Ananya Madhusudan BBA LLB 2013

PRECIS: Aruna Ramchandra Shanbaug vs Union of India & Ors

The case is a writ petition under Article 32 of the Constitution. Aruna Shanbaug, a staff nurse in King Edward Memorial Hospital was brutally sodomized by a sweeper in the hospital who had wrapped a dog chain around her neck, hence cutting the supply of oxygen to the brain. The petitioner demands that the respondent stops feeding Aruna any kind of food and to let her die peacefully. This case deals with the legality of passive euthanasia in relation to a person who is in a Permanent Vegetative Condition and whether the next friends opinion should be kept in mind. Three medical practitioners were brought in to examine Aruna Shanbaug. During the medical examination it was discovered that Aruna Shanbaug is not brain dead nor is she in coma, but she is in a vegetative state. Vegetative State refers to the complete absence of behavioural evidence for self or environmental awareness. Patients are awake but have no awareness. All features of permanent vegetative state were present during the medical examination of Aruna Shanbaug. The first issue arises whether a person who is in a permanent vegetative state, will the withholding or withdrawal of life sustaining therapies be permissible or `not unlawful? If the patient has previously expressed a wish not to have life-sustaining treatments in case of futile care or a PVS, should his / her wishes be respected when the situation arises? In case a person has not previously expressed such a wish, if his family or next of kin makes a request to withhold or withdraw futile life-sustaining treatments, should their wishes be respected? Every decision needs to be made in patients best interest and not influenced by personal convictions, motives or consideration. If the doctors treating Aruna Shanbaug, are acting in the best interest of the patient, feel that withholding or withdrawing life sustaining treatments is the appropriate course of action, they should be allowed to do so and their actions should not be considered unlawful. Active euthanasia is taking specific steps to cause the patient's death whereas Passive euthanasia is defined as withdrawing medical treatment with a deliberate intention of causing the patient's death. The Attorney-General of India, Mr Vahanvati stated that if passive euthanasia be allowed, it would give rise to cases wherein the families of patients who suffer from such Permanently Vegetative Condition conspire with the doctors to inherit property. Sanjay Oak, the appropriate surrogate to Aruna Shanbaug as her family cut all ties with her, is of the opinion that Indian society is not mature enough to accept the execution of an Act of Euthanasia and may misuse it. He was adamant about not removing her from her life support. Learned counsel argued by saying that in P. Rathinam vs. Union of India it was held that, Life is not mere living but living in health. The right to live with human dignity is the fundamental right of every Indian citizen. However, this was overruled in Gian Kaur vs. State of Punjab. No final view was expressed in the decision in Gian Kaur's case beyond the fact that in such cases to permit physician assisted termination of life is inconclusive. It was held
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Ananya Madhusudan BBA LLB 2013

that passive euthanasia can be made legal only through legislation. Mr T. R. Andhyarujina, learned senior counsel, was in favour of passive euthanasia provided the decision to discontinue life support was taken by responsible medical practitioners. He cited unnecessary USA and UK cases wherein the courts of USA took into consideration the opinion of the appropriate surrogate while determining whether passive euthanasia should be allowed to patients in a Permanently Vegetative State and the House of Lords took a contrary view on the Airedale case. In Airedale case, it was held that in cases wherein continuation of medication would not improve the condition of the patient and is on the verge of death, the doctor should not be in an obligation to nevertheless continue such medication. The question which arose in the Airedale case as to who is to decide what the patients best interest is when he/she is in a permanent vegetative state? It was held that it is ultimately for the court to decide as to what is in the best interest of the patient with the wishes of close relatives and friends and the opinion of medical practitioner. Does the court as a state has the authority to take such a decision? In the Anthony Bland case, it was held by Lord Keith that a medical practitioner is under no duty to treat such a patient where a large body of informed and responsible medical opinion is to the effect that no benefit at all would be conferred by continuing the treatment. Existing in a vegetative state with no prospect of recovery is by that opinion regarded as not being of benefit to the patient. It was observed that the principle of sanctity of life is not an absolute one. It was held by the court that passive euthanasia can be allowed under special circumstances however in this case it was declined. The High Court gave this decision with the principle of best interest of the patient and keeping in view the wishes of the next friend, in this case KEM Hospital.