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Aruna Shanbaug Case: Legal Insights into the Landmark Judgment on Euthanasia and the Right to Die with Dignity

Aruna Shanbaug was a nurse at King Edward Memorial (KEM) Hospital, Mumbai (then Bombay). On the evening of 27 November 1973, Aruna, then 25, was changing her clothes in a room meant for experimental surgeries on dogs, when a hospital sweeper assaulted her.

Intending to rape her, he immobilized Aruna by twisting a dog chain around her neck; but when he discovered that she was menstruating, he sodomized her instead. She was found nearly twelve hours later, unconscious. Aruna suffered acute brain damage because the oxygen supply to her brain had been blocked for a long period of time. She never recovered from the attack and was relegated to the status of a helpless patient for the rest of her life.

Forty years had lapsed since the said incident. She had been surviving on mashed food and could not move her hands or legs. It was alleged that there is no possibility of any improvement in the condition and that she was entirely dependent on KEM Hospital, Mumbai. It was prayed to direct the Respondents to stop feeding Aruna and let her die in peace./

Aruna Ramachnadra Shanbaug (Petitioner) v/s Union Of India (Respondent)
Date: 7th March 2011
Coram: Markandey Katju; Gyan Sudha Misra, Jj.(Supreme Court)

Arguments Of Respondents And Petitioner Respondent:
The dean of the Hospital contended that Ms. Shanbaug was being fed and taken care of by the nurse and hospital staff for as many as 36 years. The staff had exceptionally and with utmost responsibility and willingness to take care of her. Therefore, they oppose and resent the idea of Ms. Shanbaug being euthanized. Now that the patient has crossed as many as 60 years of age she might naturally succumb to death.

They begged the court to not permit the act of killing. The staff has been diligently and with respect taking care of all her fundamental necessities and prerequisites. On the off chance that this is legitimized, the act of euthanasia can be profoundly inclined to abuse. One of the medical attendants has even been willing to take care of her without being renumerated. The petitioner unlike the clinic staff neglects to have such a close-to-home association with the patients and lacks the necessary emotional attachment. Since the staff diligently and with utmost dignity took care of Mrs. Shanbaug for many years.

They looked after her basic needs and requirements. Legalization of passive euthanasia can be prone to misuse by family members, relatives, etc. they pleaded with the court to reject the allowance of practice of euthanasia. The hospital staff has an emotional connection with the patient to the extent that one of the nurses is ready to look after Mrs. Shanbaug for the rest of her life without being renumerated. Terminating Ms. Shanbaug's life would be immoral and inhuman since she has a right to live.

Moreover, the hospital's staff's exceptional and selfless service must also be taken into consideration. Furthermore, since the patient herself is not in a condition to give consent for withdrawal from the life support system the next big question to come into the picture Is who would consent for Ms. Shanbaug.

A petition was filed by Ms. Shanbaug's friend under article 32 of the Indian Constitution. The counsel for the petitioner contended that the right to life guaranteed under article 21 includes the right to life with utmost dignity. It must therefore also include the right to die with dignity.

Any individual suffering from any terminal illness or is in a permanent vegetative state must be included under the ambit of the "right to die" in order to end the prolonged suffering and agony. She lacks any awareness of her surroundings, is even devoid of the ability to chew her food, can't express anything on her own, and is just bedridden for the past 36 years with no scope of improvement. The patient is virtually dead and the respondents by not feeding Ms. Shanbaug won't be killing her.

The Hon'ble Division Bench of the Supreme Court of India, comprising Justice Markandey Katju and Justice Gyan Sudha Mishra, delivered this historic judgment on March 7, 2011. The Court opined that based on the doctors' report and the definition of brain death under the Transplantation of Human Organs Act, 1994, Aruna was not brain dead. She could breathe without a support machine, had feelings and produced necessary stimulus.

Though she is in a PVS, her condition was been stable. So, terminating her life was unjustified. The court drew the distinction 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 2 and section 3043 of the IPC. Moreover, physician-assisted suicide is an offense under section 309 4 of IPC.

Passive euthanasia on the other hand is the withdrawal of life-supporting systems or medical treatment. The main distinction between active and passive euthanasia is that in "active" something is done deliberately to end life whereas in "passive" something is not done. A proper procedure and guidelines were enlisted by the apex court for granting passive euthanasia in the "rarest of rare circumstances" while rejecting the plea made by the petitioner. The High Court under article 226 would be entitled to make decisions regarding the withdrawal of the life support system.

A bench must be constituted by the Chief Justice of the High Court when an application is received, before which a committee of three reputed doctors nominated must be referred. There should be a thorough examination of the patient and state and family members are provided with a notice issued by the bench. The High Court must give a speedy decision.

The moral justification for allowing passive euthanasia against active euthanasia is not convincing. After all, depriving a patient of food (thus causing death by starvation) or antibiotics (thus causing a painful death) seems far more merciless than administering an instant and painless dose of death. The difference between the two forms of euthanasia hinges on a questionable dichotomy: 'killing' is not the same as 'allowing to die.

All that it means is that in a case of passive euthanasia, the doctor can say, 'I did not kill him. His death was only expedited by an omission to administer medical treatment.' Well, if an act comprising active euthanasia is murder, passive euthanasia would not be very far from it. The only practical difference is that active euthanasia can be abused/misused more than passive euthanasia, since even a healthy patient would die via an active euthanasia procedure. Also, unlike passive euthanasia, active euthanasia leaves no room for miracles of nature.

On the other hand, there is also significant concern over the Supreme Court's decision that Aruna Shanbaug should not be subjected to passive euthanasia. The court may have been carried away by the pleas of the dean and nurses of KEM Hospital. No one can question the dedication with which Aruna has been taken care of for close to four decades, but is it in her best interests to stay 'alive'? The 'quality of life' element and the 'best interests of the patient' test should have played a much larger role in the court's judgement .

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