Supreme Court Reserves Judgment On Plea To Withdraw Life Support For Man In Permanent Vegetative State

The Supreme Court today(January 15) reserved the decision on the plea to withdraw life support for a 32-year old man, who has remained in an irreversible permanent vegetative state for the past 12 years after falling from a building. 

Two medical boards constituted by the Court has reported that the man has no chance for recovery.

The bench comprising Justice JB Pardiwala and Justice KV Viswanathan was hearing a miscellaneous application of the father seeking to remove all life-sustaining treatment from his son. As per the guidelines laid down in the 2018 constitution bench judgment in Common Cause , as modified in the January 2023 order, which recognised the right to die with dignity, the Court has to get the opinions of Primary and Secondary Medical Boards before allowing his plea.

If the Court allows the plea, this will be the first ever case where the directions of the Common Cause have been judicially applied. 

The Court today heard the submissions of Advocate Rashmi Nandakumar(for the petitioner) and Additional Solicitor General Aishwarya Bhati (for the Union).

Nandakumar took the Court through the existing jurisprudence on the right to die from Gian Kaur, Aruna Shaunbagh, to Common Cause, in which the Supreme Court finally recognised that the right to life includes the right to die with dignity.

Nandakumar then took the Court through the directives in Common Cause, wherein once the primary and secondary medical board is constituted, the process ends here. However, when there is a contrary opinion of the primary and secondary medical board, then the case will have to go to the High Court, which will then constitute a three-member board consisting of a neurologist, a physician and a psychologist.

She also recommended that hospitals must have at least a list of doctors from which the Chief Medical Officer can nominate, since the whole process is time-sensitive. Nandakumar said that States like Goa, Maharashtra and Karnataka have already constituted medical boards. Nandakumar has sought the withdrawal of clinically assisted nutrition and hydration in accordance with appropriate palliative protocol and under medical supervision at the Institute of Human Behaviour and Allied Sciences, Government of NCT Delhi.

"They have looked after him for 13 years. His condition has not improved from day 1. They have done their best. But it is a fact that his condition will not improve and the parents are concerned for his best interest," Nandakumar said.

Justice Pardiwala asked what led the Delhi High Court to observe that Harish is not kept alive mechanically, and he was able to sustain himself. Nandakumar submitted that the High Court was wrong in observing that, especially when there was no medical determination before it.

Both counsels have visited Harish and her family, and even the Court has met the family members of the petitioner.

ASG Bhati concurred with Nandakumar's submission that Harish is in permament vegetative state and has no chance of recovery. She stated that they could not find one single judgment or order in which the Common Cause directions had been applied. She insisted that a well-considered view of the caregivers should also be given due weight. As for the submission made by Nandakumar that there must be permanent medical boards in hospitals, she pointed out that the primary and secondary boards will have to be constituted on case to case basis. 

Bhati also argued that omission is permissible in passive euthansia but that should not be the cause of death, but the underlying medical condition.

Bhati also compared the present case to Aruna Shaunbagh's case, where the lady was in a permanent vegetative state for 37 years after a brutal rape was committed on her. She said that in Shaunbagh's case, the entire nursing staff was not in favour of the medical support being withdrawn. Moreover, Shaunbagh still had some sense in terms of responding to threat perception, etc. whereas Harish has no such movements.

After hearing the arguments, Justice Pardiwala thanked both counsels for their able assistance and also orally remarked that since the matter is quite delicate, there is always a dilemma as to whether mortal beings can really make such decisions.

Consequent to the Court's orders, the Primary Medical Board was constituted, which reported that the man's chances of recovery were negligible. It was reported that he has been lying on the bed with a tracheostomy tube for respiration and a gastrostomy for feeding. The photographs showed that he has suffered huge bed sores.