Criminal Appeal of No. 115 of 2009
This landmark judgment legalized passive euthanasia, which was for a long time considered as illegal or a matter of confusion. The case revolves around "Passive Euthanasia", removing a patient from medical support & the "Right To Die", so nothing as such is done like in Active Euthanasia, wherein deliberately the subject is killed with poisonous or lethal substances. There has always been a lot of debate whether Right To Die comes under Article 21, which has the broad scope of encompassing various rights.

Brief facts of the Case:

1. Aruna Ramchandra Shanbaug was a staff nurse at the King Edward Memorial Hospital, Parel, Mumbai.
2. On 27th November 1973, during the evening, she was assaulted by a sweeper (Sohanlal Bhartha Valmiki) in the hospital who wrapped a dog chain around her neck and tried to rape her but finding that she was menstruating, he sodomized her.
3. During this act, to prevent her from shouting or resisting him, he twisted the chain around her neck, which led to blockage of oxygen to her brain & further damage to the brain, leaving her virtually brain dead.
4. The next day on 28th November, 1973 at 7.45 a.m. a cleaner found her unconscious lying on the floor with blood all over.
5. Since then, she has been lying in the hospital in a Persistent Vegetative State (hereinafter referred to as P.V.S), where she had lost a lot of weight, her bones too had shrunk & she was overall unaware of her surroundings. Her teeth had decayed.
6. She also suffered from malaria (in 2009), which worsened her physical state and fed through Ryles' pipes, rarely she was fed orally.
7. This case, though, could have been dismissed in accordance with the judgment formed in Smt. Gian Kaur V/S State of Punjab, but based on circumstances & facts of the case, this case was continued.
8. The writ petition was filed by her friend Ms.Pinki Virani, on behalf of Aruna Ramchandra under Article 32 (Remedies), stating that she was in a persistent vegetative state, virtually dead & had no awareness of her surroundings.
9. Whereas the respondents are against the idea of passive euthanasia. According to them, she was already 60 years old and should've been left to die naturally rather than forcing her to death. She was also well-aware, feeling the presence of people and her conditions were improving too. She has been a part of the staff for four decades and was very attached to her emotionally.
10. Due to this, to look at the overall functioning of the victim, whether she suits the category of P.V.S or not, various examinations were conducted by the court.

Issues of the Case:

1. The First Issue covered in the case was whether Right To Die too came under the vast scope of Right To Life (Article 21), which had already encompassed many other rights (like, to livelihood, clean air, clean water etc.).
2. The Second Issue was about the topic of euthanasia, whether active & passive euthanasia both were illegal, or passive euthanasia was different from active euthanasia.
3. The Third Issue was about the differentiation between right to die and right to die with dignity.
4. Could the concept of passive euthanasia or living will be misused by family members and medical practitioners to gain an unfair advantage, who would consent for the victim's will to die.

Arguments from the Petitioner's Side
Aruna Ramachandra Shanbaug, about 60 years of age, is malnourished, her bones have become so weak and can break, if they are tangled by mistake. She is prone to bed sores. Her teeth had decayed causing her immense pain. She was only given mashed potatoes and later on things became worse when she was diagnosed with Malaria, due to which she was getting fed through Ryle's pipe. She is in a state of persistent vegetation and her brain is dead. She cannot feel surroundings around her or communicate at all.

According to all parameters, Aruna cannot be said to be a living person and there is not the slightest possibility of any improvement in her condition. This has been the position for the last 36 years and in this subhuman condition. The lawyer also quoted the case P.Rathinam V/S Union of India (1994); Life is not mere living but living in health. Health is not the absence of illness but a glowing vitality.

The petitioner begs and prays the respondents to stop feeding Aruna, and let her die peacefully with dignity. The right to live with human dignity also means to end natural life and includes a dignified death procedure. This right should not be equated with the right to die, which is an unnatural death.

Arguments from the Prosecution's Side
The prosecution claims that Aruna accepted the food normally and responded by facial expressions, by making sounds like shouting or grimaces, when she wanted to pass stool and urine in the toilet. She loved listening to music. They had never subjected her to intravenous food or fed her via a tube. She can easily swallow food. She was very well aware of her surroundings and functioning properly.

It had been only since September 2010, she developed Malaria and her oral intake dropped, due to which she was fed through naso-gastric tube feed. However, if small bites of food are held near her lips, Aruna accepts them gladly. It was very rare that in the world history of medicine there would not be a single case where a person is cared for and nurtured in bed for 33 long years and has not developed a single bed sore.

She was treated, not as a duty towards her but as a part of feeling of oneness. Not once, in over 33 years, has anybody thought of putting an end to her so-called vegetative existence. It would be cruel, inhuman and intolerable. For them, this practice of euthanasia might get misused by the friends or close ones of patients.

Legal Aspects Involved:
This case revolves around Articles 19, 21 of the Constitution of India and Sections 309, 306 of Indian Penal Code. They have been repeatedly mentioned in the case and so as to understand the core aspects, one needs to understand all these, well, especially in the ambit of the RIGHT TO DIE / RIGHT TO DIE WITH DIGNITY.

Article 19
Article 19, is the heart & foundation of the Constitution of India, which elaborates upon the right to freedom of speech & expression, that every individual in the country holds, to put forward their opinions without any disturbance or infringement from the state or other members of the society.

All Citizens Shall Have The Right:

• to freedom of speech and expression;
• to assemble peaceably and without arms;
• to form associations or unions;
• to move freely throughout the territory of India;
• to reside and settle in any part of the territory of India; and
• Omitted
• to practice any profession, or to carry on any occupation, trade or business

One needs to analyze this topic with maturity and comprehension, understanding that the right to die with dignity is a profoundly personal decision that intersects with broader societal values, individual autonomy, and medical ethics, how an individual can have autonomy & total rights over his/her body & choices he/she makes, keeping in minds its future consequences.

Article 21
The direct meaning over here would, to protect individuals from any restriction from state, any encroachment upon their personal liberties or life.

"No person shall be deprived of his life or personal liberty except according to procedure established by law."

It is a very wide topic that covers many rights within it: the right to live with human dignity, right to pollution-free nature, it even includes the right to protect a person's tradition, heritage and all that gives meaning to a man's life. Right to die with dignity has been taken up as a right under Article 21, by various High Courts, but it is very different from suicide, which is prohibited by law.

The sanctity of human life does not imply the forced continuation of existence in pain and suffering, but this doesn't mean that suiciding is under this only. It is in the case of a terminally ill person who should be permitted to terminate his pain and suffering by choosing to do so, rather than going through a long & slow painful death.

Section 306 & 309 of IPC
Section 306; Abetment of Suicide.- If any person commits suicide, whoever abets the commission of such suicide, shall be punished with imprisonment of either description for a term not exceeding ten years, and shall also be liable to fine (Penalizes & Criminalizes Suicide).

Section 309; Whoever attempts to commit suicide and does any act towards the commission of such offence, shall be punished with simple imprisonment for a term, which may extend to one year 1 [or with fine, or with both.] (attempt to commit suicide) KEYWORDS; Drugs/Trauma/Mental insecurities/Guilt/Abuse, considered as Unnatural Death, Mental Health Care Act 2017- Stress or Depression (to be not tried by court or punished, if not proven)

Overview of the Judgment
The court had appointed 3 distinguished Doctors (Dr. J. V. Divatia, Dr. Roop Gursahani, Dr. Nilesh Shah), to conduct a rigorous examination of Aruna Shanbaugh to determine whether the claims of Petitioner are right or that of prosecution. They concluded their examination on the basis of her medical history, physical/neurological and overall mental functioning, in which she was proclaimed as though being in a PVS, but she wasn't brain dead as said by Pinki Virani/ Petitioner. She was well aware of her surroundings and even responded through various gestures.

They also embarked upon the various statements made by staff & doctors (Dr. Sanjay Oak, Dr.Pazare) of the KEM hospital, who were willing to serve Aruna, without any remuneration. They also quoted the argument of Senior Learned Counsel for the Petitioner Mr.Naphade, who threw light upon Article 21, Right to die with dignity and case law of P. Rathinam V/S Union of India (1994), how active and passive euthanasia were different from each other.

They also talked about various foreign cases, like the Airedale NHS V/S Bland of the UK, the case Cruzan V/S Director, MDH of the USA, to touch upon the issues of passive euthanasia, right to die & also assisted suicide. Court finally referred to the past judgments upon the similar cases, overruling the judgment of P. Rathinam V/S Union of India, that Article 21 doesn't include the right to die and laws upon this matter could only be made by legislature.

They also referred to Gian Kaur V/S State of Punjab, & stressed on the need to remove Section 309 of IPC, a person committing suicide needs help rather than fine or punishment, who is already under distress or mental abnormalities. They also stressed the question of consent in such cases, as it could be used unjustly against the victim to gain unfair advantage.

With respect to technological growth in medical sciences, doctors shouldn't pronounce a case hopeless, without keeping in mind any new advancements in the field in the near future, quoting the case of Terry Wallis, who was 19 year old, with a baby daughter & a new, young family, who went into coma after accident, regardless of hopelessness in his case, he regained consciousness after 24 years. Thus, Aruna on the basis of a report formulated by the 3 doctors appointed by the court, & keeping in mind the KEM hospital's management, the court denied the plea of granting passive euthanasia to Aruna.

For future cases, they highlighted Article 226, of the Indian constitution, under which the court can grant approval for withdrawal of life support of an incompetent person.

They commended the efforts made by the KEM hospital, their unconditional dedication towards Aruna Shanbaug, & also Pinki Virani, a learned personality & activist who brought in this case & also wrote a book on Aruna Shanbaug's life.

Conclusion
This case became one of the most popular cases on the issue of Passive Euthanasia & Right To Die, even though Aruna was denied passive euthanasia, but this case very-well, outlined the procedures to be followed, & the basic, the very perplex question of whether Passive Euthanasia is legal in India or not?, whether one can be given the right to put an end to his/her life?, though the court left this upon the legislature to make laws upon, but overall the court recommended & added many interpretations & floated it in the climate of the country.

Keeping in mind, the suicidal rates in the country, the defences taken up by culprits regarding abetments or assistance in suicide, or even moves played by the wicked & the corrupt, to gain an unfair advantage over the victim, this domain is still under debate & confusion.

Though, it would not be wrong to say that, yes, the right to life might also include the right to die, if the conditions of a person are so severe or are beyond the scope of recovery, due to which he/she is not able to lead a dignified & healthy life. Right to die is a topic that has been in debate & controversies over the years, but no clear definitions or ideas have been attributed to it till now by the legislature.

There is a need for such laws, & widening the scope of RIGHT TO LIFE, to encompass this right to, under subjugations & various exceptions like, the country has done in several other laws.

References:

1. The Workmen's Compensation Act of 1923 - became known as the 1923 Employees Compensation Act - offers benefits for death, temporary incapacity, permanent partial disability, and permanent total impairment resulting from accidents or occupational diseases that happen while a person is employed. Compensation is given according to the severity of the injuries sustained while on the job.
2. The 1948 Employees State Insurance Act established a fund to cover medical expenses for workers and their families, in addition to providing monetary benefits for pregnancy and illness and monthly payments to workers in companies employing 10 or more people in the event of death or disability.
3. Maternity Benefit Act of 1961: The Indian Constitution's Article 42 imposes a duty on the state to offer maternity leave and reasonable, equitable working conditions. In order to guarantee social fairness for female workers, this Act was passed. Some of the main benefits of the Act were increased when it was revised in 2017. Women are granted 26 weeks of compensated maternity leave working in the organised sector. After Norway and Canada, India currently offers the third-longest maternity leave in the world.
4. The 1972 Payment of Gratuity Act: A gratuity is an upfront payment made by the business. The Act mandates that employers with ten or more workers give workers who have five years of professional experience or longer an extra fifteen days' pay apiece.

Also Read:

• Aruna Ramchandra Shanbaug v/s Union Of India

Award Winning Article Is Written By: Ms.Lavanya Naugai

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