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Aruna Ramchandra Shanbaug v. Union of India[1] is one of the most famous and intriguing cases of the decade which discusses euthanasia and an individual’s right to die. The right to life is a sacred fundamental right which consists of a plethora of other rights such as the right to livelihood, the right to a clean environment etc. The right to die has become an unavoidable talk in medical jurisprudence and also the possibility of misuse of this right by family members. This landmark judgement laid down the guidelines and conditions under which passive euthanasia can be administered.
Citation: (2011) 4 SCC 454
Bench: Markandey Katju, Gyan Sudha Misra
Court: Supreme Court of India
Background
The constitution of India provides the right to life to all its citizens through Article 21. Although the concept of euthanasia is very popular in western nations, in India is has had a mixed response. Moreover, if the right to life is a fundamental right can’t the right to die be also included in its ambit is an everlasting debate.
The Hon’ble Supreme Court of India, in the current case, was confronted with a petition under Article 32 of the Indian Constitution to take into consideration the termination of the life of Aruna Ramchandra Shanbaug, who was in a permanent vegetative state. The petition was filed by her ‘next friend’ Ms Pinki Virani.
The Court in all prior cases has unmistakably denied the right to die. But the Supreme Court took notice of the gravity of the situation and accepted the petition to decide on the stance of euthanasia in India.
Facts
Aruna Ramachandra Shanbaug was a staff Nurse working in King Edward Memorial Hospital, Parel, Mumbai. On the evening of 27th November 1973, she was raped by a sweeper in the clinic who wrapped a canine chain around her neck and yanked her back with it. He attempted to rape her however finding that she was menstruating, he sodomized her.
To immobilize her during this brutal act, he wound the chain around her neck. The following day, a cleaner found her in an oblivious condition lying on the floor with blood all over the place and her body. It was affirmed that because of the strangulation by the canine chain the oxygen supply to the brain halted and the cerebrum got damaged.
Issues Raised
- If Article 21 of the Constitution includes the Right to Die as well?
- In the event that the patient has recently communicated a wish not to have life-supporting medicines if there should arise an occurrence of worthless consideration or a PVS, should his/her desires be regarded when the circumstance emerges?
- If the abovementioned arrangement has not been made by the patient, can the family or dearest friends make that choice on the patient’s behalf?
- The difference between passive euthanasia and active euthanasia?
Court Appointed Doctors
The respondents, KEM Hospital and Bombay Municipal Corporation filed a counter-petition. But, there were many disparities in the petitions filed by the petitioner and respondents, therefore to gain expert knowledge and form an accurate opinion, the court-appointed a set of doctors to analyse the condition of Aruna Shanbaug.
They studied Aruna Shanbaug’s medical history in detail and came to the conclusion that that euthanasia in the instant matter was not necessary. The staff of KEM hospital was willing to take complete care of her and moreover, Aruna was not completely brain dead as she responded to certain instances in her own way.
She showed signs of distress when many people were around her, she preferred light over darkness, liked the fish soup and her body language showed no willingness to terminate her life.
Analysis
Before coming to any conclusion, the honourable court explained what is euthanasia. Euthanasia also known as mercy killing is of two types: active and passive.
Active euthanasia includes the use of lethal substances or forces to terminate the life of a person whereas passive euthanasia includes curtailing of medical treatment for continuance of life or not providing the life assistance mechanisms.
The court also observed a further categorization of euthanasia which was voluntary euthanasia and non-voluntary euthanasia. Voluntary euthanasia is where the consent is taken from the patient, whereas non-voluntary euthanasia is where the consent is unavailable or cannot be taken. For instance, if a patient is in a coma or Permanent Vegetative State (PSA) consent cannot be logically expressed by him.
Right To Die
In the State of Maharashtra v. Maruty Shripati Dubal[2], the issue was that Section 309 of the Indian Penal Code was unconstitutional as it is violative of the fundamental rights of Article 19 and Article 21. The Bombay high court held that ‘right to life’ also includes ‘right to die’ thereby Section 309 of IPC was struck down.
In the case of P. Rathinam v. Union of India[3], it was held that the scope of Article 21 also includes the ‘right to die’.
In the case of Gian Kaur v. State of Punjab[4], the legitimacy of Section 306 of the IPC was in question, which penalised the attempt of suicide. This case overruled P. Rathinam but the court opined that in the context of a terminally ill patient or one in the PVS, the right to die is a mere acceleration of the process of death.
In Airedale NHS Trust v. Bland[5], for the first time in the English Jurisprudence history, the right to die was permitted through the withdrawal of life support systems. This case placed the authority to decide whether a case is fit or not for euthanasia in the hands of the Court.
In the current case, Aruna could breathe by herself and did not need any external assistance to breathe which led to deep discussions and thoughts as to if euthanasia should be allowed in her case.
Best interest or Beneficence
The fact that Aruna cannot give her consent due to her medical condition made this case even more complicated. What decision had to be taken for the best interest of the patient was the real question and who was to take it. Beneficence is acting in the interest of the patient’s wellbeing. Acting in the patient’s wellbeing implies following a strategy that is best for the patient, and isn’t affected by personal feelings, thought processes or anything similar. Public interest and the interests of the state were additionally thought of. The major threat to pass legislation which sanctions euthanasia is its high probability of being misused.
The Supreme Court dealt with the element of informed consent and right to privacy on the own body of the patient as followed by the US after the Nancy Cruzan case. Informed Consent is the sort of assent wherein the patient is completely aware of the multitude of future courses of his treatment, the side effects, chances of survival etc.
The doctor can be held liable if the patient is in a position to give informed consent still was not asked for. The idea of Informed assent comes into question just when the patient can comprehend the results of her treatment or has made a declaration when in sound mind. Both the conditions did not fulfil in Aruna Shanbaug’s case.
Judgement
The Hon’ble Division Bench of the Supreme Court had the opinion that on the doctors’ report and the meaning of ‘brain dead’ under the Transplantation of Human Organs Act, 1994, Aruna was clearly not brain dead. She could breathe without a helping machine, had sentiments and created vital improvement. In spite of the fact that she is in a PVS, her condition was been steady. Thus, the petition for ending her life was rejected.
The court also takes notice of the claim made by Ms Pinky Virani (claiming to be the next friend of Aruna Shanbaug) that in fact, Aruna Shanbaug is already dead and hence by not feeding her body anymore we shall not be killing her. The question hence arises as to when a person can be said to be dead?
The court observed that “A person’s most important organ is his/her brain. This organ cannot be replaced. Other body parts can be replaced e.g. if a person’s hand or leg is amputated, he can get an artificial limb. Similarly, we can transplant a kidney, a heart or a liver when the original one has failed. However, we cannot transplant a brain.
If someone else’s brain is transplanted into one’s body, then, in fact, it will be that other person living in one’s body. The entire mind, including one’s personality, cognition, memory, the capacity of receiving signals from the five senses and capacity of giving commands to the other parts of the body, etc. are the functions of the brain. Hence one is one’s brain. It follows that one is dead when one’s brain is dead.”
In Aruna Shanbaug’s case, it was a well-established fact that her brain was not dead, hence Ms Pinky Virani’s claim that she was already dead did not stand true.
Further, the option to make a choice for her benefit vested with the administration and staff of KEM Hospital and not Pinki Virani, thus permitting the termination of Aruna’s life would mean turning against the endeavours taken by the medical attendants of KEM Hospital throughout the long term. The life-saving technique used in the case was the mashed food that was given to her by the hospital which cannot be equated to ventilators and life assistance machines.
Also, in encouragement of the ‘parens patriae’ guideline, the Court to forestall any abuse in the vested the ability to decide the termination of the life of an individual in the High Court. In this manner, the Supreme Court permitted passive euthanasia in specific conditions, subject to the endorsement by the High Court and the opinion of an expert medical counsel.
At the point when an application for passive euthanasia is documented, the Chief Justice of the High Court ought to form a Bench of at any rate two Judges who can choose to give endorsement or not. Prior to doing so, the Bench should look for the assessment of a board of three expert doctors assigned by the Bench subsequent to counselling to consider them fit.
Along with appointing the committee of doctors, the High Court Bench shall also issue notice to the State and close relatives e.g. parents, spouse etc. of the patient, and in their absence his/her next friend. In the wake of hearing them, the High Court seat should give its decision. The above method ought to be followed all over India until Parliament makes legislation regarding this matter.
Notwithstanding, Aruna Shanbaug was denied passive euthanasia as the court believed that the matter was fit for the equivalent. On the off chance that whenever later on, the staff of KEM medical clinic or the administration felt a requirement for the equivalent, they could move toward the High Court under the strategy recommended.
Conclusion
Aruna Ramchandra Shanbaug v. Union of India explained the issues spinning around euthanasia and set down guidelines regarding passive euthanasia. This case is a landmark judgement as it recommended the method to be continued in a space that has not been administered upon i.e., where the legislation has not yet been made by the parliament. In India, active euthanasia is illegal whereas passive euthanasia can be administered by following the prerequisites laid down by the court.
Source
Read Full Judgement : https://main.sci.gov.in/judgment/judis/37709.pdf
[1] (2011) 4 SCC 454
[2] 1987 (1) BomCR 499
[3] 1994 AIR 1844
[4] 1996 AIR 946
[5] [1993] 1 All ER 821
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