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Case Reviews

Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454

By: Megha Gautam, first year student at Amity Law School, Noida.

Introduction

There has been a constant debate upon the legality of passive euthanasia. Article 21 of the constitution of India explicitly guarantees ‘Right to Life’ to all citizens. The question that arises is whether this article shields the ‘Right to die’, this issue has remained undecided for long. The controversial issue pertaining to the concept of euthanasia has always received unequivocal reaction.

In 2009, Ms. Pinki Virani approached the apex court under Article 32 of the Constitution to get permission for putting an end to the unending miseries of Aruna Ramchandra Shanbaug, who was in the permanent vegetative state for the last 36 years. Ms. Pinki Virani was a journalist-activist who claimed to be Aruna’s next friend. Although the Supreme Court had already dismissed the legality of the right to die but seeing the perplexed nature of the case the court accepted the Public Interest Litigation.

Relevant Facts

  • The petitioner Aruna Ramchandra Shanbaug worked as a staff nurse in King Edward Memorial Hospital, Parel, Mumbai. On the evening of 27th November, 1973 a sweeper working in the hospital attacked her by wrapping a dog chain around her neck and yanked the back with it. He made an attempt to rape her but on knowing that she was menstruating, he sodomized her. To restrict her movement he even twisted a chain all around her neck.
  • Next day, a cleaner saw her in an unconscious state on the floor in a pool of blood. It was purported that the strangulation by the dog chain had stopped the oxygen supply to her brain and that it was damaged. Thereafter, she has been hospitalized in the KEM Hospital where the staff took care of her.
  • Aruna Shuanbaug was 60 years by then and there was no scope for recovery. Her teeth had decayed, skin was as thin as a paper mache. It was alleged that she was virtually dead and was just surviving on the meshed food. 
  • Therefore, it was prayed to the court to grant her relief by letting her die peacefully.

Key Issues

  • Whether it is permissible to withdraw the life sustaining system/therapies from the person who is in permanent vegetative state (PVS)?
  • Whether the wish of the patient should be respected pertaining to his/her askance to withhold from giving life-sustaining treatments in case of a PVS or futile care?
  • Whether the wishes of the family or the next kin should be respected relating to withdrawal of life support systems in the cases where the patient is not in a condition to express his/her denial or acceptance?

Findings of the team of doctors

Due to the disagreement in the writ petition, the court constituted a team of three distinguished doctors to study the physical as well as mental condition of the patient.

  • According to their examination, the patient was neither brain dead nor in the state of coma. She expressed her discontentment when lots of people were in the room. She also liked devotional music, light and fish soups.
  • The staff of the hospital took great care of her as she had not developed any bed sores, she was clean and dry.
  • The staff of KEM Hospital was found very much willing to take care of her. Consequently, the doctors suggested that the act of euthanasia was not required in this case.

Arguments of Appellant 

  • The learned counsel relied on the case of Vikram Deo Singh Tomar v. State of Bihar to state that it is essential that every person should live a healthy life. And it is a fundamental right of every citizen to live a life with human dignity.
  • Reliance was placed on P. Rathinam v. Union of India to quote: “Life is not mere living but living in health. Health is not the absence of illness but a glowing vitality”. 
  • It was contended that Ms. Pinky Virani was a next friend of the patient and she had tried to do the best for her in all possible ways. And it would in the best interest of the patient that she should be allowed to die peacefully.

“Life is not mere living but living in health. Health is not the absence of illness but a glowing vitality”. 

Arguments of Respondents

  • Aruna Shuanbaug was very much a part of the KEM Hospital and the staff was happy to serve her. They also explained that she was not dead and she responded to music and people around her.
  • They expounded that Indian society is probably not matured enough in accepting euthanasia or mercy killing.
  • They declined from recognizing Ms Pinki Virani as her next friend because though she had written a book on her, she was not as close to the patient as the KEM Hospital was. The staff considered her to be family and hence, the arguments of the hospital should be considered over hers. 

Precedents cited

  • Vikram Deo Singh Tomar v. State of Bihar (1): It was observed that each and every person should have the right to live with dignity as a fundamental right.
  • P. Rathinam v. Union of India (2): It was stated that healthy life is the essence of living and not mere living. However, the decision in this case was overruled in Gian Kaur v. State of Punjab (3) that held that both assisted suicide and euthanasia are not legal in India.
  • Airedale NHS Trust v. Bland (4): The House of  Lords stated that if the patient is incompetent to decide on the question of withdrawal of artificial support then his/her immediate next (parents or spouse) can decide for the patient. And in the least case, it would be fair for a doctor acting on medical opinion to withdraw an artificial support system in the interest of the patient then it will not be termed as a crime in law.

Laws in other countries relating to physician assisted death or euthanasia 

  • Netherlands has the “Termination of Life on Request and Assisted Suicide (Review Procedures) Act, 2002” which states that euthanasia is allowed when the physician is acting with due care and caution. It has legalized the act in very specific cases.
  • In Switzerland, according to Article 115 of the Swiss Penal Code, suicide can be considered as a crime only and only if it is done for selfish motive. Also the act can be performed even by the non-physician. The law is unique because it does not require the recipient to be a Swiss national; moreover, the requirement of a physician is also not mandatory.
  • In USA, except for states of Washington, Oregon and Montana, active euthanasia is strictly illegal. Also, countries like Canada and Belgium have laws to practice euthanasia under certain conditions.

Analysis

  • To decide upon the very issue, the court found it imperative to clearly elucidate the two types of euthanasia: active and passive. In active euthanasia, the physician deliberately acts in a way that causes end to the incurable medical condition of a patient. It is usually done by administering lethal drugs/injections.
  • On the other hand, passive euthanasia refers to the act when a physician withdraws the artificial life support system which would cause death of a patient. 
  • Further the distinction was between voluntary and non-voluntary euthanasia. Voluntary euthanasia is when the consent can be taken from the patient, but in non-voluntary euthanasia the patient is not in a condition to give consent, for example when he/she is in coma. To decide on the latter case causes various problems and that the present case is one such example.  
  • The court was of the opinion that Section 309 of Indian Penal Code (IPC) dealing with attempt to commit suicide should be deleted. 

Decision

  • On March 7, 2011, the division bench of the Supreme Court, constituting Justice Gyan Sudha Mishra and Justice Markandey Katju opined that Aruna was not brain dead. They relied on the Transplantation of Human Organs Act, 1994, for the definition of brain death. Further, they gave the decision by taking into consideration the view of the management of the KEM Hospital and Ms. Pinki Virani. 
  • Moreover, the court in a move to prevent misuse of parens patriae principle vested power in the High Court to determine the question on termination of life. Thus, the apex court allowed passive euthanasia but subject to intervention by the High Court. In deciding the matter the High Court should send a notice to the state and next relatives (spouse, parents, sisters, brothers, etc.) of the patient, and the next friend in absence of others, and subsequently a copy should be supplied to the doctor’s committee.
  • However, in the present case Aruna was not granted permission for euthanasia because she was not deemed fit for the same. But the KEM Hospital can approach the High Court if it feels the need for the same in future. 
  • The Court also recommended repealing Section 309 of IPC.

Conclusion

This judgement is considered as a landmark case in the sphere of euthanasia because it provides a mechanism to be followed as there is no legislation on this subject in the country. This pronouncement is of vital importance as it paved the way for a liberal society. 

  1. (1988) SCC 734
  2. (1994) SCC 394
  3. (1996) 2 SCC 648
  4.  (1993) All E. R. 82) (H.L.)

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