This Case Commentary is written by Rohan Sthanu, a Fourth-year law student of Amity University Mumbai

Case Details: -

Court- Supreme Court of India

Equivalent citation- AIR 2011 SC 1290

Bench - Gyan Sudha Misra, Markandey Katju

Decided on – March 7, 2011

Case type – WRIT PETITION (CRIMINAL)

Parties: -

Petitioner: Aruna Ramchandra Shanbaug

Respondents: Union Of India & Ors

Abstract

All Indian people are guaranteed the "Right to Life" by the country's constitution. There is still much disagreement about whether the phrase "Right to Die" can also be used in this way. However, the idea of euthanasia has drawn mixed reactions in India as the medical community places an increasing focus on patients' informed consent.

The real-life complicated story of Aruna Shanbaug, now presented as a landmark judgment in the Indian legal system raises many legal, ethical, and moral questions on the question of euthanasia, dignity of death, and patient’s rights. This case made the headlines of the national as well as the international newspapers not only because of the long-drawn-out conservatorship of Aruna Shanbaug in a vegetative state but also on account of several legal points relating to Euthanasia it produced in India. The Aruna Shanbaug case also involved wider legal issues and concerns that are still discussed in the essence of euthanasia, patient rights, and medical.

Introduction

The Indian Supreme Court made passive euthanasia legal in the landmark decision of Aruna Ramchandra Shanbaug v. Union of India & Others (2011), ruling that the right to die is derived from Article 21 of the Indian Constitution. For the first time, the right was acknowledged as a fundamental right in India. The ruling established the fundamentals of passive euthanasia in India, distinguished it from active euthanasia, and established the regulations and standards that must be met for passive euthanasia to be authorized.

The ruling establishes a basic right to a dignified death within the bounds of Article 21 of the Indian Constitution and guides the practice of passive euthanasia in India. It also sets a significant precedent.

Facts of the case

The petitioner, Arun Ramchandra Shanbaug, worked as a staff nurse at Khan Memorial Hospital in Parel, Mumbai. A hospital sweeper assaulted the petitioner on November 27, 1973. He attempted to sexually abuse her while securing a chain around her neck. But when he realized she was menstruating, he stopped. She was rendered unconscious after he sodomized her and wrapped the dog chain around her neck.

She was discovered lying in a pool of blood on the hospital floor by a cleaner, another member of staff, the following day.

It was said that when she was strangled, her brain's oxygen supply was cut off, causing brain damage. The hospital's medical staff also stated that the cortex and other brain regions had sustained significant damage. She also had a cervical cord injury along with a brain stem contusion.
Her subsequent acquaintance, Ms. Pinki Virani, filed a petition under Article 32 of the Indian Constitution 36 years after the incident. The petition asked for permission to end Ms. Aruna Shanbaug's life since she was confined to her bed. She was in a permanent vegetative state, according to the petition's additional explanation. She was almost completely lifeless and had no awareness of her surroundings.

The petitioner asked that Ms. Aruna Shanbaug's life-supporting procedures be stopped, and her vitals—including medicine—be taken away, allowing her to pass away in peace. The petition asked for her suffering to come to an end.

After that, the Supreme Court assigned a group of three eminent physicians to do a comprehensive examination of Aruna and provide the Court with a detailed report on her condition.

Issues Raised

1. Is it appropriate or "not unlawful" to withhold or stop providing life-sustaining therapies to someone who is in a permanent vegetative state (PVS)?

2. Should the patient's preferences be honored in the event of a PVS or futile care if they have previously stated a desire not to receive life-sustaining treatments?

3. Should a person's family or next of kin request that unnecessary life-sustaining therapies be withheld or discontinued if they haven't previously made this request, should their desires be honored?

Arguments of the Petitioner

Ms. Pinky Virani filed a petition under Article 32 of the Indian Constitution on behalf of Ms. Aruna Ramchandra Shanbaug. The petition brought up an important issue about Article 21 of the Indian Constitution, which guarantees everyone the right to pass away with dignity.

The following cases were presented by the petitioner's knowledgeable attorney to bolster his claims. He cited the 1988 ruling in Vikram Deo Singh Tomar v. State of Bihar, in which the court found that each person had a right to a standard of living commensurate with his or her unique human nature. This suggests that the right to a dignified and good existence is included in the right to life. Stated differently, the Supreme Court noted that every citizen is entitled to a life that is both meaningful and consistent with their unique nature.

The right to die with dignity is an important issue that the learned counsel emphasized, particularly when the individuals involved are in a permanent vegetative state. In situations where a person is terminally sick and there is no chance of recovery, he maintained that people should have the right to terminate their life with dignity to put an end to their protracted suffering.

Using Ms. Aruna Shanbaug's anguish and suffering as an example, the counsel clarified the circumstances. He emphasized how she has been confined to her bed for more than 35 years and is unable to eat, communicate, or carry out any other human task. Her condition was deemed virtually lifeless by the physicians, who were sure there was no chance of recovery. Therefore, the Respondents would not be killing her; rather, they would be allowing her to pass away with honor and dignity by turning off her life support and life-sustaining treatments.

Arguments of the Respondents

The Municipal Corporation of Bombay and KEM Hospital's knowledgeable attorneys submitted a counterpetition to refute Ms. Aruna Shanbaug's request for euthanasia. They offered the following justifications in favor of their opposition to euthanasia.

The attorney emphasized that Ms. Aruna Shanbaug had received meticulous care and nutrition from the hospital's nurses and personnel for more than 35 years. They have dedicated themselves to giving her the finest care possible despite her condition.

Moreover, the attorney said that because Ms. Aruna Shanbaug was older than sixty, there was a chance she might pass away on her own without any help. The attorney emphasized that the nurses and other hospital personnel would be more than happy to care for her for the days left in her life, no matter what obstacles might arise. As such, they were against the concept of euthanasia. In addition, the knowledgeable attorneys representing the Respondents argued that legalizing euthanasia would be inconsistent with the constant diligence, skill, and hard work that the nurses and other medical personnel had put in to keep Ms. Aruna Shanbaug alive for more than thirty years.

Furthermore, the Respondents' knowledgeable legal counsel continued to voice their worries regarding the ramifications of legalizing euthanasia in Indian culture. The civilization is highly individualistic and focused on providing for the requirements of each individual. The attorney said that legalizing euthanasia would allow for abuse and damage the social norms that Indian society attaches to providing care.

Related Provisions

1. Article 21 Right to Life: About Article 21 The court dismissed the idea of the right to die. The court held that Article 21 does not give the right to die to a person. But the court also that the right to live a dignified life comes under Article 21 of the Indian constitution.

2. The Doctrine of Parens Patriae, which means "parent of the nation," is a legal principle that grants the state the inherent power and authority to act as the guardian for those who are unable to care for themselves.

In India, this doctrine reflects the nation's commitment to protect the welfare and interests of its citizens.

3. Right to Refuse Treatment: The patient has a legal right to autonomy and self-determination enshrined within Article 21 of the Indian Constitution. He can refuse treatment except in an emergency where the doctor need not get consent for treatment.

Judgment and its analysis

Justice Wadhwa in the Supreme Court wrote the judgment on 7.3.2011 and this judgment was delivered by the Division Bench which consists of the Justices Markandey Katju and Gyansudha Mishra in Aruna Ramchandra Shanbaug v. Union of India & Others. The Honorable Bench further observed that no law of the land in India permits the withdrawal of life-sustaining measures from any patient who is in a persistent vegetative state or has become incapacitated to make decisions regarding his treatment. All the arguments formulated by the Respondents were dismissed by the Supreme Court. On this, they agreed with the Petitioner and affirmed that there are instances where passive euthanasia has to be permitted.

The Supreme Court went on to say that the patient’s parents, spouse, or other close relatives will decide on the removal of life support. If they are not present, decisions concerning the matter can be made by any person who is close to the patient. The Court also observed that the patient’s doctors have a prerogative to pull the plug but such decisions should be in the best interest of the patient.

During its consideration of this matter, the Court observed that the parents of Ms. Aruna Ramchandra Shanbaug were dead and her near and dear ones had not visited her since the occurrence of the said assault. Further, the patient had quality treatment, provided by the KEM Hospital’s nurses and other employees. The Court also said that before any decision about stopping the life support, the High Court of the state has to give its nod. The intended rationale for this was to close any loopholes that would lead to dishonest persons ripping the patient off to inherit his properties and other personal effects.

The Court however in its judgment held that Aruna was not brain dead as diagnosed by the doctors and the definition provided in the Transplantation of Human Organs Act, 1994. She had sensations, could breathe without the help of the ventilator, and could deliver the needed stimulation. Surprisingly, although she was in a PVS, her general health was not deteriorating and was fairly stable. It was therefore not reasonable to kill her.

Moreover, it is the management of KEM Hospital and its employees who should have the prerogative to decide matters about Pinki Virani and not the other way around. She was surviving due to the method that was saving her life, which involved mashing the food. In this instance, to cease the life-saving process would mean starving her. The Indian legal system in no way supported starving a person to death.

However, the court ruled that Aruna Shanbaug should not be administered with euthanasia which is why the request was denied. Had the management or employees of KEM Hospital felt the need for the same in the future they could follow the above procedure of approaching the High Court.

This is therefore a major landmark in end-of-life care in India overall. It is evident from the case that India requires appropriate euthanasia legislation. The judgment gave rise to discussions about the consequences of allowing passive euthanasia in society and increasing people’s awareness and empathy for those like Ms. Aruna Shanbaug.

Conclusion

The landmark ruling upheld life's sanctity and emphasized its importance as the cornerstone of the basic right to life guaranteed by Article 21 of the Indian Constitution. The legal, medical, and ethical complexities of the right to life and passive euthanasia were examined by the Supreme Court of India. After consulting with medical professionals, the Court evaluated Ms. Aruna Shanbaug's state of health. After examining the intricacies of her ailment, passive euthanasia was rejected in her instance. Nonetheless, the Court emphasized how crucial it is to respect the autonomy and desires of the patient who lacks the capacity for decision-making.

The landmark case illuminates the nuanced ethical issues surrounding the taking of a life in India, providing insight into how these instances would be handled going forward. Even though the historic ruling establishes specific standards for the practice of passive euthanasia in India and provides a precise process for its implementation, these choices are very difficult to make.