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Aruna Shanbaug was a staff member of the King Edward Memorial Hospital.

She was
raped and strangulated with a dog chain by a co-worker who worked at the dog lab. She
was found in the cleaning room in the cleaning room the next day morning covered in
blood. She was examined by the doctors at the hospital and was diagnosed with plantars
extensor. She had no sense of awareness and her brain was virtually dead. The petitioner
submitted that the respondents should be directed to stop feeding her and let her die
peacefully but Gian Kaur V. State established that right to life is guaranteed by Article 21
of the Indian Constitution but it does not include the right to die. Since there was a
variation in the explanation of the condition of Aruna Shanbaug in the writ petition and
the counter affidavit submitted by Dr. Pazare (Dean, KEM Hospital), three doctors were
appointed to examine Aruna Shanbaug and submit a report of her condition to the Court.
In the report, the doctors stated that the hospital staff provided excellent care and fulfilled
her needs. Based on Aruna Shanbaugs behaviour, they established that she recognizes
and reacts to the presence of people around her. She accepted feed she liked and spat out
what she did not. Malaria had taken a toll on her health and because of this she cannot
accept oral feed. During the assessment of her health, she was unable to cooperate and
was unaware of surroundings. There were no signs of deteriorating skin or breathing
diseases. Her eyes were open and wakeful but there was no sign of awareness. Her system
was intact but there was no sign of movement. Her eyes reacted to hand movements in
front of her eyes and she was held not to be brain dead and not in coma. She was declared
to be in vegetative state, i.e., she appeared to be awake but had no awareness. The report
stated as follows
Vegetative State (VS) The complete absence of behavioral evidence for self or
environmental awareness. There is preserved capacity for spontaneous or stimulus-
induced arousal, evidenced by sleep-wake cycles. .i.e. patients are awake, but have no
awareness. Explanation: Patients appear awake. They have normal heart beat and
breathing, and do not require advanced life support to preserve life. They cannot produce
a purposeful, co- ordinated, voluntary response in a sustained manner, although they may
have primitive reflexive responses to light, sound, touch or pain. They cannot understand,
communicate, speak, or have emotions. They are unaware of self and environment and
have no interaction with others. They cannot voluntarily control passing of urine or stools.
They sleep and awaken. As the centers in the brain controlling the heart and breathing are
intact, there is no threat to life, and patients can survive for many years with expert
nursing care. The following behaviors may be seen in the vegetative state : Sleep-wake
cycles with eyes closed, then open Patient breathes on her own Spontaneous blinking and
roving eye movements Produce sounds but no words Brief, unsustained visual pursuit
(following an object with her eyes) Grimacing to pain, changing facial expressions
Yawning; chewing jaw movements Swallowing of her own spit Nonpurposeful limb
movements; arching of back Reflex withdrawal from painful stimuli Brief movements of
head or eyes toward sound or movement without apparent localization or fixation Startles
with a loud sound Almost all of these features consistent with the diagnosis of permanent
vegetative state were present during the medical examination of Aruna Shanbaug.
Minimally Conscious State Some patients with severe alteration in consciousness have
neurologic findings that do not meet criteria for VS. These patients demonstrate some
behavioral evidence of conscious awareness but remain unable to reproduce this behavior
consistently. This condition is referred to here as the minimally conscious state (MCS).

The issues in the case were as follows

1) In a person who is in a permanent vegetative state, should withholding or
withdrawal of life sustaining therapies (many authorities would include placement
of an artificial feeding tube as a life sustaining intervention) be permissible or not
2) If the patient has previously expresses a wish not to have life sustaining treatments
in case of futile care or a permanent vegetative state, should his/her wishes be
respected when the situation arises?
3) In case a person has not previously expressed such a wish not to have life
sustaining treatments, should their wishes be respected?

The Honble 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.

Further, the right to take decision on her behalf vested with the management and staff of
KEM Hospital and not Pinki Virani. The life saving technique was the mashed food,
because of which she was surviving. The removal of life saving technique in this case
would have meant not feeding her. The Indian law in no way advocated in not giving food
to a person. Removal of ventilators and discontinuation of food could not be equated.
Allowing of euthanasia to Aruna would mean reversing the efforts taken by the nurses of
KEM Hospital over the years.

Moreover, in furtherance of the parens patriae principle, the Court to prevent any misuse
in the vested the power to determine the termination of life of person in the High Court.
Thus, the Supreme Court allowed passive euthanasia in certain conditions, subject to the
approval by the High Court following the due procedure. When an application for passive
euthanasia is filed the Chief Justice of the High Court should forthwith constitute a Bench
of at least two Judges who should decide to grant approval or not. Before doing so the
Bench should seek the opinion of a committee of three reputed doctors to be nominated
by the Bench after consulting such medical authorities/medical practitioners as it may
deem fit. Simultaneously with appointing the committee of doctors, the High Court Bench
shall also issue notice to the State and close relatives e.g. parents, spouse, brothers/sisters
etc. of the patient, and in their absence his/her next friend, and supply a copy of the report
of the doctors committee to them as soon as it is available. After hearing them, the High
Court bench should give its verdict. The above procedure should be followed all over
India until Parliament makes legislation on this subject. However, Aruna Shanbaug was
denied euthanasia as the court opined that the matter was not fit for the same. If at any
time in the future, the staff of KEM hospital or the management felt a need for the same,
they could approach the High Court under the procedure prescribed. This case clarified
the issues revolving around euthanasia and also laid down guidelines with regard to
massive euthanasia. Alongside, the court also made a recommendation to repeal Section
309 of the Indian Penal Code. This case is a landmark case as it prescribed the procedure
to be followed in an area that has not been legislated upon.

The Counsel for the Petitioner, in his respectful submissions, relied on the case of Vikram
Deo V. State Of Bihar [1988 (Supp) SCC 734]. In this case, the Court had demonstrated in
the interpretation of Article 21 that every person is entitled to a quality of life consistent
with his human personality. The right to live with human dignity is the fundamental right
of every citizen. Also in the case of P. Rathinam V. Union Of India [1994 (3) SCC 394],
the Court stated that life is not mere living but living in health. Health is not absence of
illness but a glowing vitality. In the case of Gian Kaur V. State Of Punjab [1996 (2) SCC
648], protagonism of euthanasia on the view of existence in Permanent Vegetative State is
not a benefit to the patient of terminal illness being unrelated to the principle of sanctity
of life or the right to live with dignity is of no assistance of determining the scope of
Article 21 for deciding whether the guarantee of right to life therein includes right to die.
Right to die with dignity at the end of life is not to be confused or equated with the right
to die an unnatural death curtailing the natural span of life. Thereby implying that
termination of life due to suffering is not available under Article 21. The Counsel for the
Petitioner also brought to light the Report of the Law Commission of the year 2006
regarding the Medical Treatment of Terminally Ill Patients. Learned Attorney General
stated that the Government of India has not accepted the report of the Law Commission of
India on euthanasia. He further submitted that Indian society is emotional and care-
oriented. We do not send our parents to old age homes, as it happens in the West. He
stated that there was a great danger in permitting euthanasia that the relatives of a person
may conspire with doctors and get him killed to inherit his property. He further submitted
that tomorrow there may be a cure to a medical state perceived as incurable today.

In my opinion, the Courts decision of not allowing the passive euthanasia of Aruna
Shanbaug was justified. The decision to vest the right of taking decisions on behalf of
Aruna Shanbaug with the hospital as the staff took responsibility of her well being and
made sure that her health did not deteriorate was correct. The hospital staff did so without
fail for 37 years. The court very rightly distinguished between the removal of life support
systems and the discontinuation of food.
Though she was not able to cooperate with anyone, she could not communicate with
anyone, unaware of her surroundings and the people around her, she was neither in the
state of coma nor was she brain dead. This was based not only on the fact that there might
be a possible cure for her in the future but also on the fact that the power to take a
decision with respect to her euthanasia rested in the hospital staff and not her next friend
Pinki Virani.
According to me, the issue of non-implementation of any life support equipment, if
already decided by the person should be respected only if there is no scope for
improvement in the medical condition of the patient. If the patient has not already decided
and is in a condition in which the views or wishes cannot be obtained, the procedure
established by the Court in the judgment is apt and should be followed till the time there
is proper legislation for the same.
Therefore, the judges, in this landmark case, have taken the right decision of denying the
euthanaisa of Aruna Shanbaug based on the reasons stated in the judgment.