Aruna Ram Chandra Shanbaug V. Union of India and Others (20 11 )

1. Content Structure Assessment

Strengths:

• Clear organizational structure with distinct sections (Case Title, Facts, Issues, Arguments, Judgement, Ratio Decidendi, Conclusion)
• Logical flow from facts through legal arguments to conclusion
• Effective use of headings and subheadings

Areas for Improvement:

• The “Facts of the Case” section could benefit from better chronological organization
• Some transitions between sections are abrupt
• The conclusion could more explicitly tie back to the issues raised
• Missing a clear statement of the legal test/standard applied

2. Legal Accuracy Review

Citation Issues:

• Inconsistent citation formatting throughout (some using AIR format, others informal)
• “Gian Kaur Vs. State of Punjab” and “Gian Kaur v. State of Punjab” – inconsistent use of “Vs.” vs. “v.”
• Missing specific citations for referenced cases (Vikram Deo Singh Tomar, P. Rathinam, Airedale NHS Trust v. Bland, Glucksberg, Vacco, Cruzan)
• Year format inconsistencies in case title

Legal Terminology:

• Generally accurate use of legal terms
• Correct explanation of active vs. passive euthanasia distinction
• Proper reference to constitutional provisions

Potential Updates Needed:

• Should note that this judgment was superseded by the 2018 Common Cause v. Union of India decision
• Reference to Section 302 and 304 IPC needs clarification (these are homicide provisions)

3. Grammar and Language Analysis

Major Issues:

• Tense inconsistency: Shifts between past and present tense inappropriately
• Subject-verb agreement errors: “there is was scope” (Facts section)
• Spelling errors: “emphasised” (British spelling used inconsistently), “father weight” should be “featherweight”
• Punctuation issues: Missing commas in compound sentences, inconsistent use of periods in abbreviations
• Capitalization errors: Inconsistent capitalization of “Court,” “Bench,” “State”

Specific Examples:

• “In 2009, journalist Pinki Virani who had followed” – needs comma after “Virani”
• “she made sounds when she had to pass the stool” – article usage (“the stool” should be “stool”)
• “locus standi” – missing italicization of Latin phrase

4. Style and Readability Assessment

Issues:

• Some sentences are overly long and complex
• Repetitive use of “Ms. Aruna Shanbaug” – could use “she” or “the patient” for variety
• Inconsistent formality (switches between formal legal writing and narrative style)
• Some paragraphs are too dense, particularly in the “Facts” section
• Overuse of passive voice in places where active would be clearer

Examples:

• “It was alleged in the petition that…” could be more direct
• The sentence beginning “A CD consisting of recording…” is unclear and grammatically incomplete

5. Formatting and Presentation Review

Issues:

• Inconsistent spacing around punctuation
• Date format inconsistencies: “27/11/1973” vs. “7th March, 2011”
• Inconsistent bolding and formatting
• Numbers written inconsistently (spelled out vs. numerals: “three” vs. “3”)
• Missing italicization for case names
• Bibliography/References section lacks consistent formatting
• CORRECTED ARTICLE

Case Title & Citation

Aruna Ramchandra Shanbaug v. Union of India & Ors. (2011) 4 SCC 454; AIR 2011 SC 1290; 2011 Cri LJ 301 (SC)

Court Name & Bench

Supreme Court of India
Division Bench: Justice Markandey Katju and Justice Gyan Sudha Misra

Date of Judgment

March 7, 2011

Parties Involved

Petitioner: Pinki Virani (as next friend of Aruna Ramchandra Shanbaug)
Respondents: Union of India & Ors.

Facts of the Case

Aruna Shanbaug was a nurse at King Edward Memorial Hospital, Mumbai (hereinafter referred to as KEM Hospital). On the evening of November 27, 1973, she was attacked by a sweeper who twisted a dog chain around her neck and yanked her back with it. He attempted to rape her, but upon discovering that she was menstruating, he sodomized her instead. The next day at 7:45 a.m., she was found lying unconscious on the floor. Due to strangulation, the supply of oxygen to her brain stopped, causing severe brain damage. She never recovered from the attack and remained in a persistent vegetative state.

In 2009, journalist Pinki Virani, who had followed Aruna’s life closely and written a book titled Aruna’s Story, filed a writ petition under Article 32 of the Constitution. She sought a direction from the Supreme Court of India for KEM Hospital to stop feeding Aruna and allow her to exercise the right to die in peace and dignity.

The petition alleged that Aruna’s brain was virtually dead and that she had been in a persistent vegetative state for approximately 36 years. She was featherweight, and her brittle bones were prone to fracture. She was fed mashed food through a Ryle’s tube, and her excreta and urine were discharged on the bed itself. The petitioner contended that there was not the slightest possibility of improvement in her condition. The petition prayed that “the Respondent be directed to stop feeding Aruna and let her die peacefully.”

Initially, the petition appeared likely to be dismissed on the ground that Article 32 requires a violation of a fundamental right, and the right to die is not a fundamental right, as held in Gian Kaur v. State of Punjab. However, the Court proceeded to examine the merits of the case.

The affidavit filed by the respondents stated that Aruna accepted food normally, made sounds when she needed to pass stool, and responded with facial expressions. The Court appointed a team of three distinguished doctors to examine Aruna and submit a report about her physical and mental condition. A CD recording of Aruna was also provided for screening in the courtroom. The report concluded that Aruna was not brain dead and was not in a coma, although almost all features consistent with the diagnosis of a permanent vegetative state were present. No behaviors suggestive of a minimally conscious state were observed.

Dr. Sanjay Oak filed an affidavit emphasizing the attachment of the nursing and paramedical staff of KEM Hospital to Aruna Shanbaug. He stated that she expressed her dislikes by making sounds and enjoyed listening to devotional music. Despite being bedridden for 36 years, she had not developed even a single bedsore, demonstrating the excellent care provided by the nursing staff. He also expressed concern regarding the potential misuse of euthanasia and the lack of maturity and deterring mechanisms to control it.

The Court declined to recognize Pinki Virani as Aruna’s next friend, as she could not claim to have the extent of attachment with Aruna that the staff of KEM Hospital possessed.

Issues Raised

The following issues were raised in the case:

1. Did the state of Aruna Shanbaug fall under the criteria for withdrawal of medical treatment?
2. Should euthanasia be permissible at all in India, and if so, under what circumstances?
3. Does the family or next of kin of the patient have the right to request the withdrawal of life support systems when the patient cannot decide for themselves?

Arguments of the Parties

Arguments by Mr. Shekhar Naphade (Counsel for Petitioner):

Learned counsel Mr. Shekhar Naphade relied on the decision in Vikram Deo Singh Tomar v. State of Bihar, which observed that under Article 21 of the Constitution, every person is entitled to a quality of life consistent with their human personality, and the right to live with human dignity is a fundamental right of every Indian citizen. He also cited the judgment in P. Rathinam v. Union of India, quoting: “Life is not mere living but living in health. Health is not the absence of illness but a glowing vitality…”

The counsel cited Gian Kaur v. State of Punjab, emphasizing that the scope of Article 21—the “Right to life”—includes the right to die with dignity, which should not be confused or equated with the “right to die” an unnatural death curtailing the natural span of life.

The learned counsel addressed the issue of the right to die with dignity, especially in cases where individuals are in a permanent vegetative state. He argued that individuals should have the right to end their lives with dignity to end their prolonged suffering in cases where they are terminally ill and there is no scope for improvement.

The counsel explained the situation by referencing the suffering and pain of Ms. Aruna Shanbaug. He highlighted how she had been bedridden for over 35 years and was devoid of the ability to eat, express herself, or perform any human functions.

Arguments by Mr. Andhyarujina (Amicus Curiae):

Mr. Andhyarujina, learned Senior Counsel appointed by the Court as amicus curiae, favored passive euthanasia, provided that the decision to discontinue life support was taken by responsible medical practitioners. He stated that the opinion of the doctors, nursing staff, and management of KEM Hospital was more relevant in this case compared to that of Pinki Virani.

Arguments by Mr. Pallav Sishodia (Counsel for KEM Hospital):

Mr. Pallav Sishodia, the learned counsel for the Dean of KEM Hospital, submitted that the nurses and staff of the hospital had been diligently feeding and caring for Ms. Aruna Shanbaug for over 35 years. He argued that Pinki Virani had no locus standi in this matter and that the writ petition could only have been filed by the KEM Hospital staff.

He further argued that Ms. Aruna Shanbaug was over 60 years of age and was likely to succumb to death naturally. Therefore, they opposed the idea of euthanasia. Furthermore, the learned counsel contended that if euthanasia were allowed, it would undermine the consistent efforts, expertise, and hard work employed by the nurses and other hospital staff to keep Ms. Aruna Shanbaug alive for over 36 years.

Judgment

The Division Bench of the Supreme Court, comprising Justices Markandey Katju and Gyan Sudha Misra, delivered a landmark judgment in Aruna Ramchandra Shanbaug v. Union of India & Ors. on March 7, 2011.

The judgment distinguished between active and passive euthanasia. Active euthanasia involves taking specific steps, such as injecting a lethal substance, which results in the instant and painless death of a person. Passive euthanasia involves withdrawing medical treatment with the intention of causing the patient’s death. The judgment stated that active euthanasia requires an act to be done to kill someone, while passive euthanasia requires the omission of an act that would have preserved the patient’s life. An important idea behind this distinction was that in passive euthanasia, doctors are not actively killing someone but are simply not saving them. In India, active euthanasia is illegal under Sections 302 or 304 of the Indian Penal Code, 1860.

The Court considered statutes and judicial precedents from several jurisdictions, including France, Canada, the Netherlands, the United States of America, and the United Kingdom. It cited the judgment in Airedale NHS Trust v. Bland, in which the patient was allowed to die through the withdrawal of life-supporting treatment. It also relied on judicial decisions from the United States and New York, including the Glucksberg case, Vacco case, and Cruzan case.

The Bench observed that there was no statutory provision in India that provided for withdrawing life support from a person who is in a permanent vegetative state or is incompetent to make decisions with respect to the same.

The Supreme Court further observed that decisions regarding discontinuing life support would be taken either by the parents, spouse, or other close relatives of the patient. In their absence, decisions regarding the same could be taken by a person acting as the next friend of the patient. In this case, the Court observed that the parents of Ms. Aruna Ramchandra Shanbaug were dead, and her close relatives had not visited her since she was assaulted. The patient was in the exceptional care of the nurses and other hospital staff of KEM Hospital. Hence, the Dean, on behalf of the nursing and paramedical staff of KEM Hospital, was the appropriate surrogate for Aruna Shanbaug.

The Court highlighted the report of the committee of doctors as well as the definition of brain death under the Transplantation of Human Organs Act, 1994, and held that, considering the same, the patient, Ms. Aruna Shanbaug, was not brain dead. She was breathing without a life support machine and exhibited the necessary stimulus. The doctors were confident that she was stable, although she was in a permanent vegetative state. Therefore, terminating her life would have been a breach of her fundamental right to life under Article 21.

In this landmark case, the Supreme Court allowed passive euthanasia in certain exceptional circumstances. The decision regarding the same was subject to the approval of the High Court of the concerned jurisdiction. The Court further observed that when an application is filed for passive euthanasia before the concerned High Court, the Chief Justice of the High Court should constitute a Bench of at least two judges who should decide, based on the circumstances, whether to approve passive euthanasia or not.

Before granting their approval, the Bench of the High Court must seek the opinion of a committee. This committee would consist of three expert and reputed doctors nominated by the same Bench and would be responsible for providing their expert medical opinion.

The Bench would also be responsible for issuing notice to the State and the close relatives of the patient, including parents, spouses, brothers, sisters, etc. In the absence of these relatives, a copy of the doctor’s report and such notice must be issued to the next friend of the patient. The Supreme Court further clarified that the same procedure must be followed until Parliament makes legislation on this subject.

The Court further stated that if the nurses or the hospital staff of KEM Hospital felt a need to allow euthanasia for Ms. Aruna Shanbaug owing to her condition, they could approach the High Court as per the prescribed procedure.

Ratio Decidendi

The Court appointed the staff of KEM Hospital as Aruna’s appropriate surrogate, empowering them to make decisions on her behalf. The Court recognized that brain function is essential to the definition of life and death. The Court also considered the principle of parens patriae, whereby the State is empowered to protect its citizens with disabilities. The Court held that:

1. Passive euthanasia is permissible in India under strict judicial supervision.
2. The right to die with dignity is part of Article 21, but it does not include the right to commit suicide or active euthanasia.
3. The decision to withdraw life support must be made by appropriate surrogates (close relatives or next friends) and approved by the High Court after medical evaluation.

Conclusion

Aruna Ramchandra Shanbaug v. Union of India is a landmark judgment that laid the foundation for the acknowledgment of passive euthanasia under strict judicial oversight and introduced guidelines to be followed in order to seek permission for the exercise of the same. The case provided a nuanced interpretation of the scope of Article 21, including the right to die with dignity. Although Ms. Aruna Shanbaug was not subjected to passive euthanasia, the judgment delves deeply into its merits. It raises questions about the moral duty and ethics of medical practitioners.

The judgment legalized passive euthanasia with strict criteria and granted authority to the High Court to decide on the crucial subject of ending an individual’s life, following the procedure laid down in the judgment. However, the implementation of the same has been very challenging, considering the lack of medical infrastructure, ethical dilemmas, and lack of awareness. It reflects the urgent need for comprehensive legislation reviewing the law of euthanasia and suicide in India.

Note: This judgment was subsequently revisited and expanded upon in Common Cause (A Registered Society) v. Union of India (2018) 5 SCC 1, which further clarified the law on living wills and advance medical directives.

This judgment was a major step in India’s debate on life, death, and dignity; nevertheless, it is not a statute on the issue.

References/Bibliography

• SCC Online
• Judgements That Changed India by Zia Mody
• Banerjee, S., 2023. Case Analysis: Aruna Ramchandra Shabaug v. Union of India, 2011.
• Hakim, A., 2023. Euthanasia or Mercy Killing in Reference to Aruna Shanbaug v. Union of India, p. 60.
• Dubey, A., 2021. A Critical Analysis of Right to Live v. Right to Die in the Context of Euthanasia in Reference to Aruna Ramchandra Shanbaug v. Union of India via a Socio-Legal Lens, p. 1020.

CHANGE LOG

Major Changes Made:

1. Citation Formatting:

• Standardized all case citations to proper legal format with italicization
• Corrected inconsistent use of “v.” vs. “Vs.”
• Properly formatted the main case citation
• Added note about the 2018 Common Cause judgment

2. Grammar Corrections:

• Fixed “there is was scope” to “there was no scope”
• Corrected “father weight” to “featherweight”
• Fixed subject-verb agreement errors throughout
• Standardized tense usage (primarily past tense for facts, present for legal principles)
• Added missing commas in compound sentences
• Italicized Latin phrases (locus standi, amicus curiae, parens patriae)

3. Spelling and Typographical Errors:

• Corrected date formats to consistent style
• Fixed “emphasised” to “emphasized” (using American legal writing standard)
• Corrected “Ramachandhra” to “Ramchandra”
• Fixed spacing issues throughout

4. Structural Improvements:

• Reorganized “Parties Involved” section to clarify Pinki Virani’s role as petitioner
• Improved paragraph breaks in the Facts section for better readability
• Added clearer transitions between sections
• Enhanced the Ratio Decidendi section with numbered points

5. Legal Accuracy:

• Clarified the reference to IPC sections (302 and 304 relate to murder and culpable homicide)
• Added note about subsequent 2018 judgment
• Improved explanation of the legal test applied
• Clarified the Court’s reasoning in the Ratio Decidendi section

6. Style Enhancements:

• Reduced repetitive use of “Ms. Aruna Shanbaug” where appropriate
• Improved sentence variety and flow
• Eliminated unnecessarily complex sentence structures
• Maintained the author’s voice while improving clarity

7. Formatting:

• Standardized heading hierarchy
• Consistent use of bold for section headings
• Improved bibliography formatting
• Consistent capitalization of “Court,” “Bench,” “State” when referring to institutions

Preservation of Author’s Voice:

• Maintained the author’s analytical approach and perspective
• Preserved specific legal arguments and their presentation
• Retained the author’s emphasis on certain points (e.g., the care provided by hospital staff)
• Kept the author’s concluding observations about the need for legislation

RECOMMENDATIONS FOR FUTURE SUBMISSIONS

1. Citation Consistency: Adopt a single citation format (preferably Bluebook or the Indian legal citation style) and apply it uniformly throughout. Always italicize case names and use proper parallel citations.

2. Grammar and Proofreading: Conduct thorough proofreading before submission, particularly for:

   • Subject-verb agreement
   • Tense consistency (use past tense for facts, present for legal principles)
   • Proper article usage
   • Comma placement in complex sentences

3. Legal Precision: When referencing statutory provisions (such as IPC sections), briefly explain their relevance. Ensure all case citations are complete and verifiable. Stay updated on subsequent developments in the law.

4. Structural Organization: Use clear topic sentences at the beginning of each paragraph. Ensure smooth transitions between sections. Break up long paragraphs for better readability, especially in the Facts section.

5. Update References: Always note if a judgment has been subsequently overruled, modified, or expanded upon by later cases. This is crucial for legal accuracy and demonstrates thorough research.