Author: Ramnika P Singla

1. Case Citation

Aruna Ramchandra Shanbaug v. Union of India & Others, (2011) 4 SCC 454

2. Facts of the Case

Aruna Ramchandra Shanbaug, 25 years old young vivacious, full of life nurse, employed at the King Edward Memorial (KEM) Hospital in Mumbai, who was planning to marry a colleague Doctor in the near future and start a family soon, laid in bed in a vegetative state for four decades for no fault of hers.

She was not only sexually assaulted by a hospital sweeper, Sohanlal Bhartha Valmiki, in November 1973. But was also attacked and on resistance, strangulated with a dog chain, which lead to causing a severe brain damage as the oxygen supply was cut to her brain for some time. Eventually leaving her brain dead or in a persistent vegetative state (PVS) as it is called in medical terms. Since the time of the incident the KEM hospital had been her home and she has been taken care of by the staff and nurses of the KEM hospital, as her own family disowned her. She remained in a vegetative state for over four Decades, not being able to move or speak, except that she could breathe on her own without the support of any kind of life-supporting machines.

In the year 2009, a renowned Journalist and author Pinki Virani, who was writing a Biography on Aruna, was touched by her plight and so filed a petition on Aruna’s behalf, requesting that the court allow for passive euthanasia, as Aruna’s condition had not shown any improvement for a long period of time. Virani argued that her prolonged suffering was against her right to dignity and sought permission to withdraw her life-sustaining treatments. This case was the first major instance of a euthanasia plea in India, bringing the ethical, legal, and medical dimensions of end-of-life care to the Supreme Court.

3. Issues Before the Court

There were several questions needed to be addressed by the Supreme Court through this case:

1. Firstly, the most important Question was Should passive euthanasia i.e the indirect way of ending one’s life be legally permitted in India, without the presence of any statutory guidelines?
2. Did Pinki Virani, who was a third party, and had no relation with Aruna, have any legal standing to seek euthanasia on behalf of Aruna Shanbaug?
3. How come a patient who had been in a persistent vegetative state for Four decades be allowed to die with dignity by withdrawing life support?

4. Arguments

• Petitioner (Pinki Virani):
  • The argument that was put forward By Pinki Virani was that Aruna’s continued to be in vegetative state showing no signs of recovery at all, is being deprived of human dignity and this was also an infringement of her right to die with dignity.
  • Pinki Also Claimed that keeping Aruna alive without any chance of recovery was inhumane and that withdrawal of life-sustaining treatment was the least anyone could do to provide her with Compassion and would be an ethical solution to tend to her everlasting problem.

• Respondent (KEM Hospital and Medical Authorities):
  • The Hospital staff had asserted that Aruna had not been on a ventilator or any form of mechanical life support system, but was only on minimal medical care which was necessary to maintain her basic needs.
  • It was also argued that the hospital staff who had been attending to her had become her family and that they were willing to continue caring for her.
  • The Hospital opposed the withdrawal of life support, claiming that they considered it their moral and ethical duty to care for Aruna until she dies her natural death.

5. Relevant Legal Provisions

• Article 21 of the Indian Constitution: the Fundamental Right that Guarantees the right to life and personal liberty, which includes the right to die with dignity.
• Section 299 and Section 300 of the Indian Penal Code (IPC): Pertains to culpable homicide and murder, impacting the legality of euthanasia.
• Precedents: Cited cases from other countries, including:
  • Airedale NHS Trust v. Bland (UK): Allowed passive euthanasia under strict conditions.
  • Cruzan v. Director (USA): Addressed the right to refuse life-sustaining treatment.

6. Court’s Decision

The plea forwarded by Pinki Virani to withdraw Life Supporting Systems of Aruna was rejected by the Supreme Court.  The court Created a Legal Precedent as it was marked as a land mark Judgement, which Recognized the importance of Legalising Passive Euthanasia in the Indian context for the Patients suffering from PVS or other such terminal illnesses, which gave them the right to Die with Dignity.

7. Reasoning of the Court

The Supreme Court emphasised on the Uniqueness of the case and mentioned that this case had Emotional Component also. While Delivering the Judgement came upon with Reasoned Decision that elaborated on the following Points

1. Judicial and Medical Oversight: The Court admitted that Passive euthanasia could be considered for patients in a permanent vegetative state or for patients suffering from any other Terminal Illness if approved by a High Court. This step had to be taken in the wake of preventing the potential misuse of the decision and the need to ensure that decisions to withdraw life support system were made after a careful examination of the patient and in thehis best interest.
2. Right to Die with Dignity: The court observed that Article 21, that is a fundamental right and which guarantees the right to life, also encompasses the right to die with dignity. However, they emphasized that there is a need to balance this right with the sanctity of life.
3. Lack of Legal Standing: The court ruled that Pinki Virani, being a well-wisher of Aruna, lacked the legal standing to make any request for Euthanasia on behalf of Aruna. Instead, the staff of the KEM Hospital, who had been instrumental in providing the care and support that Aruna needed, for years, were seen as her closest advocates, and to be voicing her out.

8. New Legal Principle Established

This judgment introduced formal guidelines for passive euthanasia in India:

• Passive euthanasia would be permissible but under certain conditions, with the approval from the High Court.
• A Medical Report prepared by a panel of three medical experts after thorough evaluation of the patient’s condition.
• The Opinion of the patient’s family and caregivers must be heard, and a judicial order is required before withdrawing life support.

These guidelines were a temporary measure, as the court directed the Parliament to create comprehensive legislation on euthanasia.

9. Dissenting Opinions

There was no Dissent on the Opinions in this Judgement, and this was a unanimous judgement by the Bench of the Supreme Court.  However, there were some hesitations on pronouncement of such a judgement, without a Proper legislation being in place.  The main Concern was of the Misuse, Misinterpretation and Misappropriation of the Judgement.

10. My Opinion on the Judgement

The Issue of demand Euthanasia of Mercy Killing for a patient with PVS of terminal illness, is extremely delicate issue.

In My Opinion, the issue was addressed to by the Supreme Court with great Sensitivity, respecting the Right to life along with the need to die with Dignity, both at the same time. And this is the Reason that made this Case a Landmark Judgement.

The apex court by allowing passive euthanasia under strict judicial supervision, was successful in establishing essential legal safeguards that are required to prevent the potential misuse while also providing a path for compassionate decision-making in extreme cases.

One of the most commendable and highlighting aspects of the judgment is that it shows commitment towards judicial and medical oversight.  This ensures that decisions pertaining to life and death have to be made after deep understanding and thinking. These are not made impulsively or under undue pressure of media, friends or families of the patients. It is very important to preserve the rights and dignity of patients and also to safeguard them against hasty decisions. The court has struck absolute balance by involving a High Court bench, as well as medical experts and family members in the decision-making process, between respecting patient’s autonomy and protecting patients who are vulnerable individuals, not in the state to take decisions for themselves.

Another major strength of the judgment is its alignment with the constitution. It interweaved right to life and dignity under Article 21. The court emphasising on the fact that the Right to Die with Dignity is as important as the Right to Life, and The Right to die with Dignity is also a part and parcel of Right to life. This interpretation is the one that reflects empathy and an understanding of the ethical complexities of modern medical care. By emphasizing that the patient should not be allowed to suffer by prolonging his life using the artificial means, where recovery is impossible, the judgment upholds human sentiments and dignity in profound ways.

However, while the judgment set an important precedent, it also emphasised on the urgency ed for comprehensive legislation on euthanasia. It also Pointed out that relying solely on judicial guidelines may lead to inconsistencies and delay and deter the genuine cases, as the judiciary is a time-consuming process and also not specialized in medical decision-making. This case highlighted the importance of clear set of guidelines and rules or a legal frameworks that provide a consistent and compassionate process for end-of-life care decisions across the country.

Overall, I believe the Aruna Shanbaug judgment is a progressive, humane decision that reflects both empathy and responsibility. It paved the way for future advancements in patient rights and autonomy, while ensuring that decisions around euthanasia are approached with utmost care and respect for life.

11. Impact and Significance

The Aruna Shanbaug judgment was historic for several reasons:

• Legalization of Passive Euthanasia: India became one of the few countries to allow passive euthanasia, though it has to be under judicial supervision following under stringent conditions.
• Influence on Future Cases: The judgment set a precedent and paved the way for the Supreme Court’s 2018 ruling, which permitted passive euthanasia through advance directives or “living wills.”
• Societal and Medical Awareness: The case highlighted the plight of PVS patients, leading to greater awareness and dialogue around end-of-life care, medical ethics, and the right to die with dignity.

This judgment encouraged public discourse on euthanasia in India and spurred advocacy for patient autonomy and the right to die with dignity.

12. Critical Analysis

The Judgement passed on the Aruna Shanbaug case comprises of both Compassion and caution towards euthanasia.

By legalizing passive euthanasia with judicial oversight, the court addressed the need for rendering the need for human heart towards humanity and dignity in medical care while ensuring that the judgement may not misinterpreted and misused.

Merits:

• The judgment respected the sufferings of the Patients enduring pain due to the illnesses and due to being in PVS. The court had been considerate for both the sanctity of life and the dignity of patients, allowing for compassionate decisions in cases where life extension might cause undue suffering.
• Judicial oversight was a practical solution to balance the ethical complexities, preventing hasty or uninformed decisions.
• The court recognized the importance of the evolving nature of medical ethics and practices, thus paving the way for progressive laws that respects patient’s autonomy.

Potential Weaknesses:

• The absence of a comprehensive law relating to Euthanasia can lead to potential misuse and misinterpretation of the judicial guidelines and could vary across cases.
• The Judiciary by the Landmark Judgement has been overburdened to hear more such pleas pertaining to medical decisions, which may lead to delays and inconsistencies.
• It is also argued that the requirement of judicial approval which is usually a time-consuming process, could deter families from seeking euthanasia, even in genuine cases.

We may conclude, the Aruna Shanbaug case by saying that it stands as a landmark judgment which sensitively addresses the issue of euthanasia within the Indian legal purview. It is considered to be a most significant step towards respecting patient’s dignity and autonomy.

Though we are in agreement that there is the need for clear and comprehensive legislation to for the concept of Euthanasia that serves as a guide to end-of-life care decisions in India.