The status of Euthanasia under the light of Aruna Ramchandra Shanbaug vs. Union of India

Introduction

The constitution of India under Article 21 guarantees right to life as a fundamental right to all its citizens as it states that no person shall be deprived of his life or personal liberty except according to the procedure established by the law. But over the time the judicial interpretation of article 21 has evolved expanding its scope from mere survival to a dignified life including right to health, privacy, clean environment and livelihood. Its interpretation has further been expanded by the judiciary in the landmark case of the Aruna Shanbaug vs union of India & Ors to include the right to die with dignity, it has paved the way for the legalisation of passive euthanasia in India.

Facts of the case Facts of the case">edit| ]

The petitioner, Aruna Ramachandra Shanbaug was a nurse in King Edward memorial hospital, Mumbai. On 27^th November,1973, a hospital sweeper assaulted her, wrapping a dog chain around her neck and violently pulling her back with. He wanted to rape her but after discovering that she was menstruating, he sodomized her. To disarm her during this act, he twisted the chain around her neck, which resulted in lack of supply of oxygen to the brain leading to brain damage. The next day the cleaner of the hospital found her lying on the floor with blood all over in an unconscious condition. 36 years has passed since the incident and now she is about 60 years of old. She had been serving only on the mashed food. It was alleged that Aruna Ramachandra Shanbaug was in a persistent vegetative state and was virtually a dead person and has no state of awareness, and her brain was virtually dead. She can neither see, nor hear anything nor can she express herself or communicate, in any manner whatsoever. Mashed food was put in her mouth, she was not able to chew or taste any food. She was not even aware that food has been put in her mouth. She was not able to swallow any liquid food, which shows that the food goes down on its own and not because of any effort on her part. Further it was alleged that there was slightest any possibility left for improvement in her condition and as her body lies on the bed in the KEM Hospital, Mumbai like a dead animal, and this has been the position for the last 36 years. The prayer of the petitioner was that the respondents be directed to stop feeding Aruna and let her die peacefully .

Issues raised in this case Issues raised in this case">edit| ]

1. Whether euthanasia can be made lawful by the legislature?

2. What is the difference between passive euthanasia that withdrawing the medical support to let the person die and active euthanasia means actively intervening to cause death?

3. Whether right to life guaranteed under Article 21 of the constitution of India includes the right to die with dignity, if further raises the question about whether preservation of the life of the person in persistent vegetative states infringes their dignity?

4. Whether a person incapable to provide consent, be entrusted non-voluntary passive euthanasia?

5. whether an individual be allowed to give ‘Advanced Directives’, that is directives on the medical treatment if they become incompetent or unable to communicate in the future?

Analysis of the case Analysis of the case">edit| ]

Them court defined euthanasia or mercy killing as an act or practice of painlessly putting to the death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures . It is of 2 types that is active euthanasia and a passive euthanasia.

Active euthanasia: it occurs when the medical professionals, or another person, deliberately do something that causes the patient to die .

Passive euthanasia: it occurs when the patient dies because the medical professionals either don't do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive .

1. switch off life-support machines
2. disconnect a feeding tube
3. don't carry out a life-extending operation
4. don't give life-extending drugs

Voluntary euthanasia: is when the consent is taken from the patient, whereas non-voluntary euthanasia is where the consent is not taken by the person who is not available to consent for example when the person is in a coma. Non-voluntary euthanasia poses several problems. And this landmark case deals with the legalisation of the passive euthanasia in India.

Right to die

The interpretation of Article 21 of the constitution of India has evolved over years the to include from mere right to life to right to live with dignity. In Indian context, the right to die has evolved significantly through the landmark cases such as Gian Kaur vs. state of Punjab in 1966, Aaruna Shanbaug v. union of India in 2011 and finally the common cause v. union of India in 2018.

Gain Kaur vs. state of Punjab : in this case, supreme court ruled that the right to life under article 21 does not include the right to die. The court upheld the validity of section 309 of the Indian penal code, which criminalizes attempting to suicide, ruling that life and death are natural process and that right to life does not include right to die .

Aruna Ramchandra Shanbaug vs. Union of India & Ors. : In this landmark case the court differentiate active and passive euthanasia. Further the supreme court permitted passive euthanasia under strict guidelines, allowing the withdrawal of life support for the persons in the persistent vegetative state . In this case, court ruled that right to life includes right to live with dignity, and in this case, the medical condition of Aruna Shanbaug was incurable and irreversible, and prolonging medical support infringes her right to live life with dignity. Further the court laid down specific procedure to be followed for passive euthanasia . They are as follows:

• The decisions must be taken either by the parents, spouse, or close relatives, and in the absences of any of them, by a close friend.
• A committee of medical experts must confirm the patients’ conditions.
• Then it requires approval from the high court to ensure that the decision is made in the best interest of the patients.

The court in this case also held that active euthanasia which includes active intervention to end the life, remains illegal in India .

Common cause vs union of India : in this case, the court further expanded on right to die with dignity. The court recognises the legality of living wills and advanced directives, allowing individual to outline the preferences for dying. It further issued guidelines regarding Advance Directives which are documents that detail the choices of the patient regarding treatment decisions along with who would be competent to take decisions on their behalf in case of their inability to do so. While the guidelines were amended in February 2023 to facilitate easier implementation of ADs to larger sections of society, they still place an onerous burden on each applicant. Each AD is subject to the opinion of two medical boards, and the decisions of the boards can only be challenged via writ petition under Article 226. The current position puts the onus largely on the families of the patients, who are subjected to a rigorous bureaucratic process to give effect to the ADs, which are notarised documents signed and testified in front of a judicial magistrate .

Conclusion

The Aruna Ramchandra Shanbaug case was a landmark case as it played a vital role in defining the legislative framework of euthanasia in India. The court further in this case legalised passive euthanasia under a strict guidelines and recognises the right to die with dignity while ensuring judicial oversight to prevent misuse.

Citation

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4,Ethics - euthanasia: Active and passive euthanasia BBC. Available at: .

5,Ethics - euthanasia: Active and passive euthanasia BBC. Available at: .

6.GIAN KAUR V. STATE OF PUNJAB

7.Aruna Ramchandra Shanbaug vs Union of India & Ors on 7 March, 2011. Available at: .

8.Euthanasia and the right to die in India Centre for Law & Policy Research. Available at: .

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