The Constitution of India guarantees the‘ Right to Life' to all its citizens. The constant, ever-lasting debate on whether Right to Die can also be read into this provision still lingers in the air. On the other hand, with more and more emphasis being laid on the informed consent of the patients in the medical field, the concept of Euthanasia in India has received a mixed response.

The Hon'ble Supreme Court of India, in the present matter, was approached under Article 32 of the Indian Constitution to allow for the termination of the life of Aruna Ramchandra Shanbaug, who was in a permanent vegetative state. The petition was filed by Ms. Pinki Virani, claiming to be the next friend of the petitioner.

The Court in earlier cases has clearly denied the right to die and thus legally, there was no fundamental right violation that would enable the petitioner to approach the court under Article 32. Nonetheless, the Supreme Court taking cognizance of the gravity of the matter involved and the allied public interest in deciding about the legality of euthanasia accepted the petition.

Facts
It was stated that the petitioner Aruna Ramachandra Shanbaug was a staff Nurse working in King Edward Memorial Hospital, Parel, Mumbai. On the evening of 27th November 1973 she was attacked by a sweeper in the hospital who wrapped a dog chain around her neck and yanked her back with it.

He tried to rape her but finding that she was menstruating, he sodomized her. To immobilize her during this act he twisted the chain around her neck. The next day, a cleaner found her in an unconscious condition lying on the floor with blood all over. It was alleged that due to strangulation by the dog chain the supply of oxygen to the brain stopped and the brain got damaged. Thirty six years had lapsed since the said incident.

She had been surviving on mashed food and could not move her hands or legs. It was alleged that there is no possibility of any improvement in the condition and that she was entirely dependent on KEM Hospital, Mumbai. It was prayed to direct the Respondents to stop feeding Aruna and let her die in peace.

Issues Raised

1. Whether Article 21 of the Constitution which guarantees the Right to Life includes the Right to Die.
2. Can euthanasia be made lawful only by legislation?
3. What is the difference between passive euthanasia and active euthanasia?
4. Can individuals be allowed to give 'Advance Directives', i.e. directives on medical treatment if they become incompetent or unable to communicate in the future?

Analysis
To be able to adjudicate upon the aforementioned issues, the court explained as to what is euthanasia. Euthanasia or mercy killing is of two types: active and passive. Active euthanasia entails the use of lethal substances or forces to kill a person e.g. a lethal injection given to a person with terminal cancer who is in terrible agony.

Passive euthanasia entails withholding of medical treatment for continuance of life, e.g. withholding of antibiotics where without giving it a patient is likely to die, or removing the heart lung machine, from a patient in a coma. A further categorization of euthanasia is between voluntary euthanasia and non-voluntary euthanasia.

Voluntary euthanasia is where the consent is taken from the patient, whereas non-voluntary euthanasia is where the consent is unavailable e.g. when the patient is in a coma or is otherwise unable to give consent. While there is no legal difficulty in the case of the former, the latter poses several problems. The present case dealt with passive non-voluntray euthanasia.

Right To Die:
The contention was that Section 309 of the Indian Penal Code was unconstitutional as it is violative of Article 19 and 21. It was held in this case by the Bombay high court that right to life also includes ‘right to die' and section 309 was struck down. The court clearly said in this case that right to die is not unnatural; it is just uncommon and abnormal. In the case of Gian Kaur v. State of Punjab, the validity of Section 306 of the IPC was in question, which penalized the abetment of suicide.

This case overruled P.Rathinam but the court opined that in the context of a terminally ill patient or one in the PVS, the right to die is not termination of life prematurely but rather accelerating the process of death which has already commenced. Further, it was also submitted that the right to live with human dignity must also include a death with dignity and not one of subsisting mental and physical agony. The status of Euthanasia under the light of Aruna Shanbaug case When the 'next friend' of Ms. Aruna Shanbaug had filed a petition before the Supreme Court asking it to direct the hospital to stop feeding her and allow her to die peacefully. Ms. Shanbaug was in a Persistent Vegetative State (PVS) since she had been sexually assualted in 1973.

The Court appointed a team of three doctors to examine Ms. Shanbaug and submit a report about her physical and mental condition. Although the court did not allow the withdrawal of medical treatment to Ms. Shanbaug, it discussed the issue of euthanasia at length and allowed passive euthanasia. It defined “passive euthanasia” as withdrawing treatment with a deliberate intention of causing the patient's death.

• The Supreme Court has held that the right to life includes the right to die with dignity.
• It held that passive euthanasia is allowed if the doctors act on the basis of notified medical opinion and withdraw life support in the patient's best interest.
• Invoking the Parens Patriae principle (Latin for "parent of the nation", where the Court can step in and serve as a guardian) it held that the Court is the ultimate decider of what is best for the patient. It extended this power to the High Court's under Article 226.
• 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.
• This case clarified the issues revolving around euthanasia and also laid down guidelines with regard to massive euthanasia. Alongside this, 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.

Conclusion
Fundamental Rights are necessary for leading a dignified and fulfilling life. Probably the most important Fundamental Right in the Indian Constitution is the Right to Life under Article 21. It is a right that encompasses within its broad domain the right to legal aid, right to a clean environment, and a plethora of other rights. The question that came to be considered in the present case was whether inherent in this sacred right is the right to die-whether a person can be allowed to control his death and decide to end his life.

The right to die has become important considering the advancement in medical jurisprudence and also the possibility of misuse of this right by family members. This case dealt with euthanasia in detail by distinguishing between active and passive euthanasia. Laws relating to euthanasia in different jurisdictions were considered.

The court deleted into a scenario where the patient was incapable of giving consent and specified who could approach the Court on his behalf. It also laid down guidelines prescribing the situation and procedure of administering passive euthanasia.

Written by: Sandeep Rana, BA+LLB, (5th-year student) at Chandigarh University)