Introduction
The concept of “Euthanasia” has not only been a brand new concept for the Indian medical industry; its public acceptance has been a debatable topic too. In the course of discussing the legality of Euthanasia, it has always been a general query whether the provision of the right to life under Article 21 of the Indian Constitution also encompasses the concept of the right to die. Therefore, the dire need for improvement in medical law and the potential of the patient’s family members to abuse this privilege have made the right to die a crucial issue. There is still an ongoing discussion over whether the “Right to Life” may be construed to include the “Right to Die.” On the other hand, the idea of euthanasia in India has met with various mixed reactions as the medical sector increasingly focuses on patients’ informed permission. This case of Aruna Ramchandra Shanbaug continues by separating passive and active euthanasia.
Facts of Aruna Shanbaug Vs Union of India
Aruna Shanbaug Vs Union of India case has paved the way for the legalization of passive euthanasia in India. Aruna Ramchandra, the victim, was a nurse at King Edward Memorial Hospital of Mumbai. One of the sweepers of the hospital had attacked her on 27th November 1973. He had choked and strangulated her via a dog chain with the intent to rape her and restrain her movements. Subsequent to realizing that Ms Aruna was menstruating, he sodomized her. On 28th November 1973, she was found lying on the floor, wounded, with blood everywhere and all over her. She was found in an unconscious condition by one of the cleaners. Consequent to such heinous strangulation via the dog chain, the supply of oxygen to her brain had ceased entirely, causing severe damage to the cortex of her brain. She had sustained a brain stem contusion besides having a cervical cord injury.
After 36 years of the incident, a petition for the case was filed under Article 32 of the Indian Constitution by a friend of Ms Aruna in 2009. For these many years, Ms Aruna has been in a permanent vegetative state and has become highly feeble and infirm.
Legal Issues Involved in Aruna Shanbaug Vs Union of India Case
Following Legal Issues Involved in Aruna Shanbaug Case
- Does Article 21 of the Constitution include the right to die embedded within the right to life?
- What is the difference between passive euthanasia and active euthanasia?
- Can individuals be allowed to give a “Living Will”, i.e. directives on medical treatment, if they become incompetent or unable to communicate in the future?
- Should the right to die and the right to die with dignity be studied comparatively?
Petitioner’s Arguments in Aruna Shanbaug Case
The petitioner in Aruna Shanbaug Vs Union of India case, contended that the right to life enumerated under Article 21 of the Constitution defines the right to live a fulfilled life with utmost dignity. It must, therefore, also include the right to die with dignity.
Individuals suffering from any terminal illness or permanent vegetative state must be included under the right to die with dignity to end the prolonged suffering and agony.
Ms Aruna lacks any awareness of her surroundings and is even unable to chew her food; she cannot express anything on her own and is just bedridden for the past 36 years with no scope for improvement. The patient is virtually dead, and the respondents, by not feeding Ms Shanbaug, will not be killing her.
Respondent’s Arguments in Aruna Shanbaug Case
The Respondent’s arguments in Aruna Ramchandra Shanbung Case are, the hospital dean contended that Ms Shanbaug was being fed and cared for by the nurse and hospital staff for as many as 36 years.
Now that the patient has crossed as many as 60 years of age, she might naturally succumb to death. The staff had exceptional and utmost responsibility and willingness to take care of her. Therefore, they opposed and resented the idea of Ms Shanbaug being euthanized.
They begged the court not to permit the act of killing since the staff had been diligently and with respect taking care of all her fundamental necessities and prerequisites. Therefore, if euthanasia has been legitimized, such a step can be profoundly inclined to abuse.
One medical attendant has even been willing to care for her without being remunerated. Therefore, it is evident that the petitioner, unlike the hospital staff, neglects to have a close-to-home connection with the patient and lacks the necessary emotional attachment. Moreover, since the hospital staff diligently and with utmost dignity took care of Ms Shanbaug for many years, they looked after her basic needs with care.
Legalization of passive euthanasia can be prone to misuse by family members and relatives. They pleaded with the court to reject the allowance of euthanasia.
Terminating Ms Shanbaug’s life would be immoral and inhuman since she has a right to live. Moreover, the hospital staff’s exceptional and selfless service must also be considered.
Furthermore, since the patient is not in a condition to consent to withdrawal from the life support system, the big issue is who would consent for Ms Shanbaug.
Decision of Aruna Shanbaug Vs Union of India Case
The court in the Aruna Shanbaug Vs Union of India case, distinguished between active and passive euthanasia. Active euthanasia can be seen as the positive and deliberate termination of one’s life by injecting and administering lethal substances. It is considered to be a crime worldwide except permitted by legislation. In India, active euthanasia is a straight infringement of Section 302 and Section 304 of the IPC.[1]
The High Court, under article 226, was entitled to make decisions regarding the withdrawal of the life support system. The apex court enlisted a proper procedure and guidelines for granting passive euthanasia in the “rarest of rare circumstances” while rejecting the plea made by the petitioner. A bench was constituted by the Chief Justice of the High Court when an application was received, before which a committee of three reputed doctors nominated was referred. A thorough examination of the patient, state, and family members was conducted along with a notice issued by the bench.
Therefore, in support of the “Parens Patriae” concept, the Supreme Court entrusted the authority to decide the end of a person’s life in the High Court in order to avoid any abuse. As a result, in certain circumstances and with the High Court’s consent after following the proper procedure, the Supreme Court permitted passive euthanasia.
However, Supreme Court opined that passive euthanasia could be allowed in exceptional and rare cases with due approval from the patient’s family members and doctors.
Supreme Court held that it should be sparingly used and not become a tool for eroding Article 21 of the Indian Consitution. Therefore, the court’s assessment of the medical report and the definition of brain death provided in the Transplantation of Human Organs Act, 1994, clearly explains that Ms Aruna’s brain was not dead.
Despite being in a Permanent Vegetative State, she had a stable state. She had sensations and could breathe without assistance. Therefore, ending her life was not warranted.
Ratio Decidendi of Aruna Shanbaug Case
The Supreme Court stated the following reasoning for its judgment in the Aruna Shanbaug Vs Union of India Case:
- It is pretty implied that all over the world, active euthanasia has been stated as illegal in the absence of any legislation permitting it. In contrast, even in the absence of legislation, passive euthanasia has been stated as legal.
- The report presented by the committee of doctors stated that Ms Shanbaug’s brain was then responsive to likes and dislikes, which she can express through small gestures and sounds like smiling and blinking eyes. Therefore, she was responding to the outside environment.
- The potential threat of misuse of passive euthanasia cannot be ruled out, which holds every chance of breaching Article 21 of the Constitution of India in the event of low ethical standards prevailing in our society and with increasing corruption. Therefore, there is a dire need for a balanced approach in such a sensitive issue, which includes a person’s death and life.
Critical Analysis of Aruna Shanbaug Case Judgment
Concept of Euthanasia in Brief
Euthanasia could be termed as a mercy killing, which defines any act or practice that contributes to painlessly putting to death of persons suffering from painful and irremediable disease or paralysed physical condition or permitting them to die by withdrawing treatment or any artificial life support system.
In the concerned case, High Court has provided specific guidelines concerning passive euthanasia. These guidelines enumerate the lawful procedure for withdrawing any medical treatment or artificial life support system to any patient that could lead to a person’s death. Such a judgment has legalized passive euthanasia in India under certain conditions that the High Court shall fix.
In 2018, in the case of Common Cause v. Union of India, Supreme Court stated that while considering the legality of passive euthanasia, it has to be noted that the right to die with dignity is included under Article 21 of the Constitution along with the right to life. Therefore, it is very much relevant to withdraw the life support system of patients suffering from a terminal illness who are in a coma for a lifetime; so that they can die with dignity.[2] The notion of “living will” was also provided in the concerned case. The concept of “living will” is a document that facilitates in taking the consent of a patient in advance in the event if and when, during the term of the treatment, the patient gets seriously ill or paralysed in future or becomes the victim of a situation or medical condition wherein he is unable to give consent or take any decisions. The document then serves as the concerned patient’s living will or living consent.
Right to Die v. Right to Die with Dignity
The right to life has been expressly provided in the Constitution under Article 21. On the contrary, the right to die has always been debatable and has not been expressly provided anywhere in the Constitution. However, the right to die has been diversely interpreted by various courts in their judgments based on their individual opinion and knowledge.
In the landmark case of State of Maharashtra v. Maruti Sripati Dubal, the Bombay High Court stated that the right to die had been included in the right to life as per enumerate under Article 21 of the Constitution. It was further stated that Section 309 of IPC is unconstitutional to the extent that it violates the provisions of Article 21 of the Constitution since the right to die directs towards the right to commit unnatural death.[3]
Later on, Supreme Court, in the case of P. Rathinam v. Union of India, passed the judgment, thereby recognizing the right not to live, which has been included in the right to live as enumerated under Article 21 of the Constitution.[4]
However, the Supreme Court, in the case of Gian Kaur v. State of Punjab, overruled the decision given in the P.Ratinam case and stated that the right to life should not include the right to die. Albeit, the right to life shall include a life that is lived with human dignity and further extends to the inclusion of the right to die with dignity.[5]
The Court held that there is a fundamental difference between the right to die and the right to die with dignity. The right to die shall include taking away a person’s natural life span, thereby causing unnatural death. However, the right to die with dignity shall include undertaking a process or causing a situation to accelerate the process of death in case of patients who are in a Permanent Vegetative State or under the influence of a coma for a lifetime. Therefore, the recognition of the right to die with dignity through passive euthanasia could be applied to terminate the lifelong suffering and mental agony of patients having paralysed physical conditions or incurable diseases.
It is evident that both of these rights are opposite and poles apart and should not be misinterpreted on purpose. Lately, the right to die with dignity has been recognized by upholding and legalizing the execution of Passive Euthanasia (both voluntary and involuntary).
Conclusion
Aruna Shanbaug’s case has, for the first time, laid down the guidelines relating to the procedure for execution of Passive Euthanasia in India. Prior to this, rarely was the concept brought into concern. The judgment in the concerned case has opened up a new horizon in regard to the right to die with dignity, thereby expanding the ambit of Article 21 of the Constitution.
[1] K D Gaur, Textbook on Indian Penal Code, 749.
[2] Vikram Deo Singh Tomar v. State of Bihar,1988 (Supp) SCC 734.
[3] 1987 (1) Bom CR.
[4] 1994 SCC (3) 3944. (1996) 2 SCC 648.
[5] (1996) 2 SCC 648.
