Passive Euthanasia Allowed : Mercy Killing can be allowed by the High Court.

Supreme Court of India ruled on mercy killing: passive euthanasia allowed with strict safeguards

In landmark judgment on Aruna Shanbaug case, Supreme Court permitted passive euthanasia in India, laying down detailed procedure and emphasizing the role of High Courts as parens patriae to protect patients' interests.

In a historic and deeply significant judgment dated March 7, 2011, the Supreme Court of India delivered its verdict in the case of Aruna Ramchandra Shanbaug, a nurse who was in a persistent vegetative state (PVS) for nearly 37 years after being brutally assaulted and strangled in 1973. The petition seeking permission for mercy killing (passive euthanasia) was filed by a social activist claiming to be her "next friend."

The Court rejected the petition filed by Ms. Pinki Virani, holding that she did not qualify as the next friend of Aruna Shanbaug, as the hospital staff who had cared for Aruna for decades had a stronger emotional and caregiving bond and were effectively her "next friends." The hospital staff opposed euthanasia and wished to continue care.

The Supreme Court extensively examined the medical facts and legal principles surrounding euthanasia. It distinguished between "active euthanasia" (illegal in India and amounts to murder or abetment to suicide under IPC Sections 302/304/306) and "passive euthanasia" (withholding or withdrawing life-sustaining treatment). The Court recognized passive euthanasia as legally permissible under strict conditions.

Key medical findings established that Aruna Shanbaug was in a permanent vegetative state with no hope of recovery, but she was not brain dead as her brain stem functioned, allowing autonomic functions like breathing and digestion without mechanical aid.

The Court laid down a comprehensive legal framework for passive euthanasia in India, given the absence of specific legislation. It held:

1. Decisions on withdrawal of life support must be taken by the patient's parents, spouse, or close relatives. If none are available, a next friend or doctors attending the patient may decide, but always acting bona fide in the patient’s best interest.

2. In Aruna’s case, the hospital staff acting as next friends opposed mercy killing, and their wishes were respected.

3. Any decision to withdraw life support must be approved by the concerned High Court under Article 226 of the Constitution, which acts as parens patriae (guardian of persons unable to care for themselves).

4. The High Court should constitute a medical board of at least three experts (neurologist, psychiatrist, physician) to examine the patient and submit a report.

5. The High Court must hear all interested parties including relatives, next friends, and the state before granting approval.

6. The Court emphasized the need to prevent misuse of euthanasia laws in India due to concerns about corruption and exploitation.

7. The Court recommended that Parliament consider deleting Section 309 IPC (attempt to commit suicide) as it is outdated and punishes persons who need help.

The judgment also discussed the legal and ethical principles of patient autonomy and beneficence, the distinction between euthanasia and physician-assisted suicide, and comparative international laws on euthanasia. It cited landmark foreign judgments such as Airedale NHS Trust v. Bland and US Supreme Court cases, but clarified that foreign decisions serve only persuasive value.

The Supreme Court praised the exceptional care and dedication of the KEM Hospital staff, who had cared for Aruna with compassion and professionalism for nearly four decades without a single bedsore developing.

Ultimately, the Court dismissed the petition but acknowledged that passive euthanasia could be permissible in India under a strict judicial procedure, signaling a progressive shift in Indian jurisprudence on end-of-life care.

This judgment sets a precedent for future cases involving patients in permanent vegetative states or terminal illnesses and will guide courts and medical practitioners on the legal parameters of mercy killing in India.

Statutory provisions

Article 21, Article 32, Article 226 of the Constitution of India; Indian Penal Code Sections 302, 304, 306, 309; Transplantation of Human Organs Act, 1994 Section 2(d), Section 3(6)

Aruna Ramchandra Shanbaug v. Union of India (SC) : Law Finder Doc id # 246622