Aruna Ramchandra Shanbaug vs Union Of India

Facts

A writ petition was filed by the friend of the petitioner Aruna Ramachandra Shanbaug, who was a nurse at the King Edward Memorial Hospital, Parel, Mumbai. On the petition, it was stated that in the year 1973, on November 27^th, she got attacked by the sweeper who was working in the same hospital. He used a dog chain to strangle her, trying to stop her from moving so he could rape her. On finding that she was menstruating he sodomized her. He tied the chain around her neck. On the next day morning, she was found lying unconscious by the cleaner. it was stated that due to the chain being tied around the neck, the supply of oxygen got stopped to the brain which resulted in damage to some parts of the brain. In the petition it was stated that the incident happened 37 years now the petitioner is 60 years and she is in a condition where she is classified as a featherweight, and her fragile bones are at risk of fracturing if her hand or leg becomes awkwardly trapped, even inadvertently, beneath her lighter frame. She has ceased menstruating, and her skin resembles papier-mâché stretched over a skeletal structure. She is susceptible to developing bedsores. Her wrists are contorted inward. The decay of her teeth has resulted in significant pain. She can only consume mashed food, which is the sole sustenance that allows her to survive. It was also mentioned in the petition that Aruna Ramchandra Shanbaug is in a vegetative state where her brain was virtually dead, she was not in a state to respond. Her bodily waste, including excrement and urine, is expelled directly onto the bed. Occasionally, she is cleaned, but it is only a matter of time before she returns to this deplorable state. By any standard, Aruna cannot be considered a living individual; the only semblance of life she exhibits is due to the mashed food that is fed to her, which lacks any genuine human quality. It is claimed that there is no hope for improvement in her condition, and her body remains in the bed at KEM Hospital in Mumbai, resembling that of a lifeless animal. This situation has persisted for the past 36 years. The prayers from the petitioner’s side are to stop her feeding and let her die peacefully. To All respondents notices were issued by the court on 16.12.2009. and a counter was filled by the respondents stating that there is response from Aruna when she is being fed food and there is a response for her when she has to excrement and urinate by making sounds. After her admission into the hospital she was under great care by the hospital management. According to hospital management, it was stated that She exhibits limited self-awareness and awareness of her environment. However, she does acknowledge the presence of others nearby and conveys her preferences through specific vocalizations and distinctive hand gestures. Her demeanor suggests happiness, particularly when she is presented with her preferred food items, such as fish and chicken soup. While she readily accepts food that she enjoys, she may reject and expel items that do not meet her taste.

Issues

• Whether Article 21of the Indian Constitution include the Right to dieembedded within the Right to Life?
• What distinguishes passive euthanasia from active euthanasia?
• Can a person who is unable to give consent be subjected to non-voluntary passive euthanasia?

Petitioner arguments

A petition was submitted by journalist and activist Ms. Pinki Virani, who identified herself as a close friend of the victim, under Article 32 of the Indian Constitution. The petitioner argued that the Right to Life enshrined in Article 21 encompasses the Right to live with dignity, which inherently includes the Right to die with dignity.

It was asserted that individuals suffering from terminal illnesses or those in a permanent vegetative state should possess the right to die with dignity, and this right should be recognized within the framework of Article 21 to alleviate the prolonged suffering and distress of such patients. The petitioner further argued that the victim, Aruna, is devoid of consciousness and awareness of her surroundings, unable to chew her food, and incapable of expressing her emotions. Having been bedridden for 36 years with no prospect of improvement, it was contended that the hospital staff, by refraining from feeding her, would not be causing her death but rather facilitating a peaceful end to her suffering.

Mr. T. R. Andhyarujina, learned Senior Counsel stated that Courts in the United States have recognized that the perspective of a surrogate may be considered as representative of the incompetent patient’s wishes when determining the appropriateness of withdrawing life support. However, this notion was not endorsed by the House of Lords in the Airedale case. It was argued that Aruna’s relatives appear to have shown little concern for her well-being, with the nursing staff and medical personnel at KEM Hospital being the sole caregivers for the past 37 years

Respondent arguments

The dean of the hospital expressed strong opposition to the concept of euthanasia, arguing that nearly 36 years have elapsed during which the hospital staff has consistently attended to the patient’s fundamental needs. He asserted that the staff would continue to provide care willingly in the future. Additionally, he noted that the patient is currently 60 years old and is expected to pass away naturally in due course, thereby negating the necessity for euthanasia. The dean emphasized that the caregivers have formed a deep emotional bond with the patient, with one staff member expressing a willingness to care for her without any expectation of payment. Furthermore, he argued that euthanasia constitutes a violation of justice and warned that the legalization of passive euthanasia could lead to potential exploitation by family members, ultimately undermining the compassion and love that society extends to individuals in need.

The learned attorney contended that it is not valid to terminate her life by stopping the food or the medical support. Withdrawing the food or medicine was unknown to the Indian law. The attorney general also stated that the report of law commission on the issue of the euthanasia was not validated by the government of India. It was also stated that Indian society is emotionally driven if passive euthanasia is allowed then it may lead to new offenses where the close ones may conspire with the doctors to kill. He also stated there may be a medicine to cure her disease in the future because the future is uncertain as development is taking place.

Legal analysis

Neurologically department stated that this condition represents the most extreme type of brain injury. The individual is in a state of unconsciousness, exhibiting total unresponsiveness, lacking any reflexive actions originating from the brain, and showing no independent respiratory efforts. Nevertheless, cardiac function persists. The survival of this patient is solely dependent on advanced life support systems, such as mechanical ventilation and pharmacological agents to sustain blood pressure. Such patients may be legally classified as deceased (‘brain dead’) to facilitate the procurement of their organs for transplantation. And they stated she is not in complete coma or she is not brain dead

Autonomy signifies the right to self-determination, granting an informed patient the authority to choose their treatment method. For a patient to be considered autonomous, they must have the competence to make decisions. If a patient is found to be incompetent to make choices, their previously articulated wishes, as documented in a Living Will, or the preferences of surrogates acting on their behalf, known as ‘substituted judgment,’ should be honored. The surrogate is responsible for representing what the patient might have decided if they were competent or for acting in the patient’s best interest. It is expected that a surrogate, when acting in the best interest of the patient, will choose a course of action that is most beneficial to the patient, without being influenced by personal beliefs, motives, or other considerations

It is important to differentiate brain death from a persistent vegetative state, where the brain stem is still operational, resulting in some potential reactions, although the chances of recovering consciousness are minimal. An individual who is unresponsive but capable of sustaining respiration and circulation should not be regarded as dead. Consequently, the act of breathing mechanically allows that person to be deemed “alive.

In the Aruna Shanbaug case, the judiciary explored the definition of euthanasia, differentiating between two principal forms: active euthanasia and passive euthanasia. Active Euthanasia: This form consists of the intentional use of lethal substances or techniques to bring about the death of an individual. For instance, administering a lethal injection to a terminally ill patient to alleviate their suffering exemplifies active euthanasia, as it directly leads to the person’s demise. Passive Euthanasia: On the other hand, passive euthanasia involves the withholding or withdrawal of life-sustaining treatments, thereby allowing death to occur naturally. This may involve actions such as disconnecting life support machines, refraining from providing antibiotics, or not initiating resuscitation efforts. Unlike active euthanasia, passive euthanasia does not actively cause death but permits it to happen through the cessation of medical care.

The notion of the “Right to Die” presents a multifaceted and controversial topic that has been extensively examined and debated within the legal framework of India. Article 21 of the Indian Constitution enshrines the fundamental right to life and personal liberty for all citizens. While the right to life is deemed absolute, the interpretation of Article 21 concerning the right to die has undergone significant judicial analysis and development. In several pivotal cases, Indian courts have confronted the issue of whether the right to die falls within the broader context of the right to life as guaranteed by the Constitution. The interpretation of Article 21 has progressed over time, resulting in important legal decisions regarding this issue. In the landmark case of Gian Kaur v. State of Punjab, the Supreme Court examined the validity of Section 306 of the Indian Penal Code (IPC), which criminalizes assisting in suicide. The court reversed an earlier ruling, affirming that individuals who are terminally ill or in a permanent vegetative state possess the right to die. However, this right does not permit the premature termination of life but rather allows for the acceleration of a death process that is already underway. The court underscored the necessity of enabling individuals to pass away with dignity, especially when enduring profound physical and emotional distress. In a similar vein, the Bombay High Court’s decision in State of Maharashtra v. Maruti Sripati Dubal established that the right to life under Article 21 encompasses the right to die. The court contended that Section 309 of the IPC, which criminalizes attempted suicide, infringes upon Article 21 and is therefore unconstitutional. This ruling further solidified the acknowledgment of the right to die as an essential component of the right to life and personal liberty as guaranteed by the Constitution.

Judgement

The court differentiated between active and passive euthanasia. Active euthanasia refers to the intentional and affirmative act of ending a person’s life through the administration of lethal substances. This practice is regarded as a criminal act globally, unless sanctioned by specific legislation. In India, active euthanasia constitutes a direct violation of sections 302 and 304 of the Indian Penal Code (IPC). Additionally, physician-assisted suicide is classified as an offense under section 309 of the IPC. Conversely, passive euthanasia involves the cessation of life-sustaining treatments or medical interventions. The primary difference between active and passive euthanasia lies in the fact that active euthanasia entails a deliberate action to terminate life, while passive euthanasia involves a failure to act. The Supreme Court has established a set of procedures and guidelines for permitting passive euthanasia in “rarest of rare circumstances,” while dismissing the petitioner’s request. Under Article 226, the High Court is empowered to make determinations regarding the withdrawal of life support. Upon receiving an application, the Chief Justice of the High Court must form a bench, which will consult a committee of three esteemed doctors. A comprehensive assessment of the patient is required, and notice must be provided to the state and family members by the bench. The High Court is obligated to render a prompt decision.