This article is written by Gauri Gupta. The article aims to provide a detailed analysis of the landmark judgement of Aruna Ramchandra Shanbaug v. Union of India (2011). It highlights and elaborates on the facts of the case, the issues presented before the Court, the arguments of the Appellant and Respondent, the laws and precedents laid down in the case, and the judgement put forth by the Supreme Court of India. The landmark judgement revolves around the substantial question of law regarding whether the right to life under Article 21 of the Indian Constitution involves the right to die. In other words, it revolves around the question of whether an individual has the autonomy to end his life.

Table of Contents

Introduction

“Death must be so beautiful. To lie in the soft brown earth, with the grasses waving above one’s head, and listen to silence. To have no yesterday, and no tomorrow. To forget time, to forgive life, to be at peace.”-Oscar Wilde

The Constitution of India under Article 21 guarantees the “Right to Life” to all citizens. There has always been a continuous debate on whether the “Right to Die” can be read into the provisions of Article 21 of the Constitution or not.

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The right to life is a sacred fundamental right and includes various other fundamental rights, such as the right to livelihood, the right to a clean and healthy environment, the right to privacy, the right to safe and clean drinking water, etc. The significant advancements in medical science have raised questions on whether an individual has the right to die with respect and dignity. Furthermore, it has also raised concerns regarding such rights being misused and abused by the family members of the patient. The courts in India did not recognise the right to end the life of an individual until 2018.

A writ petition was filed before the Supreme Court under Article 32 of the Constitution of India by Ms. Pinki Virani, the next friend of Aruna Ramchandra Shanbuag, who was in a persistent vegetative state after she was sexually assaulted and choked and was left blind, deaf and paralysed. 

In the historic judgement of Aruna Ramchandra Shanbaug v Union of India & Others (2011), the Supreme Court of India legalised passive euthanasia and concluded the right to die to be a derivative of Article 21 of the Constitution of India. The right was recognised as a fundamental right for the first time in India. The judgement laid down the foundation of passive euthanasia in India, differentiated it from active euthanasia and set down the rules and guidelines under which passive euthanasia can be granted.

The judgement serves as a crucial precedent laying down the fundamental right to die with dignity within the ambit of the right to life under Article 21 of the Constitution of India and serves as a guide on passive euthanasia in India.

Right to Die and Euthanasia

The term “euthanasia” originated from the Greek words “eu” and “thanatos”, which mean “good” and “death”, respectively. Thus, the term euthanasia, when translated into English, means “good death” or “mercy killing.” euthanasia is of two types: active euthanasia and passive euthanasia.

Active or voluntary euthanasia is where consent is taken from the patient before ending his life. On the other hand, in the case of passive or non-voluntary euthanasia, consent is unavailable or cannot be obtained due to the ill health and suffering of the patient.

Since time immemorial, India has been known for its religious beliefs and morality. Wilfully ending an individual’s life has always been seen as an act against the ethics of our culture and religion. 

In contemporary times, technological advancements have led to significant developments in the healthcare sector, which have enhanced the quality of life and prolonged the average life expectancy. However, these developments have prolonged their sufferings as well and are, thus, regarded as a bane rather than a boon.

There are two conflicting schools of thought on euthanasia. The first school of thought suggests that passive euthanasia dilutes the sanctity of life. This is because the supporters of this school believe that human life should be preserved and respected at all costs. It is a gift of God and only God has the power to take it away from an individual. On the other hand, some individuals firmly believe that as the Constitution grants every citizen the right to life and personal liberty, it should also empower them with the right to die with dignity and respect to end their pain and suffering.

The Supreme Court in 2018, in the landmark case of Common Cause v Union of India (2018), discussed the legality of passive euthanasia and observed that Article 21 of the Constitution of India encompasses the right to die with dignity. Thus, the Court opined that withdrawing life support from patients who are terminally ill is relevant to ensure that they die with dignity. The Court also discussed the concept of ‘living will.’ A living will is a document which provides for the consent of the patient in advance regarding the terms of their treatment in case of terminal illness in the future, especially in scenarios where the patient is not under a condition to consent to life altering decisions. The document is regarded as the living consent of the patient.

The High Court of Bombay, in the case of Maruti Shripati Dubal v. State of Maharashtra (1986), observed that the right to die falls within the ambit of Article 21 of the Constitution of India. The Court further observed that Section 309 of the Indian Penal Code, 1860, is unconstitutional in nature to the extent it is violative of the right to life under Article 21 since it provides for the attempt to suicide. The same is committing death against the course of nature. The High Court of Bombay explained that the right to life is not limited in nature and is extended to include various other rights within its ambit to ensure that an individual lives with human dignity. The Hon’ble Court reiterated that terminating one’s life cannot be equal to ending a person’s life against the course of nature, even when the individual is suffering pain. 

The High Court of Bombay struck down Section 309 of the Indian Penal Code, 1860, thereby decriminalising attempt to suicide. The rationale behind the same is that the right to life is a natural right, but suicide is ending a person’s life against the course of nature, thereby a violation of the fundamental right to life. As a result, terminating or extinguishing life by committing suicide cannot be read with the right to protection of life and liberty.

Furthermore, the Supreme Court, in the case of P. Rathinam v Union of India (1994), recognised the right to not live and included it within the ambit of Article 21 of the Constitution of India. 

However, in the case of Gian Kaur v. State of Punjab (1996), the Supreme Court overruled the judgement of the P. Rathinam case and observed that the right to life does not include the right to die. However, it includes the right to live with human dignity and incorporates the right to die with dignity and respect. 

It is crucial to note that there is a fundamental difference between the right to die and the right to die with dignity. The former implies that the natural lifespan of an individual is taken away, thus causing unnatural death. On the other hand, the right to die with dignity refers to the process of accelerating the process of death in cases where the patients are in a permanent vegetative state or a coma or where there is no scope for improvement in their condition. Thus, the right to die with dignity can be permitted by permitting passive euthanasia to terminate the lifelong suffering and pain of patients who have incurable diseases. 

The landmark judgement of Aruna Ramchandra Shanbaug v. Union of India (2011) revolves around passive euthanasia and lays down the guidelines regarding the same. While active euthanasia is illegal in India, passive euthanasia can be administered by approaching the High Court under Article 226 of the Constitution of India and following the guidelines laid down by the Supreme Court of India in this case.

Details of the case

Title of the Case

Aruna Ramchandra Shanbaug v. Union of India & Others

Date of Judgement

7th March, 2011

Parties to the case

Appellant

Aruna Ramchandra Shanbaug

Respondent

Union of India, State of Maharashtra, Dean – King Edward Memorial Hospital Mumbai

Represented by

Advocates on behalf of Appellant

Mr. Shekhar Naphade, learned Senior Counsel

Amicus Curiae

Mr. T. R. Andhyarujina, learned Senior Counsel

Advocates on behalf of the Respondents

Mr. Vahanvati, learned Attorney General for the Union of India

Mr. Pallav Sisodia, learned Senior Counsel for the Dean, KEM Hospital, Mumbai

Mr. Chinmay Khaldkar, learned Counsel for the State of Maharashtra

Citation

WP (Criminal No.) 115 of 2011

Equivalent citation

AIR 2011 SUPREME COURT 1290

Type of case

Criminal Original Jurisdiction under Article 32 of the Constitution of India

Court

The Supreme Court of India

Provisions and Statutes Involved

Article 14 of the Constitution of India, 1950

Article 21 of the Constitution of India, 1950

Article 32 of the Constitution of India, 1950

Section 306 of the Indian Penal Code, 1860

Section 309 of the Indian Penal Code, 1860

Corum

Justices Gyan Sudha Misra and Markandey Katju

Author of the Judgement 

Justice Markandey Katju

Facts of the case

The factual matrix of the historic judgement can be summarised in the following points:

  1. Arun Ramchandra Shanbaug, the petitioner, was a staff nurse at King Edward Memorial Hospital, Parel, Mumbai. On 27th November 1973, the petitioner was attacked by a sweeper in the hospital. He wrapped a chain around her neck and tried to assault her sexually. However, he stopped when he found out that she was menstruating. He sodomised her and twisted the dog chain around her neck, leaving her in an unconscious state.
  2. The next day, another staff member of the hospital, a cleaner, found her lying on the hospital floor in a pool of blood. 
  3. It was alleged that the supply of oxygen to her brain was cut off when she was strangled, which damaged her brain. The doctors at the hospital also indicated that there was a lot of damage to the cortex and other parts of the brain. Furthermore, she had a brain stem contusion injury with associated cervical cord injury. 
  4. After 36 years of the incident, her next friend, Ms. Pinki Virani, filed a petition under Article 32 of the Constitution of India. The petition made requests for allowing euthanasia for Ms. Aruna Shanbaug due to her bedridden state. The petition further explained that she was in a permanent vegetative state. She had no sense of her surroundings and was virtually a dead individual. 
  5. The petitioner prayed for Ms. Aruna Shanbaug to be allowed to depart peacefully by terminating her life-supporting treatments and withdrawing the necessary medicine and other essentials that kept her alive. The petition prayed for ending her pain and suffering.
  6. Following this, the Supreme Court appointed a team of three distinguished doctors to examine her thoroughly and submit an elaborate report of Aruna’s state to the Court.

Issue of the case

The following issues were raised by way of  a writ petition, which was filed under Article 32 of the Constitution of India:

  1. Whether it is lawful and permissible to withdraw life support from a person who is in a permanent vegetative state?
  2. Whether the living will of such a patient be respected in such cases?
  3. Does the family or next of kin of the patient have the right to request the withdrawal of life-supporting systems in case the patient cannot decide the same for himself?

Arguments

Arguments of the Petitioner

A petition was filed under Article 32 of the Constitution of India by Ms. Pinky Virani on behalf of Ms. Aruna Ramchandra Shanbaug. The petition raised a crucial question regarding the right to die with dignity, which is inherent under Article 21 of the Constitution of India. 

The learned counsel for the Petitioner put forth the following cases in support of his contentions. He relied on the judgement of Vikram Deo Singh Tomar v. State of Bihar (1988), wherein the court observed that every individual is entitled to a quality of life which is consistent with his human personality. This implies that the right to life encompasses the right to a dignified and quality life. In other words, the Supreme Court observed that every citizen has the right not just to life but to a life which has quality and is consistent with human personality. An individual should not lead a life where his state of being is reduced to such a state where he has no control over himself and no sense of his surroundings.

Further, the learned counsel relied on the landmark judgement in the case of Gian Kaur v State of Punjab (1996) wherein the court established that the right to life is inclusive of the right to die. The counsel further underscored the importance of addressing the central issue of the right to die with dignity in cases wherein individuals are in a permanent vegetative state.

The learned counsel highlighted the significance of addressing the issue of the right to die with dignity, especially in cases where the individuals are in permanent vegetative state. He argued that individuals should have the right to end their lives with dignity in order 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 taking the example of the suffering and pain of Ms. Aruna Shanbaug. He highlighted how she has been bedridden for over 35 years and is devoid of the ability to eat, express herself and perform any human functions. The doctors were confident that there was no scope for improvement in her health conditions, and they had declared her virtually dead. Thus, by withdrawing life support and life-sustaining treatment, the Respondents would not be killing her but would rather be allowing her to die with dignity and respect. 

Arguments of the Respondent

The learned counsel for KEM Hospital and the Municipal Corporation of Bombay filed a counter-petition opposing the request for euthanasia for Ms. Aruna Shanbaug. They put forth the following arguments to support their position against euthanasia. 

The counsel highlighted that the nurses and the staff of the hospital had been diligently feeding and taking care of Ms. Aruna Shanbaug for over 35 years. Despite her condition, they have been committed to providing her with the best care to ensure her well-being. 

Further, the counsel contended that Ms. Aruna Shanbaug was over 60 years of age, and thus, there was a likelihood of her succumbing to death without any intervention. The counsel emphasised that the nurses and the other hospital staff were happily willing to take care of her regardless of any challenges for the remaining days of her life. Therefore, they were opposed to the idea of euthanasia. Furthermore, the learned counsel for the Respondents 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 30 years. 

Moreover, the learned counsel for the Respondents further expressed their concerns about the implications of allowing euthanasia in Indian society. The society is deeply care-oriented and places a strong emphasis on supporting the needs of the individuals. The counsel contended that permitting euthanasia would open the doors to misuse and undermine the social values that Indian society places on caregiving.  

Laws discussed in Aruna Ramchandra Shanbaug vs. Union of India & Others (2011)

Article 14 of the Constitution of India, 1950

The right to equality is a fundamental right enshrined under Part III of the Constitution of India and prohibits unequal treatment. The provision provides that every citizen in India is equal before the eyes of law. This implies that no individual can be discriminated against on the basis of their race, caste, creed, religion, place of birth, sex, etc. 

Article 14 provides for equality before law, which states that all individuals are treated equally by the law. There are certain exceptions to the same. This includes the following:

  1. The President is empowered to refrain from answering for the activities and duties conducted in office.
  2. The President cannot be criminally prosecuted during his term.
  3. The President of India or the Governor cannot be arrested or imprisoned.
  4. No civil proceedings can be initiated against the President and the Governor in cases where they are acting in their official capacity.
  5. An individual may not be liable for civil or criminal proceedings in case he publishes any true report of the proceedings of the Parliament.

Furthermore, Article 14 provides for equal protection of law, which states that law provides equal treatment to all individuals in similar situations. In other words, the right to equality provides for similar treatment in similar situations. The concept has been borrowed from the American Constitution.

The Supreme Court of India, in the case of Navtej Singh Johar v. Union of India (2016), struck down Section 377 of the Indian Penal Code, 1860, which provided for criminalising consensual sex between same-sex adults. The rationale behind the same was that the provision violated the fundamental right of equality under Article 14 of the Constitution of India. 

In the landmark case of Shayara Bano v. Union of India (2016), the five-judge bench of the Supreme Court struck down Triple Talaq and declared the practice unconstitutional on the ground that the same is violative of the fundamental right to equality enshrined under Article 14 of the Constitution of India. 

Furthermore, in the case of Joseph Shine v Union of India (2018), the Supreme Court struck down Section 497 of the Indian Penal Code, 1860. The Court was of the firm opinion that the provision infringed upon the dignity and autonomy of women and was, thus, violative of their fundamental right to equality guaranteed under Part III of the Constitution of India. 

Article 21 of the Constitution of India, 1950

Article 21 of the Indian Constitution provides that every citizen of India has the fundamental right to life and personal liberty. The right is granted even to foreign citizens. Considered the most progressive provision of the Indian Constitution, the ambit and scope of Article 21 is ever evolving in nature. The provision provides for two rights: the right to life and the right to personal liberty. Article 21 of the Constitution prohibits the deprivation of these rights except according to the procedure established by law. 

The Supreme Court describes the right to life and personal liberty as the ‘heart’ of the fundamental rights. The right is provided against the state only. The term ‘state’ includes the government, local bodies, the legislature, etc. 

The right to life includes the right to privacy, shelter, social justice, protection of cultural heritage, a pollution-free environment, safe drinking water, education, economic empowerment, and many others. 

In the case of Maneka Gandhi v. Union of India (1978), the Supreme Court of India gave new dimensions to Article 21. The right to life includes not only the physical right to life but also the right to live with human dignity. The case revolved around the question of whether Section 10(3) of the Passport Act, 1967, which allows the government to impound the passport of an individual, violates the fundamental rights enshrined under Articles 14 and 21 of the Constitution of India. The Court observed the provision to be violative of the fundamental rights since it empowered the authorities with vague and undefined powers. The case is a landmark judgement which expanded the horizon of Article 21 of the Constitution of India. 

Further, in the case of People’s Union for Democratic Rights v. Union of India (1982), the Apex Court observed that the failure to pay minimum wages to the workers is a denial of their right to life with basic humanity, thus violating Article 21 of the Constitution of India. 

The Supreme Court, in the landmark case of Vishakha v. State of Rajasthan (1997), observed that sexual harassment at the workplace is violative of Articles 14 and 21, which provide for the right to equality and the right to life and personal liberty. 

Article 32 of the Constitution of India, 1950

Article 32 of the Constitution of India under Part III provides for legal remedies for protecting the fundamental rights enshrined under the Constitution of India. It empowers the citizens of India to move to the Supreme Court of India to enforce these rights. These legal remedies are writs, which are written orders issued by the Apex Court to grant constitutional remedies to protect the fundamental rights of people.

These writs are as follows:

  1. Habeas Corpus:

The term “habeas corpus” is a Latin phrase which means ‘to produce the body.’ The writ is used to enforce the fundamental right of liberty of an individual in cases where he is unlawfully detained. When the writ is issued, the detained person has to be produced before the Magistrate within 24 hours. The writ can be issued against both the public and private entities. However, it cannot be issued in case the detention is lawful, the proceedings are for contempt of court, the individual has been detained by a competent court, and such detentions fall outside the jurisdiction of the court. 

  1. Mandamus:

The Latin term Mandamus means ‘we command.’ The writ of mandamus is issued by the court to a public official in cases where he fails to perform his duty or refuses to perform his duty. The writ orders the public official to discharge his functions. The writ of Mandamus can be issued against any public body, a corporation, an inferior court, a tribunal or a government directing them to discharge their public duties. The writ of Mandamus cannot be issued to enforce the following:

  • A departmental instructions without a statutory force, 
  • A contractual obligation,
  • It cannot be issued against the President of India or the Governors of the State,
  • It cannot be issued against the Chief Justice of the High Court in cases where he/ she is acting in his/ her judicial capacity.
  1. Prohibition:

The writ of Prohibition is issued by a higher court against the lower court, preventing them from exceeding their jurisdiction or exercising their powers in a jurisdiction over which they have no authority. The term “Prohibition” means ‘to forbid’ in the literal sense. It cannot be issued against judicial or quasi-judicial authorities, administrative authorities, legislative authorities and private individuals or bodies.

  1. Certiorari:

The term “Certiorari” means to certify or to inform. The writ is issued by a higher court to a lower court or tribunal ordering them to either transfer a case pending before it to the said authority or to quash the orders passed by them in a particular case. This writ is issued in cases where the court has acted in excess of its jurisdiction, lacks its jurisdiction or committed an error of law. 

  1. Quo Warranto:

The term Quo Warranto means by what warrant or authority. The writ is issued by the Supreme Court of India in the exercise of its power under Article 32 of the Constitution of India to prevent an individual from sitting in a public office without having the necessary authority to do so. The writ can be issued only in cases where the public office has been established by the Constitution of India or any other legislation. It cannot be issued against private offices. 

The Supreme Court, in the landmark judgement of Skill Lotto Solutions Pvt Ltd. v. Union of India (2020), observed that Article 32 of the Constitution of India is an integral part of the basic structure of the Indian Constitution. It is the heart and soul of the Indian Constitution and is crucial for enforcing the fundamental rights of the Indian citizens enshrined under Part III of the Constitution of India. 

In the landmark judgement of ADM Jabalpur v. Shivkant Shukla (1976), popularly known as the Habeas Corpus case, the Supreme Court observed that the writ of Habeas Corpus cannot be suspended even when the emergency is declared in India. 

It is crucial to note that the right to constitutional remedies under Article 32 of the Constitution of India is not absolute in nature. There are certain limitations on the same. These are as follows:

  • The Parliament, under Article 33 of the Constitution of India, is empowered to modify the application of the fundamental rights to the armed forces and the police officers in order to ensure fair and just discharge of public duties. 
  • In case an emergency is proclaimed under Article 352 of the Constitution of India, the fundamental rights of the citizens stand suspended.
  • Furthermore, Article 359 of the Constitution of India empowers the President of India to suspend Article 32 during war, external aggression, financial crisis and armed rebellion.

Section 306 of the Indian Penal Code, 1860

The Indian Penal Code, 1860, under Section 306, deals with the punishment of abetment of suicide. It provides that when an individual aids or instigates another individual to commit suicide, he shall be punished with imprisonment that may extend to ten years and will also be liable to pay a fine. The aim behind enacting the provision was to deter individuals from assisting or encouraging others to take their lives. Abetment to suicide is a non-bailable and cognizable offence.

In the landmark judgement of Smt. Gian Kaur v. The State of Punjab (1996), the Supreme Court of India, observed that Section 306 of the Indian Penal Code is constitutionally valid. The Court firmly observed that anyone who aids and abets an individual in killing himself will be held liable and be rigorously punished.

The Supreme Court of India, in the case of Amalendu Pal @ Jhantu v. State of West Bengal (2009), observed that convicting an individual under Section 306 of the Indian Penal Code is not solely on the basis of an accusation. An individual cannot be convicted in the absence of a positive action of prompting or forcing another to kill himself. In order to convict an individual under this provision, there has to be a commission of suicide, which was supported and encouraged by another individual.

Section 309 of the Indian Penal Code, 1860

The provision punishes the attempt to commit suicide in India. It provides that any individual who attempts to kill himself and does an act towards the commission of suicide will be punished. This punishment shall include imprisonment for a term which may extend to one year or fine or both. The rationale behind enacting this provision was to deter individuals from taking their lives and ensuring harsh consequences in case they try to do so.

In the case of Maruti Shripati Dubal v. State of Maharashtra (1986), the High Court of Bombay dealt with the issue pertaining to the constitutional validity of Section 309 of the Indian Penal Code.  The Court observed that the provision was ultra vires the fundamental rights enshrined under Articles 14 and 21 of the Constitution of India and struck it down. Furthermore, the Court was of the firm opinion that if the rationale behind such provisions is to prevent suicide by punishment, the same cannot be achieved by punishing those who tried to kill themselves. The Court held that those who make attempts to kill themselves on account of their poor mental health should be given immediate treatment. They should not be confined to prisons since imprisonment will have a harsh effect on their mental health. 

Furthermore, the Supreme Court, in the case of P. Rathinam v. Union of India (1994) observed that Section 309 of the Indian Penal Code is violative of Article 21 of the Constitution of India, which grants every citizen of India the right to life and personal liberty. 

Judgement of the Supreme Court in Aruna Ramchandra Shanbaug vs. Union of India & Others (2011)

The Division Bench of the Supreme Court, comprising Justices Markandey Katju and Gyansudha Mishra, delivered a landmark judgement in the case of Aruna Ramchandra Shanbaug v. Union of India & Others on March 7, 2011. The Hon’ble Bench observed that there is no statutory provision in India which provides 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 did not agree with the contentions put forth by the Respondents. They agreed with the Petitioner and held that passive euthanasia must be permitted in certain circumstances. 

The Supreme Court further observed that decisions regarding discontinuing life support will be taken either by the parents, spouse or other close relatives of the patient. In case of their absence, decisions regarding the same can be taken by a person who is acting as the next friend of the patient. Furthermore, the Court also observed that the doctors of the patient are empowered to withdraw life support, and such decisions should be taken in the best interest of the patient. 

While dealing with the present case, the Court observed that the parents of Ms. Aruna Ramchandra Shanbaug are dead and her close relatives have not visited her since she was assaulted. Furthermore, the patient was in the exceptional care of the nurses and other hospital staff of the KEM Hospital. The Court further held that in case a decision regarding withdrawal of life support is taken, the same has to be approved by the High Court of the concerned state. The rationale behind the same was to ensure that the same was not misused by unscrupulous individuals who wished to inherit the property and other assets of the patient.

The Court followed the principle of parens patriae which implies that the king is the father of the country. He is under an obligation to look into the interest of all those individuals who are not in the state of looking after themselves. However, the same is under the scrutiny of the Court. 

The Court highlighted the report of the doctors of the KEM Hospital as well as the definition of brain death under the Transplantation of Human Organs Act, 1994. Assessing 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 be a breach of her fundamental right to life and would be unfair. 

The Supreme Court of India, in this historic case, 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 explained that the necessary parties can approach the High Court under writ jurisdiction under Article 226 of the Constitution of India, following which the High Court will grant its approval for withdrawing life support. 

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 on the basis of the circumstances whether to approve passive euthanasia or not. Before granting their approval, the Bench of the High Court has to 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 as it may deem fit. 

The High Court is also responsible for issuing notice to the State and the close relatives of the patient, which includes parents, spouses, brothers/sisters, etc. In the absence of these relatives, a copy of the doctor’s report and such a notice has to be issued to the next friend of the patient. The Supreme Court further clarified that the same procedure has to be followed until the Parliament makes legislation in this regard. 

The Court denied euthanasia to Ms. Aruna Ramchandra Shanbaug as the matter was not fit for allowing the withdrawal of life support. The Court also observed that if the nurses or the hospital staff of the KEM Hospital felt a need to allow euthanasia owing to her condition, they could approach the High Court as per the prescribed procedure. 

Ratio Decidendi

The Court was of the firm opinion that since Ms. Aruna Shanbaug was in a permanent vegetative state, someone should be entrusted to a surrogate due to her inability to make decisions for her own good. The Court appointed the staff of the KEM Hospital as her appropriate surrogate, empowering them to make decisions on her behalf. 

The Court held that active euthanasia is illegal in India and is an offence under the Indian Penal Code. Furthermore, the Court acknowledged the evolving understanding of death and expanded its definition beyond cardiopulmonary function. It included brain functions within the meaning of death. The Court also discussed the concept of parens patriae, wherein the state is empowered to assume the role of protecting its citizens with disabilities. 

Obiter Dicta

The Hon’ble Division of the Supreme Court expressed its apprehension regarding the societal understanding of euthanasia and put forth its concerns regarding its potential misuse. The Bench advocated for a compassionate society which focuses on prioritising the welfare of its citizens with permanent disabilities. 

The Bench also advocated repealing Section 309 of the Indian Penal Code, which provides that attempt to suicide is a criminal offence. Furthermore, they suggested a shift towards offering support and assistance to individuals who are struggling with mental health issues and have suicidal tendencies.

The Bench emphasised on the duty of the state to safeguard individuals with disabilities. It underscored the principle of parens patriae which highlights the obligations of the state to protect disabled and vulnerable individuals and uphold their rights in the contemporary era. 

Medical Ethics

In this historic judgement, the Supreme Court of India dealt with the concept of informed consent and the patient’s right to bodily integrity. Informed consent implies that the patient is completely aware of all aspects of his or her treatment including its outcomes, the scope of recovery and its side effects. The Court clarified that if the doctor, in spite of the patient’s ability to provide informed consent, does not ask him for the same, he or she could be charged with battery, assault or culpable homicide. The concept of informed consent is relevant only in those circumstances where the patient can understand the consequences and outcome of their treatment. 

In this case, Ms. Aruna Shanbaugh’s consent could not be obtained due to her permanent vegetative state, which raised questions about who should be making decisions on her behalf. The Supreme Court took into consideration the public interest and the interests and duties of the state. It provided that the State is responsible for looking after the welfare of its vulnerable citizens. However, the Apex Court legalised passive euthanasia by ensuring adequate safeguards to ensure that the same is not misused.  

International Perspective

All across the globe, there are numerous nations where active euthanasia is considered to be illegal. However, passive euthanasia has been permitted in various countries across the globe. It is crucial to note that it is subject to numerous conditions, which have been explained below:

Netherlands

In the Netherlands, the Termination of Life on Request and Assisted Suicide Act, 2002 regulates euthanasia. It provides that euthanasia and physician-assisted suicide are not a punishable offence if the physician acts in accordance with the set criteria for ensuring the due care of the patient. However, passive euthanasia is allowed subject to certain conditions, including the time period, the mental state of the patient, and the chance of survival. Furthermore, the law provides for an explicit recognition of the validity of the written declaration of the will of the patient. These wills are crucial in cases where the patient is in a coma or is terminally ill and is in no state to decide what his best interests are.

Switzerland

Switzerland has an unusual position on assisted suicide. The country permits assisted suicide even by non-physicians. However, euthanasia is illegal in Switzerland. There is a significant difference in the concept of assisted suicide and euthanasia. While the former allows the patient to administer the lethal injection himself, the latter provides for the administration of the necessary drug by a doctor or some other medical professional. The Swiss Penal Code under Article 115 provides that assisted suicide is a criminal offence if the motive behind the same is selfish in nature. What is extremely unique about assisted suicide in Switzerland is that it is not necessary for the recipient to be a Swiss National, and there is no pre-requisite that requires the involvement of a physician.

Belgium

In Europe, Belgium was the second country after the Netherlands to legalise euthanasia. The Belgium Act on Euthanasia, 2002, provides for conditions under which euthanasia can be practised without empowering the doctors to do so. The Belgian law provides that patients who wish to terminate their lives must be conscious when they demand so and repeat their request for being euthanised.

United States of America

The USA prohibits active euthanasia in all states. However, physician-assisted suicide is legally permitted in Oregon, Washington, and Montana. 

Report of the Law Commission on euthanasia

The Law Commission of India in its 196th Report, which was published in 2006, made recommendations for legislation to be enacted to protect terminally ill individuals from Section 309 of the Indian Penal Code in cases where they refuse medical care, artificial feeding, or water. Furthermore, the report provided that physicians who follow the decisions of the patients or make decisions on behalf of those who are terminally ill and cannot decide what is best for themselves should be protected from legal action under Section 306 and Section 299 of the Indian Penal Code, 1860. 

The recommended legislation by the Law Commission was the Medical Treatment of Terminally Ill Patients (Protection of Patients, Medical Practitioners) Bill, 2016. Furthermore, it is crucial to note that the report of the Law Commission specifically provided that the following is necessary:

  1. The patient must have a terminal illness.
  2. The disease must be chronic, and the patient must be in a permanent vegetative state.
  3. Even if the patient’s family has consented to passive euthanasia, the medical expertise of the doctor must not be ignored since his judgment is of extreme significance.
  4. The doctor must notify the patient, along with the parents or close relatives of the patient, about euthanasia by issuing a written document before they withdraw medical treatment.

Case analysis of Aruna Ramchandra Shanbaug vs. Union of India & Others (2011)

“That a man has reached immortality who is disturbed by nothing material.”

  • Justice Deepak Misra

Justice Misra once said, “Everyone has a right to life but at the same time, he or she has a right to life with dignity. If he/she is unable to live with dignity because of prolonged illness, from which he/she will not overcome then, in such cases he/she has the right to die with dignity. This is what balancing of rights means. Adjustment, acceptance, compromise, and settlement comes in the balancing of rights and for the coexistence of rights. We have to balance them for the well being of mankind.”

The Supreme Court, in the Gian Kaur case, rejected the recognition of the right to die within the ambit of Article 21 of the Constitution of India, which provides for the right to life. The landmark judgement of Aruna Ramchandra Shanbaug v. Union of India & Others is a historic case which provides for certain guidelines relating to the procedure for the execution of passive euthanasia in India. The judgement has paved the way for a new path concerning the ambit of Article 21, which provides for the right to life, which now encompasses the right to die with dignity.

Although the landmark case provides guidelines and circumstances along with the steps required for approving passive euthanasia, the Court did not clarify whether the right to die with dignity falls within the ambit of the fundamental right to life under Article 21 of the Constitution of India. Furthermore, there is no clarity regarding whether the individual who is terminally ill but is stable enough to make decisions regarding his life can terminate his life owing to the insufferable pain or not. 

The judgement is a crucial milestone in the history of India with respect to end of life care. The case highlighted the requirement of a comprehensive law on euthanasia in India. It prompted discussions on the impact of allowing passive euthanasia on society and the need for spreading awareness and empathy for those in situations like that of Ms. Aruna Shanbaug. 

The case is a significant example of how society grapples with the challenges posed by advancing technologies, which require urgent legal and ethical frameworks to be responsive to the needs of the patients. 

Conclusion

The historic judgement reiterated the sanctity of life and underscored its significance as the cornerstone of the fundamental right to life under Article 21 of the Constitution of India. The Supreme Court of India delved into the intricacies of the legal, medical, and ethical questions surrounding the right to life and passive euthanasia. The Court assessed the medical condition of Ms. Aruna Shanbaug after considering her status of health with the medical experts. After analysing the complexities of her condition, denied passive euthanasia in her case. However, the Court underscored the importance of honouring the dignity and wishes of the patient who is unable to make decisions on their own. 

The landmark judgement in the Aruna Shanbaug case forms the foundation for legalising passive euthanasia in India. The judgement touches upon the important principle of parens patriae which provides for the responsibility of the state to safeguard the interests of its vulnerable citizens. 

The historic case highlights the complex moral considerations surrounding ending an individual’s life in India, thus shedding light on how such cases are to be dealt with in the near future. While the landmark judgement outlines the detailed procedure for passive euthanasia in India and has put forth certain guidelines on how the same can be exercised, these decisions are extremely hard to make. The ground reality of the right to die with dignity is very difficult and hard to implement. 

Frequently Asked Questions (FAQs)

What is the difference between euthanasia and physician-assisted suicide?

The concept of euthanasia is often confused with that of physician-assisted suicide. Both of these phenomena are completely different. In the case of the former, a physician or a third party administers the lethal injection to the patient. However, in the case of the latter, the patient himself administers the lethal injection on the advice of the medical professional. Euthanasia and physician-assisted suicide fall within the umbrella term ‘assisted dying.’

What is the difference between active and passive euthanasia?

Active euthanasia is when an individual with complete intention intervenes to end someone else’s life with the use of lethal substances. For example, administering a lethal injection to end the life of an individual.

On the other hand, passive euthanasia is to cause the death of a person by withholding or withdrawing treatment, which is essential to maintain life. For example, withdrawing antibiotics that are necessary to continue the life of a patient or withdrawing ventilator support systems.

Is the Right to Die a fundamental right in India?

Article 21 of the Constitution of India grants the fundamental right to life to every Indian citizen. It prohibits the deprivation of an individual’s life except according to the procedure established by law. In the landmark case of Common Cause v. Union of India (2018), the Supreme Court of India recognised the right to die with dignity as a fundamental right within the ambit of Article 21. The case also gave effect to a living will and the authorisation of the medical expert to facilitate the right to die with dignity. 

Is euthanasia legal in India?

The Supreme Court, in the landmark judgement of Aruna Ramchandra Shanbaug v. Union of India & Others (2011), observed that although active euthanasia is illegal in India, passive euthanasia is permitted subject to certain conditions. The final approval regarding whether passive euthanasia can be granted rests with the High Court of the concerned state, where the petition for euthanising an individual has been made.

What is the doctrine of Parens Patriae?

The doctrine of parens patriae originated in the early 13th century in Britain. The doctrine implies that the King of the State is the father of his territory and is, thus, under an obligation to look after the interests of all those individuals who are not able to make decisions that are in their best interests. The rationale behind the doctrine is that if the citizen of a state is in need of someone who can act as his parent or guardian and make decisions on his behalf, the State is the best parent for deciding the best interest of that individual.

How can passive euthanasia be exercised in India?

In the landmark case of Aruna Shanbaug v. Union of India, the Supreme Court observed that passive euthanasia can be exercised in India only on individuals who are in a permanent vegetative state. In such a case, the parents or close relatives of the patient can approach the High Court under Article 226 of the Constitution of India to get permission to euthanize the individual to end his suffering and pain. 

What is a Permanent Vegetative State?

A Permanent Vegetative State refers to a chronic disorder wherein the patient has severe brain damage. Although the patient appears to be awake, he is completely unaware of his surroundings. An individual who is in a permanent vegetative state may open their eyes, experience regular sleep-wake cycles, and exhibit basic reflexes such as blinking in response to loud noises. 

What is a “Living Will?”

The Living Will is a document which empowers the patient to issue directions on the course of his/ her treatment. Also referred to as an Advance Medical Directive, the living will should be signed in the presence of two attesting witnesses and be affirmed by a judicial magistrate. 

Can a living will be revoked?

An individual can withdraw his living will or advance directive at any time. Such a withdrawal or revocation must be in writing. In case the same is ambiguous and not in writing, the Medical Board shall not give effect to such withdrawal or revocation. Therefore, the withdrawal of a living will should be clearly made in writing.

References

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