CASE COMMENTARY: Aruna Shanbaug Vs. Union Of India

CASE COMMENTARY: Aruna Shanbaug Vs. Union Of India

By- Ayush Shukla 

Case Commentary: Aruna Shanbaug vs. Union of India

Dated: 7th March 2011

Court: Supreme Court of India

Bench: Justice Markandey Katju and Justice Gyan Sudha Mishra

Introduction

While the Constitution of India provides its citizens with the ‘Right to Life’, the debate on whether this encompasses a ‘Right to Die’ is an issue that is very contentious. As medical science advances further and greater stress on patients’ autonomy are demonstrated, debates regarding euthanasia have been sparked off. The case before the Supreme Court of India is one of legitimacy of passive euthanasia concerning one Aruna Ramchandra Shanbaug, who had lain in a PVS for some decades. One Ms. Pinky Virani had filed a petition stating that the aforesaid Shanbaug should be allowed to die with dignity by using passive euthanasia as she was not recoverable.

Brief Facts of the Case

One such example is that of Aruna Ramchandra Shanbaug, a nurse in King Edward Memorial Hospital, Mumbai, who was brutally attacked in November 1973. In the attack, he strangled her with a dog chain that caused severe brain damage to Shanbaug and rendered her into a permanent vegetative state. Considering the critical stage, she continued to survive due to the sustained care by the authorities of the said hospital itself. Applicant Ms. Pinki Virani, as next friend to Shanbaug, filed a writ petition before the Supreme Court to allow the withdrawal of life support on various grounds, among others that continued existence in PVS would be undue suffering to Shanbaug.

In response, the hospital and municipal authorities objected to it and the Supreme Court made a team of three well-known doctors to assess Shanbaug’s condition. The report submitted by the doctors gave their view that Shanbaug’s brain was not dead and she was having some responses as well as awareness about what was happening around her. They decided at this stage euthanasia was not necessary.

Identified Issues

• Withdrawal of Life-Sustaining Treatment: Should life-sustaining treatment in a PVS be allowed or not?
• Respect for the Patient’s Wishes: The patient, while he was of good health, expressed a wish to not be artificially kept alive in case he ever gets reduced to a PVS state. Should such a wish be acceded to or not?

Requesting Withdrawal: In case there has been no such request from the patient in the past, can the family or next of kin request withdrawal of life support?

Analysis of the Case

The case of Aruna Shanbaug versus Union of India highlights a major constitutional dilemma on the relationship between the right to live and the right to die. This has been one of the most legally debated topics in India, as earlier cases have clearly illustrated.

In Maruty Shripati Dubal v. State of Maharashtra (1987), the Bombay High Court had held that Section 309 IPC, making attempt to suicide a criminal offence, was unconstitutional as it infringed Arts. 21 and 19 of the Constitution. The court had taken such a view because right to life enshrined under Art. 21 would include right to live or to end it if one so desires. The right to die was not per se unnatural and should form a part of the larger right to life.

On the other hand, in P. Rathinam v. Union of India, the court held that under Article 21, the right to die is also included, both positive and negative aspects. The Supreme Court held that just as the freedom of speech enables a person to say, the right to life gives a person the right not to live. This view made Section 309 attempting to commit suicide an offense unconstitutional, so as to establish that right to die was an integral part of right to life.

However, the decision in Gian Kaur v. State of Punjab reflected a departure in judicial reasoning. As a judgment, it overturned the constitutionality of Sections 306 and 309 of the IPC, respectively, dealing with abetment of suicide and attempts to commit suicide. This judgment set aside the earlier decision in Rathinam, distinguishing between the right to die, which is unnatural, and the right to die with dignity. The court explained that the right to die with dignity for the terminally ill or those in a permanent vegetative state, though entertained, did not include suicide. Indeed, the more narrow issue of dying with dignity in a state of prolonged suffering was addressed instead of one dealing with a general right to die.

While Gian Kaur instituted the sanctity of life, that in Maruty Shripati Dubal and Rathinam had been scaled down. The approach recognizes exceptions like the death penalty but asserts the inviolability of life in most areas, especially in the issue of vegetative-state individuals. Therefore, case law underpins the fact that whereas in a given context the right to die would come into play, such a right does not extend uniformly in all situations, particularly in regard to assisted suicide or euthanasia.

The Concept of Euthanasia

Euthanasia is the intentional killing of a human being to end the suffering of a person. It may be characterized as:

• Active Euthanasia: Death caused directly through intervention.
• Passive Euthanasia: Death caused by withholding or withdrawing life-sustaining measures, letting the patient die naturally.
• Voluntary Euthanasia: At the request of the patient.
• Non-voluntary Euthanasia: Without the patient’s will and consent, wherein the patient usually cannot state their wishes.

In PVS cases, passive euthanasia-withholding life-sustaining treatment-and lethal medication administration differ. The court must ensure that any decision made is in the best interest of the patient-legally and ethically speaking.

Observation of Supreme Court

The right to die issue was dealt with earlier by the Supreme Court of India. In State of Maharashtra v. Maruty Shripati Dubal, the Bombay High Court had struck down Section 309 of the Indian Penal Code as unconstitutional, finding a right to die within the meaning of Article 21. On the other hand, Gian Kaur v. State of Punjab explained that the right to die did not imply the right to curtail life sooner than along its path but to accelerate the inevitable process of the very dying itself.

The Court in Aruna Shanbaug cited Airedale NHS Trust v. Bland which maintained the removal of life support if seen fit. In the case of Shanbaug, however the Court ruled that she was not in a position where euthanasia would be carried out. She was breathing on her own and showed no signs of giving up her life. 

Law Commission Report on Euthanasia

Through its 196th Report dated 2006, the Law Commission of India recommended legislative reforms relating to euthanasia and the care of the terminally-ill. It suggested the passage of a law which would grant immunity from prosecution under Section 309 of the Indian Penal Code that criminalises attempt to suicide in case a person suffering from terminal illness refuses medical treatment, artificial nutrition or hydration. It also recommended that doctors who are acting in accordance with a patient’s wishes or acting in the best interests of patients rendered incapable of taking a decision should be protected from liability under Section 306 of the IPC (abetment of suicide) and Section 299 of the IPC (culpable homicide). The initiated law was to be exclaimed the Medical Treatment of Terminally Ill Patients (Protection of Patients, Medical Practitioners) Act.

The Report laid down the following specific conditions for the proposed legislation:

• Terminal Illness: The patient should have been diagnosed as having a terminal disease.
• Vegetative State: The patient should be in a chronic and irreversible vegetative state.
• Consultation and Decision-Making: The family of the patient should be consulted, though the final clinical decision must be taken by the doctor, who is best competent to form a medical judgment based on expertise.

Also, considering the need above for notification, the physician should give written notice of the decision to withhold or withdraw medical treatment to the patient-if conscious-and to the members of the patient’s family or relatives, particularly if the patient is unable to provide an informed consent by his or her own. The bill would further clarify the end-of-life decision-making process and protect physicians from liability when acting in their patients’ best interests.

Judgement of the Case

On 7 March 2011, the Supreme Court of India passed an order that Aruna Shanbaug’s life should not be ended. The Court held that Shanbaug was not in a stage where she was entitled to euthanasia as of date. The decision to remove the life-sustaining systems of Aruna Shanbaug had to be given by the hospital management and not by Pinki Virani.

It also laid down a procedure to be followed in cases of euthanasia in the future. It held that in any case of passive euthanasia, the High Court must have scrutiny and confirmation of the request. For considering such applications, the Chief Justice of the High Court should constitute a Bench of at least two judges, and a panel of three doctors and issuance of notices to the State and close relatives is proposed as a safeguarding process which ensures due diligence and minimum misuse.

Furthermore, besides these important pronouncements on euthanasia, the Court suggested that Section 309 of the Indian Penal Code be abrogated as well-a pronouncement on the wider ramifications of the laws on euthanasia. The instant case is an important milestone in pointing out the legal position regarding euthanasia in India and issuing guidelines on its consideration until such time as legislation is carried out.

Conclusion

The case of Aruna Shanbaug is a landmark reference in the Indian jurisprudence on mercy killing. It tries to bring a fine balance between respecting patient autonomy and safeguarding against its abuses. The judgment pronounced by the Supreme Court went into the procedural aspects of euthanasia and the, thus mentioned, balancing of legal, ethical, and medical considerations in a sensitive issue like this. Such a decision by the Supreme Court to allow passive euthanasia, in certain cases, when a person is in a permanent vegetative state or in a final stage of incurable terminal illness expressed appreciation of the right to die with dignity. This judgment laid down stringent guidelines to make sure that the process for granting euthanasia is carefully evaluated and monitored to avoid misuse of the process.

The case of Aruna Shaunbaug brought to the limelight that India needed comprehensive legislation on euthanasia and end-of-life care. Further discussions were carried out at the legislative level in an attempt to allow merciful choice for those suffering with irreparable suffering. Besides bringing about legal changes, this case sensitized society in a big way and increased awareness among most for those in similar situations to that faced by Aruna Shanbaug. It has thrown up complicated questions with regard to decisions at the end of a person’s life and respect for a person’s autonomy and dignity from individuals, medical professionals, and policymakers.

Even though the case provided a rightful framework in which to deal with passive euthanasia in the country, the debate on euthanasia and end-of-life care has moved on. It is necessary that, considering the evolving medical technology and changing social views expressed through demands, the legal and ethical mechanisms will evolve sensitive to the needs and values of those they are supposed to serve.

Eventually, the case of Aruna Shanbaug brings us to a point where we are forced to realize that at the end of life, care should be humane and controlled enough. She beckons us to continue pondering different ways out of the dilemma, weighing the sanctity of life against a person’s right to die with dignity, working on the creation of a society concerned with the protection of the autonomy and well-being of all its citizens up to the last moment of their lives.

FAQs on Aruna Shanbaug v. Union of India

1. What was the main issue that existed in the case of Aruna Shanbaug?

The main issue existed regarding the performance of passive euthanasia on Aruna Shanbaug since she was in a permanent vegetative state.

2. What did the Supreme Court conclude concerning the case of Aruna Shanbaug?

The Supreme Court rejected the performance of euthanasia on Shanbaug and laid down a procedure for future cases involving passive euthanasia.

3. What was the suggestion of the Law Commission of India with regard to euthanasia?

The Law Commission indicated that patients who refused treatment should be given legal immunity, and doctors, too, must be protected if acting in the best interest of the patients by the help of a new proposed law.

4. What kinds of euthanasia are differentiated by the case commentary?

Euthanasia may be active-by directly intervening-passive-by withholding life support systems, medications, etc.-voluntary-at the patient’s request-or non-voluntary-without consent.

5. To what extent does this judgment of the Supreme Court affect the process for euthanasia in India?

The Court held that the procedure for euthanasia should be that the High Court would have to review such a plea, and it should include a medical board, after informing the State and family and others, so as to ensure fairness in the process.

6. What was the general legal effect of the Supreme Court judgment in the Shanbaug case?

In the case of euthanasia, the judgment has underlined the need to introduce a systemic process. Again, it has advocated the removal of Section 309 of the IPC, which criminalises attempts to suicide.