Aruna Shanbaug v.

Union of India: A Landmark Case on Euthanasia

1. Introduction to the Case

1.1 Background of Aruna Shanbaug

- Aruna Shanbaug was a nurse at King Edward Memorial (KEM) Hospital in Mumbai.

- In 1973, she was assaulted by a ward boy, Sohanlal Bhartha Walmiki, who choked her with
a dog chain and sexually assaulted her.

- The assault cut off oxygen supply to her brain, leaving her in a Persistent Vegetative State
(PVS) with severe brain damage.

- Since the attack, Aruna remained in a vegetative state for 42 years, being cared for by the
staff of KEM Hospital until her death in 2015.

1.2 Persistent Vegetative State (PVS)

- PVS is a condition where a patient is awake but not aware of their surroundings or able to
communicate.

- Aruna could breathe without a ventilator but was completely bedridden, unable to speak,
move, or perform basic functions independently.

1.3 Significance of the Case

- The case raised fundamental questions about the right to life, the right to die with dignity,
and the legal status of euthanasia in India.

- It was the first major legal challenge to India’s stance on euthanasia and set the groundwork
for future laws on end-of-life decisions.
2. Facts of the Case

2.1 Filing of the Petition

- Pinki Virani, a journalist and author who wrote a book about Aruna’s plight, filed a writ
petition before the Supreme Court in 2010.

- She sought permission for passive euthanasia, arguing that Aruna’s continued existence was
without dignity and served no purpose.

2.2 Arguments for Euthanasia

- Virani argued that Aruna was not conscious of her surroundings, had no possibility of
recovery, and her existence was purely biological.

- The continued care was burdensome and devoid of any medical or ethical benefit to Aruna.

- The petition claimed that Aruna was effectively "trapped" in a body that no longer served
her, amounting to cruel and inhuman treatment.

2.3 Arguments Against Euthanasia

- KEM Hospital and the nurses who had cared for Aruna opposed the petition, emphasizing
the love and care they provided.

- They argued that Aruna was not in pain, was not suffering, and continued to show basic
reflexive responses.

- The staff contended that euthanasia was not necessary and that Aruna’s life still held value,
no matter the limitations of her condition.
3. Legal Issues Raised

3.1 Definition of Euthanasia

- Active Euthanasia: Involves directly causing the death of a patient, such as through
administering a lethal drug. This form is illegal in India.

- Passive Euthanasia: Involves withdrawing medical treatment or life support that keeps a
patient alive. This could include stopping feeding tubes, ventilators, or other life-sustaining
measures.

3.2 Constitutional Right to Life

- Article 21 of the Indian Constitution guarantees the right to life and personal liberty. This
right has been interpreted broadly, including aspects like the right to privacy, dignity, and
humane conditions of existence.

- The court had to determine whether the right to life included the right to die or to refuse
medical treatment.

3.3 Ethical Dilemmas

- Balancing the sanctity of life against the need to respect the dignity and autonomy of the
individual.

- The role of consent: Who has the right to make decisions for a patient in PVS? What if there
is no clear expression of the patient’s wishes?
4. Supreme Court's Judgment

4.1 Key Highlights of the Judgment

- The Supreme Court delivered its judgment on March 7, 2011.

- The court recognized the legality of passive euthanasia under specific circumstances but
rejected the plea for active euthanasia.

- The judgment created a legal framework for passive euthanasia, ensuring safeguards to
prevent abuse.

4.2 Guidelines for Passive Euthanasia

- Consent: For patients unable to consent, the decision must involve the patient’s family, close
relatives, or guardians.

- High Court Approval: A High Court bench must approve the withdrawal of life support,
ensuring it is in the patient’s best interest.

- Medical Board: The court must appoint a medical board of specialists to evaluate the
patient's condition before approving euthanasia.

4.3 Reasoning of the Court

- The court differentiated between active and passive euthanasia, recognizing that while
active euthanasia involves an intentional act to cause death, passive euthanasia allows natural
death by withholding life-sustaining treatment.

- The judgment was influenced by global precedents, such as the UK’s *Airedale NHS Trust
v. Bland* and the USA’s *Cruzan v. Director, Missouri Department of Health*.

- The court acknowledged the need for respecting patient autonomy but emphasized
safeguards to ensure that decisions are not taken lightly or abused.
5. Impact of the Judgment

5.1 Recognition of Passive Euthanasia in India

- The case established a legal framework that allowed passive euthanasia under judicial
oversight, marking a significant shift in Indian medical and legal practices.

- It provided clarity on how doctors and families could handle cases involving terminally ill
patients or those in PVS.

5.2 Advance Directives and Living Wills

- The judgment laid the groundwork for allowing advance directives, which are legal
documents in which a person can state their wishes regarding end-of-life care.

- In 2018, the Supreme Court in *Common Cause v. Union of India* recognized the validity
of living wills, allowing individuals to refuse life-sustaining treatment in the event of terminal
illness or PVS.

5.3 Ethical and Social Implications

- Sparked widespread public debate on the moral and ethical dimensions of euthanasia.

- Highlighted the importance of patient rights, autonomy, and the need for compassionate
care at the end of life.
6. Relevant Precedents and Cases

6.1 Indian Case: Gian Kaur v. State of Punjab (1996)

- In this case, the Supreme Court ruled that the right to life under Article 21 did not include
the right to die. This case had previously reinforced the illegality of suicide and euthanasia in
India.

6.2 International Cases

- Airedale NHS Trust v. Bland (1993, UK): The court allowed the withdrawal of life support
for a PVS patient, recognizing the legality of passive euthanasia under specific
circumstances.

- Cruzan v. Director, Missouri Department of Health (1990, USA): The U.S. Supreme Court
recognized a patient’s right to refuse medical treatment, emphasizing the importance of clear
evidence of the patient’s wishes.
8. Conclusion

8.1 Summary of Key Points

- The *Aruna Shanbaug* case was a landmark in Indian legal history, setting a precedent for
passive euthanasia and the rights of patients in PVS.

- The judgment balanced legal, ethical, and medical considerations, ultimately allowing a
humane approach to end-of-life care while ensuring necessary safeguards.

8.2 Future Implications

- The evolving legal landscape regarding euthanasia in India continues to shape how medical
professionals, patients, and families make decisions about end-of-life care.

- The recognition of living wills empowers individuals to make informed decisions and
ensures that their wishes are respected even when they cannot communicate them.
8.3 Ratio Decidendi (Binding Part of the Judgment)

1. Recognition of Passive Euthanasia: The Supreme Court allowed passive euthanasia in

2. Guidelines for Implementation: The court mandated that passive euthanasia requires High
Court approval, family consent, and evaluation by a medical board to prevent misuse.

3. Right to Die with Dignity: The court interpreted Article 21 of the Indian Constitution to
include the right to die with dignity, allowing the withdrawal of life support for patients in
terminal or irreversible conditions.

8.4 Obiter Dicta (Non-Binding Observations)

1. Discussion on Active Euthanasia: The court discussed active euthanasia, emphasizing its
legal prohibition due to ethical concerns and potential misuse.

2. Call for Legislation: The judgment highlighted the need for Parliament to create
comprehensive laws on euthanasia rather than relying on judicial guidelines alone.

3. International and Ethical Insights: The court referred to international cases and ethical
debates to provide context but these were not binding on the decision.