Aruna Ramchandra Shanbaug vs Union Of India & Ors

COURT NAME: SUPREME COURT OF INDIA

BENCH: GYAN SUDHA MISRA, MARKANDEY KATJU 

DATE OF JUDGMENT: 30/12/1996

Relevant Provisions/Statutes:

• Article 14 of the Constitution of India
• Article 21 of the Constitution of India
• Article 32 of the Constitution of India
• Section 306 of the Indian Penal Code
• Section 309 of the Indian Penal Code

Brief Fact:  

Aruna Ramachandra Shanbaug was a nurse at King Edward Memorial Hospital in Mumbai. On  November 27, 1973, she was attacked and strangled by a hospital worker using a dog chain,  which caused serious brain damage from lack of oxygen and left her in a permanent vegetative  state. She lived in this condition for over 42 years without being aware of her surroundings, and  her case raised important questions about euthanasia in India.

Here’s what happened:

Aruna was attacked and strangled, then assaulted while her attacker noticed she was  menstruating. The next morning, she was found unconscious and covered in blood on the  hospital floor. The strangling cut off oxygen to her brain, causing severe damage. 

She stayed in the hospital and was cared for by staff who provided excellent nursing care,  preventing bedsores and fractures even after many years of not being able to move. At first, she

was fed by mouth, but later, she needed a feeding tube because she lost the ability to swallow or  communicate. 

The following key points regarding her medical and legal status emerged:

• Doctors confirmed that she was in a persistent vegetative state, meaning she was not aware of herself or her surroundings, could not chew, speak, or move on her own, and needed complete care from staff to survive. 
• In 2009, journalist Pinki Virani, who was close to her, asked the Supreme Court of India to allow stopping her life support, saying her life was not worth living.
• The hospital responded by pointing out that she showed small facial movements and sounds, and argued against stopping her treatment, saying it was not right legally or morally. 
• The Supreme Court appointed doctors who agreed she was in a vegetative state but not brain dead, and praised the hospital staff for their hard work.
• On March 7, 2011, the Supreme Court rejected the request to end her life but made a significant ruling that allowed passive euthanasia in India under strict rules, requiring approval from the High Court and a medical board review for each case. 

Aruna Shanbaug remained in the care of KEM Hospital staff until her death from pneumonia on  18 May 2015, after nearly 42 years in a vegetative state.

This case became the focal point for discussions on the “right to die with dignity” and  established crucial legal precedent for passive euthanasia in India. 

Issues:

• Aruna was conscious but unaware of herself or her environment, unable to communicate, and confined to bed with contractures.
• She responded to certain stimuli (e.g., blinking to movement, accepting some food by mouth) but did not exhibit purposeful behaviors.
• CT and EEG studies showed severe, irreversible brain damage with generalized cerebral atrophy.
• She met criteria for a Permanent Vegetative State (PVS), with spontaneous breathing, sleep-wake cycles, preserved reflexes, but no voluntary interaction or awareness.

1. If someone is in a permanent vegetative state (PVS), is it okay to stop life support, including feeding tubes?
2. If a patient said before that they do not want life support in case of PVS, should their wishes be followed?
3. If a person did not say anything before, but their family asks to stop life support, should their request be honored?
4. Aruna Shanbaug has been taken care of by KEM Hospital staff for 37 years after her family left her. Who should make decisions for her?

Judgment: 

The Supreme Court’s decision in Aruna Ramchandra Shanbaug v. Union of India (2011) set  important rules for passive euthanasia in India. Here are the main points from the judgment:

1. No Specific Law: The Court noted that India did not have a law that allowed stopping life support for people in a permanent vegetative state or those who cannot make decisions. So, the Court created guidelines to follow until a law is made.
2. Allowing Passive Euthanasia: The Supreme Court allowed passive euthanasia, which means stopping or not starting life-support treatment, but only in special cases with strict rules and court checks.
3. Who Can Decide: The patient’s parents, spouse, or close relatives can decide to stop life support. If there are none, a “next friend,” like a main caregiver, can make the decision. Doctors can suggest stopping treatment if it is best for the patient, but this needs careful review.
4. Court Approval: Any choice to stop life support must be approved by the High Court in the state, through a petition. This is to prevent misuse by those who may want to gain from the patient’s assets.
5. Specific Case—Aruna Shanbaug: The Court found that Aruna was not brain dead and was stable, so it denied the request for euthanasia. The hospital staff could ask the High Court to withdraw life support later, following the set rules.
6. Until a Law is Made: The process for passive euthanasia will be followed until Parliament creates a law for these situations.

This judgment was a significant moment in Indian medical law, balancing compassion, patient  rights, and protection against misuse.

Ratio decidendi:  

The Court was of the firm opinion that since Ms. Aruna Shanbaug was in a permanent vegetative  state, someone should be entrusted to a surrogate due to her inability to make decisions for her  own good. The Court appointed the staff of the KEM Hospital as her appropriate surrogate,  empowering them to make decisions on her behalf.

The Court held that active euthanasia is illegal in India and is an offence under the Indian Penal  Code. Furthermore, the Court acknowledged the evolving understanding of death and expanded  its definition beyond cardiopulmonary function. It included brain functions within the meaning 

of death. The Court also discussed the concept of parens patriae, wherein the state is empowered  to assume the role of protecting its citizens with disabilities.

Obiter Dicta:

The Hon’ble Division of the Supreme Court expressed its apprehension regarding the societal  understanding of euthanasia and put forth its concerns regarding its potential misuse. The Bench

advocated for a compassionate society which focuses on prioritising the welfare of its citizens  with permanent disabilities.

The Bench also advocated repealing Section 309 of the Indian Penal Code, which provides that  attempt to suicide is a criminal offence. Furthermore, they suggested a shift towards offering  support and assistance to individuals who are struggling with mental health issues and have  suicidal tendencies.The Bench emphasised on the duty of the state to safeguard individuals with  disabilities. It underscored the principle of parens patriae which highlights the obligations of the  state to protect disabled and vulnerable individuals and uphold their rights in the contemporary  era. 

Final desicion:

1. Passive euthanasia is permitted in certain circumstances for patients in a permanent vegetative state (PVS) or those unable to make decisions, but such action requires prior approval from the relevant High Court.
2. Decisions about discontinuing life support can be made by close relatives of the patient (parents, spouse, or others), or if none are available, by a “next friend” such as a long term caregiver. However, the court must be satisfied that this is in the patient’s best interests.
3. The High Court, when approached, must appoint a committee of at least three reputed doctors for expert medical opinion, issue notice to all concerned parties, and only then decide whether to permit passive euthanasia.
4. In Aruna Shanbaug’s specific case, the Supreme Court rejected the petition to withdraw her life support. It acknowledged the exceptional care provided by KEM Hospital staff and appointed them as her appropriate surrogates or “next friends,” rather than the petitioner, Pinki Virani. The Court also found that Aruna was not brain dead and was  medically stable, so terminating her life was not justified.
5. The Court clarified that these guidelines would apply until Parliament enacted a law specifically addressing euthanasia.