In a landmark case of Aruna Shanbaug vs Union of India the Supreme Court of India addressed passive euthanasia for individuals in a persistent vegetative state. The Court allowed passive euthanasia under strict guidelines, recognised prolonged suffering of Aruna Ramachandra Shanbaug after a sexual assault. It defined passive euthanasia as withdrawing life-sustaining treatment to allow natural death. The Court in Aruna Shanbaug Case mentioned guidelines including the recommendation of the medical board, consent through a surrogate decision maker and judicial review. The Aruna Ramachandra Shanbaug vs Union of India case set a significant precedent for passive euthanasia in India. Explore other significant Landmark Judgements.

Aruna Shanbaug vs Union of India: Introduction

Aruna Shanbaug vs Union of India 2011 is a landmark judgment by the Supreme Court of India that addressed the legality of passive euthanasia. The case involved Aruna Shanbaug, a nurse left in a permanent vegetative state after a brutal assault. The Court in Aruna Shanbaug Case considered whether withdrawing life support in such cases violated constitutional rights

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Before proceeding with the facts of the Aruna Shanbaug vs Union of India case let us first understand what is the term Euthanisa? The term ‘Euthanasia’ is derived from the Greek words meaning “good death.” It refers to the practice of intentionally ending a person’s life to relieve them from prolonged pain and suffering. It is often called mercy killing which involves complex ethical, moral and religious considerations, especially in countries like India where these values hold great significance.

With the development of medical technology, sustaining life artificially has become possible but this can sometimes prolong suffering instead of alleviating it. Opinions on euthanasia are divided. Some believe that life is sacred and only a higher power has the authority to end it, viewing euthanasia as a violation of this sanctity. Others argue that if the Indian Constitution guarantees the right to life, it should also safeguard an individual's right to die with dignity, ending unbearable pain and suffering.

Initially, the Courts in India did not recognize the right to end life. However, the landmark Aruna Shanbaug vs Union of India 2011 case laid the foundation for the legal acceptance of passive euthanasia under certain circumstances.

Euthanasia Historical Background

The euthanasia debate dates back to ancient Greece and Rome, where it was commonly accepted. However, during the Middle Ages, physicians following the Hippocratic Oath opposed it. In modern times, the issue resurfaced with longer life spans and chronic illnesses. Sir Thomas More mentioned euthanasia in 1516 and the medical community began discussing it more openly in the 19th and 20th centuries as medical technology advanced. The rise of degenerative diseases has further fueled ethical and legal discussions on end-of-life care.

Types of Euthanasia

Euthanasia can be divided into various types based on the consent of the patient and the method used to end life. Understanding these classifications is important for ethical and legal discussions surrounding the practice.

1. Voluntary Euthanasia: It is performed with the consent of the patient and is often called assisted suicide when a doctor helps the person end their life.
2. Non-voluntary Euthanasia: It is done when the patient is unable to give consent, such as in cases involving infants or comatose patients.
3. Involuntary Euthanasia: This is carried out against the wishes of the patient-
   • Active Euthanasia: It involves a deliberate act like administering a lethal injection to end life.
   • Passive Euthanasia: It involves withdrawing or withholding life-saving treatment like not administering antibiotics.

Living Will

A living will is a written directive in which a person mentions their medical preferences in case they become terminally ill or incapable of decision-making. It includes consent to withdraw life support. The government has raised concerns about its potential misuse.

Aruna Shanbaug vs Union of India: Facts

The Aruna Ramachandra Shanbaug vs Union of India case revolves around Aruna Shanbaug, a nurse who was left in a persistent vegetative state for over three decades after a brutal assault. The case focuses on whether passive euthanasia i.e., the withdrawal of life support to end prolonged suffering should be allowed in her case. The Aruna Shanbaug case raised fundamental questions about the right to die with dignity, medical ethics, and the boundaries of legal intervention in ending life. The following are the brief facts of Aruna Shanbaug vs Union of India -

Aruna Shanbaug vs Union of India: Background

Aruna Shanbaug was a nurse employed at King Edward Memorial Hospital (KEM) in Mumbai. On 27th November, 1973, she was violently attacked by a ward boy at the hospital which resulted in severe brain injury that left her in a persistent vegetative state. He attempted to rape her by choking and tying her with a dog chain to prevent resistance. Upon realizing she was menstruating, he sodomized her instead. On the next day, 28th November, 1973, a hospital cleaner found her unconscious and covered in blood. The strangulation had cut off oxygen to her brain which caused extensive damage to the cerebral cortex. She also suffered a brain stem contusion and cervical spinal cord injury.

Medical Condition of Aruna Ramachandra Shanbaug

Since the assault, Aruna Shanbaug remained in a vegetative state for over 36 years. She lost awareness of her surroundings and was unable to communicate or eat normally and was entirely dependent on others for care and life support.

Care and Custody of Aruna Ramachandra Shanbaug

The hospital staff took on the responsibility of caring for Aruna Shanbaug by providing her with food, medical attention and hygiene with great dedication. The nurses and other personnel developed a strong emotional connection to her with some even offering to care for her without payment.

Petition for Passive Euthanasia

In 2009, a close friend of Aruna Shanbaug filed a petition under Article 32 of the Indian Constitution and requested the Supreme Court of India to permit passive euthanasia i.e., to allow withdrawal of life support to end prolonged suffering of Aruna Ramachandra Shanbaug.

Aruna Shanbaug Case: Arguments of the Respondent

The Respondents in the Aruna Shanbaug vs Union of India case, particularly the hospital staff and administration presented various arguments against allowing euthanasia for the nurse Aruna Shanbaug:

• The dean and staff of the KEM Hospital strongly opposed the petition and stated that Aruna had been cared for with utmost dedication and compassion for over three decades.
• They emphasized that the staff had willingly and responsibly provided all her needs and were emotionally attached to her.
• The Respondents in Aruna Ramachandra Shanbaug vs Union of India argued that Aruna, who had lived for more than 60 years, might naturally pass away without intervention.
• They warned that legalizing euthanasia could lead to misuse and abuse by family members or others with vested interests.
• Since Aruna was unable to give consent, they raised concerns about who would have the authority to make such a decision on her behalf.
• The hospital staff maintained that ending her life would be immoral and inhumane, given their long-standing care and the respect they had for her right to life.

Aruna Shanbaug Case: Arguments of the Petitioner

The Petitioner in Aruna Shanbaug vs Union of India approached the Supreme Court of India and sought permission for passive euthanasia and contended that it was a constitutional extension of the right to death with dignity.

• The Petitioner who was a friend of Aruna filed the petition and invoked Article 21 which guarantees the right to life with dignity.
• The argument in Aruna Shanbaug Case was made that this right should also extend to the right to death with dignity, especially in cases of terminal illness or permanent vegetative state.
• The petitioner pointed out that Aruna had no awareness of her surroundings and could not perform basic functions like chewing or expressing herself and had been bedridden for decades without any hope of recovery.
• They argued that continuing life support only prolonged her suffering and that withdrawing it would not be an act of killing but a release from a state akin to being practically dead.
• The petitioner urged the court to consider passive euthanasia as a humane way to end unbearable pain and suffering in such hopeless medical conditions.

The following issues were addressed in the case of Aruna Shanbaug vs Union of India 2011 -

Legality of Passive Euthanasia in India

The foremost issue before the Supreme Court of India was whether passive euthanasia which is defined as the withdrawal of life-sustaining treatment from a person in a Permanent Vegetative State (PVS) was legally permissible in India.

Scope of Article 21: Right to Life vs Right to Death

The Supreme Court in Aruna Shanbaug vs Union of India had to examine whether Article 21 of the Constitution, which guarantees the right to life and personal liberty, also encompasses the right to die with dignity.

Aruna Shanbaug Case: Determination of ‘Next Friend’ and Legal Standing

Another legal issue arose in Aruna Shanbaug vs Union of India was whether the petitioner, Pinki Virani, had the locus standi to file the plea on behalf of Aruna Shanbaug. The Supreme Court had to examine who qualifies as a “next friend” capable of making such critical decisions in the absence of close family members and whether Pinki Virani fit that role or if it should rest with the KEM Hospital staff who had cared for Aruna for decades.

Absence of Legislative Framework for Euthanasia

Since there was no legislative provision governing euthanasia in India at the time the Supreme Court in Aruna Shanbaug vs Union of India had to determine whether it could lay down guidelines under its constitutional authority to fill the legal vacuum.

Relevance of Section 309 IPC and Its Constitutional Validity

The Aruna Ramchandra Shanbaug vs Union of India case reignited the constitutional debate surrounding Section 309 of the Indian Penal Code which criminalizes attempts to commit suicide.

Role of High Courts under Article 226

The 2-Judge Bench of the Supreme Court of India comprising Justice Markandey Katju and Justice Gyan Sudha Misra had to evaluate whether High Courts have jurisdiction under Article 226 of the Constitution to decide matters related to euthanasia.

Aruna Shanbaug vs Union of India: Legal Provisions

In Aruna Shanbaug vs Union of India 2011 Article 14, Article 21 and Article 32 of Indian Constitution played a significant role. The following are the legal analysis of these provisions -

Article 14 of Indian Constitution

Article 14 ensures that every individual is entitled to equality before the law and equal protection of the law within India. This right applies universally to all persons, including citizens, foreigners, companies, statutory bodies, and other legal entities. Article 14 was invoked in Aruna Shanbaug vs Union of India to argue that Aruna Shanbaug, like any other individual, was entitled to equal protection under the law.

Article 21 of Indian Constitution

Article 21 guarantees that no person shall be deprived of their life or personal freedom except through a legally established procedure. In Aruna Shanbaug vs Union of India it was invoked to argue that the right to life includes the right to die with dignity, especially in cases of prolonged suffering without hope of recovery.

Article 32 of Indian Constitution

Article 32 of the Constitution of India provides the right to approach the Supreme Court through appropriate legal means to seek enforcement of fundamental rights granted to individuals. Article 32 was relevant in Aruna Shanbaug case because a close friend of Aruna Shanbaug filed a petition under this article and requested the Supreme Court of India to permit passive euthanasia of Aruna Ramchandran Shanbaug.

Section 306 of Indian Penal Code

Section 306 (Now Section 108 of Bharatiya Nyaya Sanhita, 2023) states that if a person commits suicide, anyone who aids, abets, or encourages that suicide can be punished with imprisonment for up to ten years and may also be fined. This section was considered in Aruna Shanbaug vs Union of India to understand in evaluating the legality of euthanasia or withdrawal of life support.

Section 309 of Indian Penal Code

Section 309 states that anyone who attempts to commit suicide may face imprisonment for up to one year, a fine, or both. Section 309 was relevant in Aruna Shanbaug vs Union of India because it criminalizes attempted suicide which raised questions about the right to death and whether passive euthanasia or withdrawal of treatment could be considered an attempt to hasten death.

Aruna Shanbaug vs Union of India: Judgment and Impact

The Supreme Court of India on 7 March, 2011 through a Division Bench comprising Justice Markandey Katju and Justice Gyan Sudha Mishra, delivered a landmark judgment Aruna Shanbaug vs UOI that became the foundation for the legality of passive euthanasia in India. The Court denied euthanasia to Aruna Shanbaug and laid down ‘Aruna Shanbaug vs Union of India case guidelines’ to be followed in such cases.

Aruna Ramachandra Shanbaug was not Brain Dead

The Supreme Court in Aruna Shanbaug vs Union of India relied on the definition of brain death under the Transplantation of Human Organs Act, 1994 and concluded that Aruna Shanbaug was not brain dead. She could breathe on her own, responded to pain stimuli and had some emotional awareness. The condition of Aruna Ramachandra Shanbaug, although categorized as Permanent Vegetative State (PVS), was medically stable, and therefore, the termination of her life was unjustified.

Rejection of the Euthanasia Plea in Aruna Shanbaug Case

The Petitioner, Pinki Virani, had requested permission for euthanasia. However, the Court in Aruna Shanbaug vs Union of India held that she did not qualify as Aruna’s next friend in legal terms. The hospital staff at KEM Hospital, who had been caring for Aruna for over 36 years, were found to be more appropriate custodians of her welfare and best positioned to decide on her behalf.

The Court in Aruna Ramchandra Shanbaug vs Union of India acknowledged the unparalleled care provided by the hospital and rejected the plea and stated that withdrawing mashed food would amount to starving her to death, which is neither passive euthanasia nor permissible under Indian law.

Legalization of Passive Euthanasia in India

The Supreme Court in Aruna Shanbaug vs Union of India denied euthanasia but recognized and legalized passive euthanasia in exceptional circumstances, filling the legislative vacuum with judicial guidelines until Parliament enacts a law on the subject.

Aruna Shanbaug vs Union of India Case Guidelines

The Supreme Court in Aruna Shanbaug vs Union of India laid down a clear judicial procedure for Passive Euthanasia to be followed across the country:

• Applications for passive euthanasia must be filed under Article 226 of the Constitution before the High Court.
• The Chief Justice of the High Court should form a bench of at least two judges to decide on such cases.
• The Bench must appoint a committee of three competent doctors, nominated in consultation with reputed medical institutions.
• The State government, the patient’s relatives, and in their absence, the “next friend” must be given notice.
• The medical report must be shared with all concerned parties.
• After due consideration, the High Court will issue its ruling.

The process as stated in Aruna Shanbaug vs Union of India is to be followed uniformly across India until Parliament legislates on the matter.

Aruna Shanbaug vs Union of India: Precedents Referred

The Supreme Court in Aruna Shanbaug vs Union of India 2011 referred to the following important legal precedents to help shape the understanding of euthanasia and the right to death.

State of Maharashtra v. Maruti Sripati Dubal (1987)

The Bombay High Court held that Section 309 IPC, which criminalizes attempted suicide, was unconstitutional and stated that the right to death is included under Article 21 of the Constitution. The Court declared that choosing to end one’s life in certain conditions is not unnatural.

P. Rathinam v. Union of India (1994)

The Supreme Court in Aruna Shanbaug vs Union of India also referred to the P. Rathinam case which extended the reasoning of the Maruti Sripati Dubal case and held that Article 21 includes the right to death. Section 309 IPC was deemed violative of Article 21. It viewed the right to life as not merely the right to live, but also the right not to live under conditions of suffering.

Gian Kaur v. State of Punjab (1996)

The case of Gian Kaur v. State of Punjab overruled P. Rathinam and upheld the constitutional validity of Section 306 IPC, which penalizes abetment of suicide. However, the Court drew a distinction and stated that while there is no right to death, in the case of terminal illness or PVS, allowing a dignified death could be permissible. The concept of dying with dignity was recognized as a part of the right to live with dignity under Article 21.

Airedale NHS Trust v. Bland (1993, House of Lords, UK)

The Supreme Court in Aruna Shanbaug vs Union of India also referred to this landmark British case which permitted the withdrawal of life support for Tony Bland, a PVS patient. This was the first recognition of passive euthanasia in English jurisprudence, where non-provision of food and water was judicially allowed under strict scrutiny and medical consensus.

Cruzan v. Director, Missouri Department of Health (1990, US Supreme Court)

The Supreme Court in Aruna Shanbaug vs Union of India also referred to this US case which introduced the principle of informed consent in medical decision-making. The Court observed that individuals have the constitutional right to refuse treatment, and if the patient is unable to communicate, the decision must align with what the patient would have wanted, using prior declarations or evidence.

Ethical Considerations: Informed Consent & Beneficence

The Supreme Court in Aruna Shanbaug vs Union of India analyzed the ethical principles of:

• Informed Consent – A patient’s autonomous decision regarding treatment must be honored. If unavailable, the decision should reflect the patient’s best interest.
• Beneficence – The concept that actions must be guided by the patient’s well-being. Since Aruna was incapable of providing informed consent, the Court highlighted that any decision on her behalf must promote her welfare, devoid of external bias.

Aruna Shanbaug Case & Role of Parens Patriae

The Court in Aruna Shanbaug vs Union of India invoked the doctrine of parens patriae and stated that the State has a duty to act as guardian for individuals unable to care for themselves. In Aruna Shanbaug v UOI case, the High Court would act in the role of legal guardian to ensure the procedure for passive euthanasia was not misused.

Recommendation to Repeal Section 309 IPC

Finally, the Court in Aruna Shanbaug vs Union of India strongly recommended the repeal of Section 309 IPC described it as cruel and irrational to penalize a person attempting suicide, especially one undergoing severe psychological or physical pain.

Law Commission Report on Euthanasia

In its 196th Report of 2006, the Law Commission of India proposed legislative reforms regarding euthanasia and the care of terminally ill patients. It recommended enacting a law to provide protection from prosecution under Section 309 of the Indian Penal Code, which criminalizes attempted suicide, for terminally ill patients who choose to refuse medical treatment, artificial nutrition, or hydration. The report also suggested shielding doctors from legal liability under Section 306 and Section 299 of the IPC when they act according to the patient’s wishes or in the best interests of patients unable to make decisions themselves. The proposed legislation was to be called the Medical Treatment of Terminally Ill Patients (Protection of Patients, Medical Practitioners) Act.

The report outlined certain key conditions for this proposed law:

• Terminal Illness: The patient must be diagnosed with a terminal disease.
• Vegetative State: The patient should be in a chronic and irreversible vegetative state.
• Consultation and Decision-Making: The patient’s family should be consulted, the final clinical decision must rest with the doctor, who is best qualified to make medical judgments based on their expertise.

Additionally, the report highlighted that physicians should provide written notification of the decision to withhold or withdraw medical treatment to the patient (if conscious) and to the family or relatives, especially when the patient cannot give informed consent. The bill aimed to clarify the process of end-of-life decision-making and protect doctors from liability when acting in the best interests of their patients.

Aruna Shanbaug vs Union of India Conclusion

The Supreme Court in Aruna Shanbaug vs Union of India denied euthanasia and held that her condition did not warrant the withdrawal of food and that her dignity was preserved by the hospital staff. However, the Court laid down a framework to permit passive euthanasia under judicial supervision. The decision in Aruna Shanbaug Case paved the way for legal recognition of passive euthanasia in India while safeguarding against abuse and preserving the sanctity of life and dignity in death.

Conclusion

The Supreme Court in Aruna Shanbaug vs Union of India judgment denied euthanasia but laid the foundation for recognizing passive euthanasia in India. The Court affirmed that the right to death with dignity is a part of the right to life under Article 21. The Supreme Court allowed passive euthanasia under strict guidelines, balancing ethical concerns with individual autonomy and compassion in end-of-life care.