Author: Arindam Chakravarty,Symbiosis Law School, Hyderabad
To The Point
In 1973, Aruna Shanbaug, a nurse at King Edward Memorial Hospital in Mumbai, suffered significant brain damage after being viciously attacked and strangled with a dog chain. She spent more than thirty years in a persistent vegetative state as a result of the assault. Author and journalist Pinki Virani petitioned the Supreme Court in 2009 under Article 32 of the Constitution to allow Aruna to be passively euthanized, claiming that her continued life in such a state was against her dignity and a violation of her Article 21 fundamental rights.
The case brought up important legal, moral, and constitutional issues: Is the right to a dignified death a part of the right to life? Did Indian law allow for passive euthanasia? Without particular regulation, how should such decisions be governed?
Abstract
Particularly with regard to the idea of passive euthanasia and the right to die with dignity, the seminal decision of Aruna Ramachandra Shanbaug v. Union of India was a turning point in Indian jurisprudence. The Supreme Court considered whether it would be legal to remove a person in a permanent vegetative state (PVS) from life support and whether doing so would violate the right to life and personal liberty, a constitutional right granted to the masses under Article 21. The Court’s ruling filled a major legislative gap by establishing principles that authorise passive euthanasia under strict judicial safeguards, even if it denied euthanasia in Aruna’s particular case. In India, discussions on patient autonomy, medical ethics, and constitutional rights have been influenced by this case.
Use of legal jargon
1)Does the right to a dignified death fall under Article 21’s right to life?
2)Is it lawful in India to do passive euthanasia?
3)Without parliamentary legislation, can the courts create guidelines?
4)When a patient is incapable of moving for euthanasia, who can do so?
These issues had broad ramifications, impacting the judiciary, healthcare providers, caretakers, and the right to personal autonomy of those with fatal or irreparable illnesses.
Judges Markandey Katju and Gyan Sudha Misra of the Supreme Court Bench distinguished between aggressive and passive euthanasia. Because it would be considered culpable murder under Sections 299 and 300 IPC, active euthanasia—which entails a direct act (such as giving a lethal injection)—was declared unlawful. Conversely, passive euthanasia is stopping medical interventions that are required to maintain life, such as life-supporting equipment.
The Court ruled that, in accordance with Article 226 and with stringent legal protections, passive euthanasia could be allowed with prior consent from the appropriate High Court. A medical board of reputable physicians’ opinion, judicial review, and the opinions of the patient’s family or nearest friend must all be taken into consideration before such approval may be granted.Because Aruna was not brain dead and still exhibited some involuntary reflexes, the court denied her request for euthanasia. Her caregivers, who work at KEM Hospital, also opposed the petition and said they would be happy to keep taking care of her.
The Proof
To evaluate Aruna’s condition, the Court assembled a group of three eminent physicians from the best medical schools in Mumbai. According to their findings, Aruna was not brain dead even though she was in a PVS. She possessed some reflexes, facial reactions to stimuli, and the ability to breathe on her own. Crucially, although being completely reliant on nursing care, she did not require life support in the strictest sense of the word (such as feeding tubes or ventilators). Additionally, the doctors noted that she was stable and didn’t seem to be in any pain. The Court determined that her case did not warrant passive euthanasia based on this report and the loving care provided by the medical staff. The court established guidelines for passive ethunasia.
Guidelines for Passive Euthanasia in the Style of Vishaka
The Court set procedural criteria for passive euthanasia, taking inspiration from its previous approach in Vishaka v. State of Rajasthan,. These comprised:
The decision to withdraw life support must come from the parents, spouse, or next friend of the patient.
Such a decision must be approved by the High Court.
The High Court must constitute a bench to hear the application.
The High Court must seek the opinion of a medical board.
Notice must be given to the State and other relevant parties.
These guidelines were to remain in force until the legislature enacted a comprehensive law on the matter.
Reflections on the Constitution and Ethics
The Court affirmed that the right to life encompasses the right to a dignified existence, which may thereafter encompass the right to a dignified death. To differentiate this decision from Gian Kaur v. State of Punjab (1996), where the Supreme Court ruled that the right to life does not include the right to die, it made clear that this did not equate to a general right to die or to commit suicide. The ruling put the onus of action on the legislature and stressed judicial restraint. Additionally, it demonstrated the court’s awareness of the moral implications of life and death, acknowledging that in PVS situations, extending life may be financially costly for families, emotionally distressing, and medically pointless.
Importance and Legal Heritage
In India, passive euthanasia was first formally recognized by the courts in the Aruna Shanbaug case. The Court’s instructions became the de facto legal foundation on euthanasia, even if her individual request was rejected. Additionally, this case paved the way for future jurisprudential advancements.
In Common Cause v. Union of India (2018), a Supreme Court Constitution Bench expanded on Aruna Shanbaug to acknowledge the legitimacy of living wills and advance medical directives in addition to reaffirming the legality of passive euthanasia. It gave people the freedom to state beforehand that they do not want to be placed on life support in the event of a terminal illness or incurable coma. This broadened Article 21’s definition of autonomy and physical integrity.
Case Law
1. Union of India v. Common Cause (2018) 5 SCC 1
Building on Aruna Shanbaug, a five-judge Constitution Bench acknowledged the legitimacy of advance directives and living wills and legalized passive euthanasia. According to the Court, people with PVS or terminal illnesses have the right to decline life-prolonging treatment because Article 21 guarantees the right to die with dignity. It established a thorough process for carrying out living wills that included judicial supervision and medical boards.
2. Union of India v. Naresh Marotrao Sakhre (1994)
Justice Lodha explained in this Bombay High Court case that as euthanasia is different from suicide, instances involving voluntary euthanasia would not be covered under Section 309 IPC (attempt to suicide). Despite the fact that euthanasia was still prohibited at the time, this case established the conceptual framework for understanding medical end-of-life decisions and helped distinguish between terminologies.
3. Missouri Department of Health v. Cruzan, 497 U.S. 261 (1990)
A significant turning point in the recognition of patient autonomy and dignity under due process was reached when the U.S. Supreme Court acknowledged that a competent individual has the constitutional right to decline life-saving treatment. This ruling influenced similar thinking in India.
4. Tony Bland v. Airedale NHS Trust [1993] One Every ER 821 (UK)
This UK House of Lords ruling allowed a PVS patient to stop receiving life-sustaining care. It demonstrated how courts might permit passive euthanasia while maintaining patient dignity, which had a significant jurisprudential impact on Indian courts, particularly in Aruna Shanbaug.
Conclusion
An important development in Indian constitutional and medical jurisprudence is the Aruna Shanbaug ruling. It raised awareness of the suffering of people with terminal illnesses and gave passive euthanasia its first official legal approval. Although legal action did not end her life, the case sparked a much-needed ethical and legal discussion about end-of-life care.
The Court struck a balance between medical ethics, state interest, and individual dignity through its comparative study, reasoned approach, and interim guidance. The decision’s enduring influence stems from both its procedural innovations and its dedication to making sure that the law changes in accordance with human compassion and constitutional morality.
FAQS
Q1. What is passive euthanasia? Passive euthanasia is the withdrawal of medical treatment or life support with the intention of allowing a terminally ill or PVS patient to die naturally. It contrasts with active euthanasia, which involves a direct act to end life.
Q2. Did the Supreme Court allow euthanasia in Aruna Shanbaug’s case? No, the Court rejected the plea for euthanasia in her specific case but laid down guidelines for permitting passive euthanasia in other cases.
Q3. What are the safeguards laid down in the Aruna Shanbaug judgment? The Supreme Court mandated High Court approval, formation of a medical board, and involvement of the patient’s next friend or family before allowing passive euthanasia.
Q4. Is passive euthanasia now legal in India? Yes, following the Common Cause judgment (2018), passive euthanasia is legal, and individuals can also issue living wills expressing their wish to refuse life support in terminal conditions.
Q5. What is a living will? A living will is an advance directive by a person specifying that they should not be put on life support if they become terminally ill or enter a permanent vegetative state.
