ARUNA RAMCHANDRA SHANBAUG V. UNION OF INDIA & OTHERS AIR 2011 SUPREME COURT 1290

BENCH: Justice Markandey Katju and Justice Gyan Sudha Misra

FACTS:

Arun Ramchandra Shanbaug, a staff nurse at King Edward Memorial Hospital in Mumbai, was brutally attacked on November 27, 1973, by a hospital sweeper who attempted to sexually assault her. When he discovered she was menstruating, he sodomized her and strangled her with a dog chain, leaving her unconscious. The following day, a hospital cleaner found her lying in a pool of blood, and it was later determined that the strangulation had cut off oxygen to her brain, causing severe and irreversible brain damage. Medical reports indicated extensive cortical damage, brain stem contusion, and cervical cord injury, leaving her in a permanent vegetative state. After 36 years, journalist Pinki Virani, acting as her next friend, filed a petition under Article 32 of the Indian Constitution, seeking permission for euthanasia. The petition argued that Aruna had no awareness of her surroundings and was effectively lifeless, relying entirely on medical support for survival. It urged the Court to allow the withdrawal of life-supporting treatments and essential medication to end her prolonged suffering. In response, the Supreme Court appointed a panel of three distinguished doctors to conduct a thorough medical evaluation and submit a detailed report on her condition.

ISSUES:

The case raised important legal and ethical questions regarding the withdrawal of life support for individuals in a permanent vegetative state. The primary concerns included whether it is lawful and permissible to disconnect life-support systems from a patient who is unable to recover or regain consciousness. Additionally, the issue of whether a living will, if available, should be respected in such cases was considered, as well as the rights of the family or next of kin to make decisions on behalf of the patient when the individual is unable to express their own wishes. These questions touch upon autonomy, ethics, and the role of medical professionals in decisions regarding the end of life, particularly when the patient is in a condition where they cannot make decisions themselves.

JUDGEMENT WITH REASONING:

The Supreme Court ruled in favour of allowing passive euthanasia under certain exceptional circumstances, subject to approval by the High Court. The Court emphasized that the decision to withdraw life support must be taken by close relatives or a "next friend" if family members are absent, with medical input from doctors, and approved by the concerned High Court. The Court denied euthanasia for Ms. Aruna Shanbaug, as the circumstances did not justify withdrawal of life support, and appointed the hospital staff as her surrogate for decision-making. Active euthanasia was firmly rejected as illegal under Indian law, and the Court urged the legislature to establish a clear framework for euthanasia.

The Court's decision was based on the understanding that, at the time of the ruling, there was no statutory provision in India explicitly permitting the withdrawal of life support for a person in a permanent vegetative state. The Court highlighted the importance of protecting the patient's fundamental right to life and the potential misuse of euthanasia by unscrupulous individuals. The Court noted that passive euthanasia, which involves withdrawing life support, could only be allowed in exceptional cases where it is in the best interests of the patient, subject to a thorough review by the High Court. This was to ensure that such decisions are not made lightly and are protected from misuse, particularly regarding cases involving individuals with no clear advocates.

The Court further relied on the principle of parens patriae, which holds that the state has a responsibility to act as the protector of individuals who cannot look after themselves. In this case, since Ms. Shanbaug was in a permanent vegetative state and had no close family to represent her, the Court appointed the hospital staff as her surrogate, ensuring her well-being and the proper handling of any future requests regarding her life support. Additionally, the Court addressed concerns over the societal implications of euthanasia, emphasizing that the decision should be made cautiously and with compassion for individuals facing permanent disabilities. The Bench also called for reforms, including the repeal of Section 309 of the IPC, criminalizing suicide attempts, in favor of offering mental health support to those struggling with such tendencies.

ANALYSIS:

The Supreme Court's decision in Aruna Ramchandra Shanbaug v. Union of India established a landmark stance on the permissibility of passive euthanasia under exceptional circumstances. The Court emphasized that while there was no statutory framework at the time regarding the withdrawal of life support from a person in a permanent vegetative state, it was important to ensure that any decision in such cases was made with utmost caution and scrutiny. The Court allowed for passive euthanasia but strictly subject to approval by the High Court, ensuring that such decisions were not made arbitrarily or out of malice. The Court rejected active euthanasia, deeming it illegal under Indian law, and highlighted the need for a clear legal framework to address euthanasia in a structured manner. This ruling underlined the Court's commitment to protecting the patient's right to life, while safeguarding against potential misuse in cases of vulnerable individuals.

The Court's reliance on the principle of parens patriae reflects its understanding of the state's role in safeguarding the interests of individuals who are incapable of making decisions for themselves. In this case, the hospital staff was appointed as the surrogate decision-maker, recognizing that Ms. Shanbaug’s condition left her without any family to represent her interests. The Court stressed the importance of ensuring that the withdrawal of life support was not only in the best interest of the patient but also done with compassion, given the societal implications of euthanasia. The decision further acknowledged the need for legal reforms, particularly regarding the criminalization of suicide attempts under Section 309 of the IPC, advocating for a more compassionate approach toward individuals facing severe mental health struggles. The case set a precedent for future legal discourse on euthanasia, balancing the sanctity of life with ethical considerations in end-of-life care.