Aruna  Ramchandra Shanbaug  v.  Union Of India, AIR 2011 SC 1290: (2011) 4 SCC 454: 2011 (3) SCALE 298

 Court : Supreme Court of India

Bench :  Justice Markandey Katju, Justice Gyan Sudha Mishra

Date Of Judgment :  March 7th, 2011

Relevant Provisions / Statutes :

Article 21 of the constitution of India, 1950

Article 32 of the constitution of  India, 1950

Section 309 of the Indian Penal Code,1860

Brief Facts :

Aruna Ramchandra Shanbug was a staff nurse employed in King Edward Memorial Hospital, located in mumbai. One of the sweepers of the hospital attacked her on 27th November 1973. He choked and strangulated her via a dog chain in order to restrain any movement from her end in an attempt to rape her. Upon realizing that Ms. Aruna was menstruating he sodomized her. To immobilize her during this act he twisted the chain around her neck. The next day, 28th November 1973 a cleaner found her body lying on the floor unconscious with blood all over. It was believed that the supply of oxygen to the brain stopped because of strangulation by the chain and hence the brain got damaged. This incident caused permanent damage to her brain and led her into a permanent vegetative state (PVS). Later an activist-jouralist Pinki Virani filed a petition in the Supreme Court under Article 32 of the constitution alleging that there is no possibility for her to revive again and get batter. So, she should be allowed to go with passive euthanasia and should be absolved from her pain and agony

To this petition, the respondent parties i.e, KEM  Hospital and Bombay Municipal Corporation filed a counter-petition. This led to a rise in the disparities bewteen both groups. Since there were disparities, the supreme court in order to get a batter picture of the situation appointed a team of 3 eminent doctors to investigate and provide a report of the exact mental and physical condition of Aruna Shanbaug. During this study, doctors investigated her entire medical history and opined that her brain is not dead. She has her own way of understanding and reacting to situations.  Also, Aruna’s body language did not show any sign of her willingness to terminate her life. Neither the nursing staff of the hospital showed any carelessness towards taking care of her.  Thus, it was believed by the doctor that the euthanasia in the current matter is not essential. She stayed in this position for 42 years and died in 2015.

It was prayed to direct the Respondents to stop feeding Aruan and let her die in peace.

Issues :

1. Does the withdraw of life sustaining system and means for a person who is in a permanent vegetation state (PVS), should be permissible?
2. If a patient declares previously that he/she does not want to have a life sustaining measures in case of futile case or a permanent vegetation state (PVS), should his/her wishes be respected in such a situation?
3. Does the family or the next of kin (blood relative) of a person get to make a request to withhold or withdraw life sustaining system, in case a person himself has not place such a request previously?

Arguments :

Petitioner’s Argument:

 A petition was filed by Ms. Shanbaug’s friend under Article 32 of constitution. The counsel for the petitioner contended that the right to life guaranteed under Article 21 includes the right to life with utmost dignity. It must therefore also include the right to die with dignity. Any individual suffering from any terminal illness or is in a permanent vegetative state must be included under the ambit of the “right to die ” in order to end the prolonged suffering and agony. She lacks any awareness of her surroundings, is even devoid of the ability to chew her food, can’t express anything on her own, and is just bedridden for the past 36 years with no scope of improvement.

The patient is virtually dead and the respondents by not feeling Ms. shanbaug won’t be killing her.

 Respondent’s Argument :

1. The dean of the Hospital contended that Ms. Shanbaug was being fed and taken care of by the nurse and hospital staff for as many as 36 years. The staff had exceptionally and with utmost responsibility and willingness to take care of her. Therefore, they oppose and resent the idea of Ms. Shanbaug being euthanized. Now that the patient has crossed as many as 60 years of age she might naturally succumb to death.
2. They begged the court to not permit the act of killing. The staff has been diligently and with respect taking care of all her fundamental necessities and prerequisites. On the off chance that this is legitimized, the act of euthanasia can be profoundly inclined to abuse. One of the medical attendants has even been willing to take care of her without being renumerated. The petitioner unlike the clinic staff neglects to have such a close – to – home association with the patients and lacks the necessary emotional attachment.
3. Since the staff diligently and with utmost dignity took care of Mrs. Shanbaug for many years. They looked after her basic needs and requirements. Legalization of passive euthanasia can be prone to misuse by family members, relatives, etc. they pleaded with the court to reject the allowance of practice of euthanasia. The hospital staff has an emotional connection with the patient to the extent that one of the nurses is ready to look after Mrs. Shanbaug for the rest of her life without being renumerated.
4. Terminating Ms. Shanbaug’s friend under article 32 of the Indian Constitution. The counsel for the petitioner contended that the right to life guaranteed under article 21 includes the right to life with utmost dignity. It must therefore also include the right to die with dignity. any individual suffering from any terminal illness or is in a permanent vegetative state must be included under the ambit of the “right to die” in order to end the prolonged suffering and agony. She lacks any awareness of her surroundings, is even devoid of the ability to chew her food, can’t express anything on her own, and is just bedridden for the past 36 years with no scope of improvement. The patient is virtually dead and the respondents by not feeding Ms. Shanbaug won’t be killing her.

 Judgement :

1. 1. Euthanasia as we all know also known as mercykilling, is an act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life – support measures.
2. It can be of two types Active or Passive. Active Euthanasia is the use of some hazardous substance or lethal methods to kill a person. Passive Euthanasia is stopping some medical treatment in the absence of which a person is likely to die. The passive euthanasia can be both voluntary and involuntary. When the consent from a patient is taken it becomes voluntary and in case when a patient is not in a condition to provide other person, then it is involuntary.
3. In Aruna Shanbanu’s case, Supreme Court laid down guidelines for passive euthanasia. These guidelines provided for withdrawal of life support system which can ultimately lead to a person’s death. This verdict made passive euthanasia possible in India in certain conditions which will be decided by the High Court.

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 obligation of the state to protect disabled and vulnerable individuals and uphold their rights in the contemporary era.

Final Decision :

The Hon’ble Division Bench of the Supreme Court of India, comprising Justice Markandey Katju and Justice Gyan Sudha Mishra, delivered this judgement on 7th of march, 2011. The court declared that Aruna is not brain deed and for its judgement relied on the doctor’s report and definition of brain death given under the Transportation of Human Organs Act, 1994. She was able to breathe on her own without a machine’s support, she had feelings and used to show some symptoms. Though she was in a (PVS) but still her condition was stable. So, the grounds presented here are not sufficient for terminating her life. It would be unjustifiable. Further, the court while addressing the issue opined that in the present case next to the kin of the patient would be the staff of the KEM Hospital not Pinki Virani. Thus, the right to take any such decision on behalf of her is vested in KEM Hospital. In  the present case it was the food on which she was surviving. Thus, removal of life saving techniques would here mean depriving her of food which is not justified in Indian Law in any way.

The Supreme Court allowed passive euthanasia in certain conditions. But the court decided that in order to prevent misuse of this provision in the future, the power to determine the termination of a person’s life would be subjected to High Court’s approval following due procedure

Whenever any application will be filed in High Court under Article 226 of the constitution which  for passive euthanasia, the Chief  Justice of the High Court should constitute a Bench of at least two judges declining the matter that where such termination should be granted or not. The Bench before laying out any judgment should consider the opinion of a committee of 3 reputed doctors. These doctors are also nominated by the Bench after discussing with the appropriate medical practitioners. Along with appointing this committee, it is also the duty of the court to issue a notice to the state, relatives, kin, and friends and provide them with a copy of the report made by a committee of doctors, as soon as it is possible. And after hearing all the sides, the court should deliver the judgment. This procedure is to be followed in India everywhere until any legislation is passed on the subject.

In the Ultimate decision of this case, by keeping all the important facts of the case in consideration, Aruna  Shaunbaug was denied euthanasia. Court also opined that if at any time in the future, the hospital staff feels a need for the same, they can approach the High Court under there prescribed rules. The verdict of this case has helped in clarifying the issues relating to passive euthanasia in India by providing a broad structure of guidelines which are to be followed. The court also recommended the repealing of section 309 of the IPC. We have discussed all about the case. The High Court should give its decision speedily at the earliest, since delay in the matter may result in causing great mental agony to the relative and the persons close to the patient.