In a landmark verdict, the Supreme Court recently allowed withdrawal of life support for a 32-year-old man in coma for the past 13 years. Though this is the court’s first order allowing passive euthanasia, the groundwork for it was laid as far back as 2011.
The case that set the ball rolling
The first legal recognition of passive euthanasia came in the Supreme Court’s judgment in the Aruna Shanbaug vs Union of India case in 2011. In 1973, Aruna Ramchandra Shanbaug was sexually assaulted by a janitor at the King Edward Memorial (KEM) Hospital, Mumbai, where she worked as a nurse. Shanbaug suffered severe brain injuries during the brutal attack and fell into a coma.
Decades later, in 2009, activist and author Pinki Virani filed a petition seeking the Supreme Court’s approval to withdraw Shanbaugh’s life support, arguing that her continued existence is a violation of her right to live with dignity. As per the petitioner, Shanbaugh “cannot be said to be a living person and it is only on account of mashed food which is put into her mouth that there is a facade of life which is totally devoid of any human element”.
However, the staff at KEM Hospital, under whose care she had been, opposed the plea. In their submission, they argued, “Aruna accepts food normally and responds to commands through facial expressions or by making sounds. She appears happy and smiles when she receives her favourite food. She also enjoys devotional songs and music played in her room, which has a calming effect on her.”
In the end, the court rejected Virani’s plea to end Shanbaugh’s life, stating it is for the KEM Hospital staff to take a call on it, and not the petitioner.
“It is the KEM Hospital staff who have been caring for her devotedly, day and night, for so many years as her next friend. Therefore, it is for them to make that decision. They have clearly expressed their wish that Shanbaug should be allowed to live,” the court noted.
Guidelines laid down
However, what made this judgment significant is that the court agreed that passive euthanasia "could be considered as an option" in certain situations. Laying down the guidelines, it directed that when a euthanasia petition comes before a high court, its chief justice must constitute a two-judge bench to look into it. The bench must appoint a panel of three medical experts, which after carefully examining the patient, studying their medical history and consulting doctors treating them, must give its opinion on the right course of action. The bench can then take a call on granting passive euthanasia based on their opinion. “The above procedure should be followed all over India until Parliament makes legislation on this subject,” the top court ruled.
In the Shanbaug case, it noted that if and when the authorities at the KEM Hospital feel that withdrawing Shanbaug’s life-sustaining treatment is the appropriate course of action, they should be allowed to do so. Shanbaug passed away in 2015 after 42 years in a coma.
Passive euthanasia legalised
Although the court opened the door to passive euthanasia in 2011, it was only in 2018 that the “right to die with dignity” was recognised as a fundamental right under Article 21. In 2005, Common Cause, a Mumbai-based NGO, moved the Supreme Court seeking its recognition for ‘living wills’ or ‘advance medical directives’ of patients who are terminally ill. The petitioner also sought that ‘the right to die with dignity’ be declared a fundamental right. In its judgment, a five-judge Constitution Bench permitted the creation of a 'living will' by terminally ill patients on withdrawing medical support if they slip into a coma.
The court agreed with the petitioner and ruled that the right to live with dignity under Article 21 also includes the right to die with dignity. In doing so, it concurred with the views of American legal scholar Ronald Dworkin that “dignity may be compromised if the dying process is prolonged and involves becoming incapacitated and dependent”. The court directed the Centre to ensure that persons with “deteriorated health” or those who are terminally ill are able to execute a living will that contains an appropriate course of action that can be taken if they fall into a coma.
However, before a living will can be executed, the patient’s condition must be assessed by two medical boards: one appointed by the hospital treating the patient and the other by the chief medical officer of the relevant district. Both must agree that passive euthanasia is the best course of action.
Revisiting the norms
While the 2018 judgment legalised passive euthanasia, the court went a step further in 2023 by making the process easier and less time-consuming. Responding to a plea by the Indian Council of Critical Care Medicine, the court removed the requirement that a judicial magistrate attest the patient’s living will and that the document be kept in the custody of the district court. The medical boards were also given 48 hours to provide their opinions.
Landmark verdict
The first court order approving passive euthanasia came nearly eight years after the Common Cause judgment. Thirty-two-year-old Harish Rana from Ghaziabad suffered severe head injuries after falling from the fourth floor of a building in 2013 and has remained in a coma for nearly 13 years. In 2024, the Delhi High Court rejected a petition by his parents seeking permission to withdraw Rana’s life support, saying he was not on a ventilator.
The parents then approached the Supreme Court, which directed that two medical boards be constituted to assess Rana’s condition. Both concluded that he has been in a persistent vegetative state for 13 years and has no chance of recovery. Based on these and the submissions made by his parents and others, the court ruled that prolonging Rana’s life was not in his best interests and approved the withdrawal of life support.
“For the past 13 years, the appellant has lived a life defined by pain and suffering. A suffering made more cruel, as unlike most of us, he was stripped of his ability to even give voice to his anguish,” Justice Pardiwala stated. Life support in the case of Rana included the Clinically Administered Nutrition (CAN), which means food delivered directly to the stomach via a PEG tube and a tracheostomy tube to help with breathing.
The Supreme Court had recognised in the Common Cause case that a feeding tube constituted a form of life support. “Passive euthanasia occurs when medical practitioners do not provide life-sustaining treatment or remove patients from life-sustaining treatment,” Justice AK Sikri had said in the Common Cause judgment. While the Rana case verdict has been celebrated, what stands out in the eight years since the Common Cause ruling is the absence of legislation on passive euthanasia. The Rana case verdict reiterated that its guidelines will remain in place only until Parliament enacts a law on the subject.