Akshita Sankaranarayanan

Christ ( deemed to be University)

Editor: Sakshi Soni

I.        Introduction 

Euthanasia refers to the practice of hastening the process of death of a person to prevent their suffering in this world. It originates from the Greek words, ‘Eu’ meaning good and ‘Thanatos’ meaning death. ^[1] Euthanasia had for long been illegal in a country like India, where ethics, morality, politics all come into play while considering the question of mercy killings. There are also significant fears of misuse of enacting such a provision such as Euthanasia. The Aruna Shanbaug v Union of India case ruled in favour of allowing Passive Euthanasia to be legal in the country, subject to preconditions. However, the Supreme court in the case of Common Causes v. Union of India had overturned this judgement. There are two conflicting opinions about allowing giving such a practice legal sanction. On one hand, people believe that since god has given human beings life, only he has the power to take it away. However, others are of the belief that to relieve a human being of pain and suffering, they must be emancipated from this world. This is precisely what the courts held in the case of Aruna Shanbaug v Union of India. The central question of law lies in whether Article 21 of the Indian constitution guarantees, along with the right to life and liberty, the right to die with dignity. This case analysis recognises the role of the case in being a turning point for Euthanasia in the country. It analyses the facts of the case, the issues raised and a critical analysis of the judgement passed by the court.  

II.       Facts of the Case 

Aruna Ramachandra Shanbaug was a nurse working at King Edward Memorial (KEM) hospital in Mumbai. On November 27^th, 1973 she was sodomnised by a ward boy working in the same hospital. She was tied down by dog chains, which strangled her, and cut off oxygen supply to her brain. She was left in this condition for a few hours, which left her in a coma and caused long lasting brain damage. As a result of this, Aruna entered into a permanent vegetative state in which although she was aware of her surroundings partially, she was not able to communicate with the world. Aruna remained dependent on a feeding tube and constant care for the next four decades at the hospital, until in 2009, a journalist by the name of Pinki Virani filed a petition under article 32 of the constitution, claiming to be Aruna’s next friend. She

 

argued that it is imperative to remove Aruna from her life support, since her treatment violated the right to live with dignity. However, the hospital opposed this petition, stating that Aruna was not on life support, and she was being properly cared for by the hospital. They also argued that since the hospital is the official guardian, they should be allowed to take decisions on her behalf, and that removing her from her care would amount to causing voluntary death. The Supreme Court, in the case, was required to decide whether this type of passive Euthanasia is legally permissible under the law. ^{[2] [3]} 

III.     Issues Raised Before the Court 

Below are the main issues raised before the Supreme Court in this case. 

1.     Whether the Indian law permits passive euthanasia, that is, allowing the emitter to die by withholding medical support, rather than causing active death?  

2.     Whether the right to life under Article 21 encompasses within its fold the right to live with dignity at the end of life? 

3.     Whether a person who is not a family member of the victim can approach the court to seek withdrawal of life support?  

4.     Who should have the legal power to decide whether treatment should be continued or stopped when the patient is not in a state to take any decision?  

IV.      Relevant Case Laws 

Aruna Shanbaug v. Union of India raised issues relating to whether it would be permitted, legally, to withdraw life support systems from a person in a permanent vegetative state, encompassing constitutional, statutory, jurisprudential, ethical and comparative law issues. At the constitutional level, the right to die with dignity found its home in Article 21, which protects the right to life and personal liberty. Additionally, Articles 14 and 19 would also provide guidance in looking at autonomy and equality issues. Statutorily, the scenario implicated a number of sections of the Indian Penal Code including Section 302 (murder),

 

Section 304 (culpable homicide not amounting to murder), Section 306 (abetment of suicide) and Section 309 (attempt to commit suicide) which would be determinative whether the doctors/ caregivers would be criminally liable for participating in assisted or withdrawal of treatment. In respect of the Criminal Procedure Code, the issues raised were under Section 482, which were inherent powers of the High Courts with respect to the Code, under which the Supreme Court provided interim guidelines. There were precedents relevant, such as P. Rathinam v. Union of India (1994)^[4] that struck down Section 309 IPC; and Gian Kaur v. State of Punjab (1996)^[5] that overruled P. Rathinam v. Union of India (1994) however provided that the right to die with dignity in terminal cases. Medical ethics, in accordance with the Medical Council Regulations, 2002, also shaped the obligations of physicians in providing end-of-life care, while the principle of ‘Parens Patriae’ guided the Court in appointing Guardians ad litem to act in the best interests of those unable to make decisions for themselves. Comparative jurisprudence from the UK Airedale NHS Trust v. Bland (1993)^[6] and references to international human rights law and global euthanasia practices, also provided more context for the Court's reasoning. 

V.   Petitioner and Respondent Arguments Petitioner’s arguments: 

The petitioner in this case, the KEM hospital contended that Ms. Shanbaug was being duly fed and taken care by the nurse, and has been continuing to do so for the past 36 years. Since the hospital has taken utmost care and responsibility in dealing with Aruna, they did not wish to have Aruna Euthanised, and would like for her to die naturally. The contention is that the nurses have a close bond with the patient, with one nurse even offering to take care of her at no cost. Since the caretaking of Aruna was duly performed by the hospital, they considered that they had the authority to decide whether Aruna would get to live or be Euthanised. They also contended that such a plea for Euthanasia can only be performed by family members, relative, etc. Taking away Aruna’s life would be in violation of Article 21 of the Indian Constitution, violating her right to life.⁷ Respondent’s Arguments:

 

The counsel for the petitioner contended that the Right to life under Article 21 of the Indian constitution, also includes the Right to die with Dignity. They also contend that any person in a permanent vegetative state must be provided with the ‘Right to Die’. This is to end the prolonged suffering of the victim. They also contend that Aruna, although being capable of being aware of her surroundings, cannot respond to external stimulus and hence is subjected to extreme agony. They also contend that there is no scope for her to get better, since she has remained in the same state for over 36 years. It is better to kill her, to end her sufferings rather than subjecting her to further misery. 

VI.     Supreme Court Judgement 

The court, in this case, made an important distinction between active Euthanasia and Passive Euthanasia. The court held that Active Euthanasia is the positive and deliberate termination of life, however passive euthanasia is simply removing the pre-existing conditions for continuation of survival. Active euthanasia was held to be a crime in India as well as the rest of the world, however passive euthanasia can be permitted subjected to some conditions. The court strictly emphasised, however, that under Article 226 of the Indian constitution, the granting of passive euthanasia would only be done under the ‘rarest of rare’ circumstances. The Supreme Court also invoked the doctrine of ‘Parens Patriae’, wherein the final decision as to whether to grant Euthanasia or not would lie in the hands of the High court. Additionally, it was held that to grant passive Euthanasia, a committee of three reputed doctors, with a thorough examination of the patient and the family’s consent, must give their opinion to the high court The Supreme Court was very clear and strict in its direction that these provisions should be used with the utmost caution and should not become a tool to misuse Article 21 of the constitution. In the case of Aruna Shanbaug specifically, the court held that under the Transplantation of Human Organs Act, 1994, she was not brain-dead, and due to this ending, her life was not permissible. ^[7] 

VII.    Critical Analysis 

1. How the Court Changed the Law on End-of-Life Care

The case law marked a major shift in the way that India perceived Euthanasia and the legality surrounding it. For the first time in Indian history, the court had allowed passive

 

Euthanasia to be allowed in the country, only in certain situations. By linking Article 21, which is the Right to Live with dignity, the court assured that living does not merely mean the functioning of the body, but also refers to the right to live in a proper and dignified manner. This is significant in cases of permanent vegetativeness, where the patient has no chance of recovery and lives in a unconscious state. The judgment therefore moved Indian law away from a rigid idea that life must be preserved at all costs, even when it serves no human purpose. 

2. Right to Life v. Right to Die

The case also raised a difficult question about whether the right to life includes the right to die. The court has not given complete autonomy to patients to choose whether they get to live or die. Instead, it allowed only passive euthanasia, where treatment is stopped and the person is allowed to die naturally. This is a very restricted form of Euthanasia, that requires heavy procedures and approvals before it can be actually implemented. It is understandable that this was done to keep a check on the uncontrolled use or misuse of this provision. While this does protect against significant abuse of the law, but it also makes the process of obtaining euthanasia tedious and time consuming.  

3. Global Comparison

Worldwide, passive euthanasia is legal without any specific legislation enabling it into action. Some countries like the Netherlands regulate euthanasia with a strict hand, allowing only certain cases to be executed, However, countries like Switzerland follow a more liberal policy. Switzerland allows assisted suicide under monitored conditions, including Swiss and non-Swiss nationals, which does not require medical supervision. A similar process in India would be highly destructive for the Indian society and the growth of the Indian population. Compared to other countries in the world, India is more restrictive in its policies. ^[8] 

VIII. Conclusion 

 

The judgment in Aruna Shanbaug v. Union of India stands as a Landmark Judgement since it open doors to the discussion on the legal permissibility of Passive Euthanasia in the country. Although the judgement was overturned in the case of Common Causes v. Union of India, it still serves as an important step in recognised euthanasia. The case also highlights the discourse between the right to life and the right to die with dignity, stating that both must be interpreted in a balanced manner, depending on the facts and circumstances of each case. Dignity must be a basic right guaranteed to every citizen in the country.  

References

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC4311376/

[2] Aruna Ramchandra Shanbaug v. Union of India, (2011) 4 S.C.C. 454

[3] Case Analysis of Aruna Ramchandra Shanbaug v. Union of India, Manupatra Articles,

https://articles.manupatra.com/article-details/Case-analysis-of-Aruna-Ramchandra-Shanbaug-vs-Union-of 

[4] P. Rathinam v. Union of India, 1994 AIR 1844, 1994 SCC (3) 394

[5] Gian Kaur v. State of Punjab, (1996) 2 S.C.C. 648 (India) 

[6] Airedale NHS Trust v. Bland, [1993] A.C. 789 (H.L.) (House of Lords, U.K.) ⁷ Aruna Ramchandra Shanbaug v. Union of India, (2011) 4 S.C.C. 454

[7] Transplantation of Human Organs Act, 1994, No. 42, Acts of Parliament, India (1994)

[8] Kanak Sharma, Aruna Ramchandra Shanbaug vs. Union of India: Case Analysis, International Journal for Legal Research and Analysis,

https://www.ijlra.com/public/index.php/details/aruna-ramchandra-shanbaug-vs-union-of-india-case-analysis-byhttps://www.ijlra.com/public/index.php/details/aruna%1eramchandra%1eshanbaug%1evs%1eunion%1eof%1eindia%1ecase%1eanalysis%1eby%1ekanak%1esharmakanak-sharma