was one that KEM Hospital staff, who had been caring for her since the assault, were best placed to take.

The court declared the hospital staff as her “next friend", legally and morally responsible for all medical decisions pertaining to her and rejected Virani’s appeal to be declared “next friend".

Shanbaug who lost her father at the age of 10, came to Mumbai from Haldipur, Karnataka, to study nursing. Umesh Pai, her neighbour in her village, said that she was the only one of her eight siblings to have been educated and was very ambitious.

Pai was one of those who came to pay their last respects at the hospital on Monday.

In the 42 years she had been in KEM Hospital, Shanbaug had very few visitors. But for the nurses, she was one of them. “Aruna was a big part of our lives here. We knew her likes and dislikes. She could not stand hunger and hated vegetarian food," said tutor nurse Gajula Kalpana. “She was like family to us."

She had supporters outside the hospital too—people like Virani, who also collaborated with filmmaker Chetan Shah to make a film on Shanbaug. The film, Passive Euthanasia: Kahaani Karuna Ki (A Story Of Compassion), was released last year.

They argued against KEM Hospital’s decision to keep Shanbaug on feed, even though, they argued, there was no proof of Shanbaug’s awareness of auditory, visual, somatic and motor stimuli. According to Virani, this was the biggest irony of the case.

“Those who claim to love her won’t let her go because they think that suffering is in her destiny. Ironically, the very law that she has brought for India shows clearly that there is free will over fate," she told Mint in November 2014.

“I heard the news today, and felt that she has finally been released," said filmmaker Shah on Monday. “It was not in the best interest of the patient to keep her alive. She shouldn’t have had to suffer for so long. The medical profession should not use life support to keep someone alive indiscriminately."

However, for the nurses looking after Shanbaug, it was a matter with both professional and emotional implications. Shanbaug was ‘one of them’—someone who had been assaulted in the hospital premises. Swati Varadkar, a 61-year-old retired nurse, who was a student when Shanbaug slipped into a state of semi-coma, said, “We are in the profession of taking care, so to expect us to stop giving one of our own care is not reasonable."

Shanbaug received round-the-clock care from the nurses on duty, with about 10 nurses attending to her in a day, said tutor nurse Kalpana.

Shanbaug’s body was brought to the hospital lobby in the afternoon, and nurses lined up to pay their last respects, with chants of Aruna Shanbaug amar rahe. Nurses from other hospitals like Wadia Hospital, students, the mayor of Mumbai, the police commissioner and a few of Shanbaug’s relatives, including a nephew, visited.

Shanbaug’s rape was the grim predecessor to many more such grisly incidents that have occurred over the years—over and over again. Finally, it was the brutal 2012 gang rape and torture of a medical student in Delhi—who died of internal injuries—that led to the expansion of the legal definition of rape in India.

“I think that the law is very different today than it was then," said senior lawyer Rebecca John, who works on criminal cases.

The 2013 Criminal Law (Amendment) Act broadened the definition of rape to include oral, anal and urethral penetration. The earlier definition limited rape to peno-vaginal penetration.

“Under the Criminal Amendment Act of 2013, Section 376(2)(e) on aggravated rape the punishment is a minimum of 10 years rigorous imprisonment, which can be extended to life imprisonment. Further, Section 376A punishes rape where the woman dies or is in a permanent vegetative state, with a minimum of twenty years and can be extended to life imprisonment," said John.

On Monday, the country lost yet another woman to rape amid a debate over the security of women and mounting demands for harsher punishment for rapists.

For the nurses in KEM, though, ward number 4 will no longer be the same.

Shreeja Sen in New Delhi contributed to this story.

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