Background of the case
The petitioner in this case, Aruna Ramchandra Shanbaug used to work as a Nurse in King Edward Memorial Hospital, Parel, Mumbai. On the evening of the 27th November 1973 a sweeper of the same hospital attacked her and he wrapped her neck with a dog chain and yanked her back with it. The sweeper also tried to rape her but when he found out that she was menstruating he sodomized her. To prevent her from moving or creating any chaos, he twisted that chain really hard around her neck. Next day, 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-journalist 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 better. So she should be allowed to go with the 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 among both the groups. Since there were disparities, the Supreme Court in order to get a better 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.
- Does withdrawal of life sustaining systems and means for a person who is in a permanent vegetative state (PVS), should be permissible ?
- If a patient declares previously that he/she does not want to have life sustaining measures in case of futile care or a PVS, should his/her wishes be respected in such a situation?
- Does the family or next of kin of a person get to make a request to withhold or withdraw life sustaining systems, in case a person himself has not placed such a request previously?
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 dead 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 a due procedure.
Whenever any application will be filed in High Court for passive euthanasia, the Chief Justice of the High Court should constitute a Bensh of atleast two judges decinding the matter that whether such termination should be granted or not. The Bench before laying out any judgement 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, kins and friends and also 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 judgement. 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 these 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. Now let’s discuss the emergence of two important features which came out in this case and have been discussed a lot in subsequent events.
Euthanasia, as we all know also known as mercy killing, 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 measures1.
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 cases when a patient is not in a condition to provide consent and the decision on his/her behalf is taken by some other person, then it is involuntary.
In Aruna Shanbaug’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. Later in the year 2018, Supreme Court passed another order in the case of Common Cause v. Union of India, in which right to die with dignity was again recognized and passive euthanasia was legalized and permit was given to withdraw the life supporet system of those who are terminally ill and are in life long coma. Along with this the Court also provided with the concept of “living wills”.
Living will – it is a document that allows a person to make decisions in advance with regard to what course of treatment he wants in case he gets seriously ill in the future and becomes unable to take decisions.
Thus, India is now one of the countries in the world which has recognized Passive Euthanasia. But there are still loopholes in the execution of passive euthanasia. As after Shanbaug case, it was made mandatory to take High Court’s permission before every case, so it was a tedious process. And now in this new judgement it has been made harder to give passive euthanasia an effect as now it involves execution of the directive in presence of two witnesses, authentication by a Judicial Magistrate, permission from two Medical Boards and a jurisdictional collector. Thus this delay is a major problem coming in the way, as it defeats the main purpose of passive euthanasia which is to end the suffering of the person concerned but on the other hand if the process is made too liberal and easy it ia always prone to a great misuse.
Thus we can see on both sides there are problems and issues involved and what we need is a better way out of this all in order to make the concept of passive euthanasia effective and efficient
Right to Die with Dignity
Our constitution and laws explicitly provides for Right to life to all its subjects. It is an absolute right guaranteed under Article 21 of the constitution and there are no doubts when it comes to the right to life. But questions always arise whenever we talk about Right to Die, it has always been an issue of contention for our lawmakers. The courts in various judgments have interpreted it differently and have based their opinion accordingly.
The Bombay High Court in the case of State of Maharashtra v. Maruti Sripati Dubal2 stated that Right to life under Article 21 also includes Right to die. It was contended that Section 309 of Indian Penal Code (attempt to commit suicide) is thus unconstitutional, as it is violative of Article 21 of the Constitution. Court clearly stated in this judgement that Right to die is just uncommon not unnatural. Subsequently in P. Rathinam v. Union of India3 the Supreme Court also accepted that Right to live also includes Right not to live under Article 21 of our Constitution. But later in a case Gian Kaur v. State of Punjab4, the Supreme Court overruled the P .Rathinam’s judgement and declared that Right to life does not include Right to die but at the same time court also stated that Right to life will include live with human dignity and the right to die with dignity. The court held that the right to die with dignity should be distinguished from Right to die. As right to die is an unnatural death which takes away natural span of a person’s life, on the other hand the right to die with dignity is a subsistence provided to a person. For instance, a person who is in a condition of PVS, if provided the right to die, it will end his suffering, physical and mental agony.
Hence, both these rights are altogether different and should not be misconstrued. Various nations in the world recognise “Right to Die with Dignity” as an important right for an individual, thus creating a way for passive euthanasia.
This case marked the beginning of the discussions on the issue of Passive Euthanasia which was rarely even discussed earlier. It clarifies the position of the right to die with dignity and further enhances the ambit of Article 21 of our constitution . A judgement which we can definitely call a progressive one in Indian context.
2. 1987 (1) Bom CR
3. 1994 SCC (3) 3944. (1996) 2 SCC 648
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