Aruna Shanbaug v. Union of India

The Aruna Shanbaug v. Union of India (2011) case is a landmark judgment of the Supreme Court of India that dealt with the legality of euthanasia — specifically, passive euthanasia — in India. The Court, while rejecting a plea for active euthanasia in this particular case, for the first time recognised passive euthanasia as legally permissible under strict safeguards. The judgment opened a new chapter in Indian medical and constitutional jurisprudence by balancing the right to life and dignity (Article 21) with ethical and humanitarian concerns regarding the end of life.

Background and Context

Aruna Ramchandra Shanbaug, a nurse working at the King Edward Memorial (KEM) Hospital, Mumbai, was brutally assaulted on 27 November 1973 by a hospital sweeper. She was strangled with a dog chain and sexually assaulted, which left her brain-dead and in a permanent vegetative state (PVS).
Since then, Aruna was kept alive for over 37 years at the KEM Hospital, where she was cared for by nurses and doctors. She was unable to move, speak, or perform basic bodily functions independently but could breathe on her own and respond to some stimuli.
In 2009, Pinki Virani, a journalist and human rights activist, filed a writ petition under Article 32 of the Constitution, seeking permission for mercy killing (euthanasia) of Aruna Shanbaug. The petition argued that keeping her alive artificially violated her right to live with dignity under Article 21 of the Constitution.
The case raised profound ethical, legal, and medical questions about the meaning of life, death, and dignity under the Constitution.

Facts of the Case

• The petitioner, Pinki Virani, claimed to be Aruna’s “next friend” and sought permission for the withdrawal of life-sustaining treatment, arguing that Aruna was effectively “dead” and continuing medical intervention only prolonged her suffering.
• The respondents, including the KEM Hospital and the State of Maharashtra, opposed the petition. They maintained that Aruna was not brain-dead, that she was being cared for lovingly by the hospital staff, and that withdrawing treatment would amount to murder.
• To assist the Court, a three-member medical board comprising neurologists and psychiatrists was appointed by the Supreme Court to assess Aruna’s condition. The medical board confirmed that she was in a permanent vegetative state but not brain-dead, as she was able to breathe without external support.

Issues Before the Court

1. Whether euthanasia (mercy killing) should be permitted in India.
2. Whether the withdrawal of life support from a person in a permanent vegetative state is legally and constitutionally permissible.
3. Whether Article 21 (right to life) includes the right to die with dignity.
4. Who should decide — the patient, relatives, or the State — when life-sustaining treatment can be withdrawn.

Arguments of the Parties

Petitioner’s Arguments (Pinki Virani):

• The petitioner argued that Aruna had no chance of recovery and that keeping her alive in such a condition violated her right to live with dignity, which is an integral part of Article 21.
• It was contended that the continuation of artificial sustenance amounted to cruel and inhuman treatment, denying her dignity in death.
• The petitioner relied on international jurisprudence, including the Airedale NHS Trust v. Bland (1993) case from the UK, where passive euthanasia was permitted.

Respondents’ Arguments (KEM Hospital and State of Maharashtra):

• The respondents contended that Aruna was alive in the biological sense and was not in pain, as she could breathe unaided and had minimal reflexes.
• They argued that the hospital staff had taken loving care of her for decades and did not consider her life meaningless.
• They also submitted that permitting euthanasia could lead to misuse and abuse, particularly in cases involving elderly or dependent persons.

Judgment of the Supreme Court

The judgment was delivered on 7 March 2011 by a two-judge Bench comprising Justice Markandey Katju and Justice Gyan Sudha Misra.
The Court rejected the plea for active euthanasia in Aruna Shanbaug’s case but recognised passive euthanasia under strict judicial supervision.

Key Findings

1. Active vs. Passive Euthanasia:
   • The Court distinguished between two types of euthanasia:
     • Active Euthanasia: Involves a deliberate act of ending a patient’s life, e.g., by administering a lethal injection. This was held illegal in India.
     • Passive Euthanasia: Involves withdrawing or withholding life-sustaining treatment (e.g., removing a ventilator or feeding tube). The Court permitted passive euthanasia under strict conditions.
2. Right to Life and Dignity:
   • The Court held that Article 21 guarantees the right to live with dignity, which includes the right to die with dignity in cases of terminal illness or irreversible vegetative states.
   • However, this right cannot be interpreted as a right to die arbitrarily or by suicide.
3. Aruna Shanbaug’s Condition:
   • Based on the medical board’s report, the Court concluded that Aruna was not brain-dead, and her caregivers did not wish to withdraw life support.
   • Therefore, euthanasia was denied in her specific case.
4. Legalisation of Passive Euthanasia:
   • The Court recognised that passive euthanasia may be permissible in exceptional cases to relieve prolonged suffering.
   • It laid down detailed guidelines to regulate such cases until Parliament enacted a law.

Guidelines Laid Down by the Court

The Supreme Court formulated interim guidelines for allowing passive euthanasia in India:

1. Who Can File the Petition:
   • A decision to withdraw life support can be initiated by the parents, spouse, close relatives, or, in their absence, by a “next friend” (such as a doctor or hospital staff).
2. High Court’s Permission Required:
   • Such a request must be made to the High Court under Article 226, which will decide after considering medical opinions and all relevant facts.
3. Constitution of a Medical Board:
   • The High Court must appoint a team of three qualified doctors to assess the patient’s condition.
4. Hearing of All Stakeholders:
   • The Court must hear the views of relatives, doctors, and the State before granting permission.
5. Judicial Oversight:
   • Passive euthanasia can be carried out only with the approval of the High Court, ensuring judicial oversight to prevent misuse.

These guidelines were to remain in force until the legislature enacted a specific law governing euthanasia.

Ratio Decidendi

The ratio decidendi of the case is that passive euthanasia, involving the withdrawal of life-sustaining medical treatment for a person in a permanent vegetative state, is permissible under Indian law under judicial supervision. However, active euthanasia remains illegal. The Court interpreted Article 21 to include the right to die with dignity, but not the right to end one’s life by unnatural means.

Significance of the Judgment

The Aruna Shanbaug judgment is a milestone in Indian constitutional and medical ethics jurisprudence, marking the first time the Supreme Court addressed the legality of euthanasia.
1. Legal Recognition of Passive Euthanasia:

• The case legally recognised passive euthanasia in India for the first time, subject to safeguards.

2. Humanisation of Article 21:

• It expanded the interpretation of Article 21, linking life, dignity, and death as interconnected aspects of human existence.

3. Framework for Future Legislation:

• The judgment provided a judicial framework pending parliamentary legislation on euthanasia and end-of-life care.

4. Medical Ethics and Autonomy:

• It acknowledged patient autonomy and the need for compassion in end-of-life decisions.

5. Protection Against Misuse:

• The guidelines ensured judicial oversight to prevent euthanasia from being used for selfish or malicious purposes.

Criticism

• Ambiguity and Complexity: The distinction between active and passive euthanasia was criticised as artificial and ambiguous, as both lead to the same outcome.
• Excessive Judicial Control: Requiring High Court approval for each case was seen as cumbersome and impractical.
• Legislative Inaction: The absence of a specific law led to confusion among medical practitioners for several years.
• Moral and Religious Concerns: Certain groups opposed euthanasia on ethical and spiritual grounds, arguing that life and death are divine domains.

Subsequent Developments

1. Aruna Shanbaug’s Death (2015):
   • After being in a vegetative state for 42 years, Aruna Shanbaug died of pneumonia on 18 May 2015, still under the care of KEM Hospital nurses.
2. Common Cause v. Union of India (2018):
   • The Supreme Court in Common Cause (A Registered Society) v. Union of India (2018) built upon Aruna Shanbaug and went further, legalising passive euthanasia with advance medical directives (living wills).
   • It held that the right to die with dignity is a fundamental right under Article 21, thereby giving full legal recognition to living wills and end-of-life decisions.
3. Legislative Proposals:
   • The Law Commission of India, in its 241st Report (2012), recommended the enactment of legislation governing passive euthanasia, leading to the draft Euthanasia (Regulation) Bill, though it has yet to become law.

Legacy

The Aruna Shanbaug v. Union of India (2011) judgment remains a landmark precedent in Indian constitutional law for its humane approach to end-of-life care. It marked the judiciary’s first recognition that the right to live with dignity includes the right to die with dignity in certain circumstances.
The case transformed Indian legal discourse on bioethics, human rights, and medical decision-making, and paved the way for the Common Cause (2018) ruling, which fully legalised passive euthanasia and recognised living wills.
Through this judgment, the Supreme Court sought to harmonise law, medicine, and morality, affirming that compassion, dignity, and humanity must guide society’s approach to life and death.