From Aruna Shanbaug To Harish Rana: How India's Passive Euthanasia Law Evolved

India's conversation on the right to die with dignity has evolved slowly, cautiously, and often through deeply tragic human stories. Two such stories, separated by more than a decade, mark the arch of this evolution: the case of Aruna Shanbaug, and the decision in Harish Rana allowing passive euthanasia for the first time.While the former set up the legal framework, the latter demonstrates how that framework is being implemented in practice. The judgments trace India's gradual shift from 'right to life with dignity' to 'right to die with dignity' too.Right to DieThe debate around the “right to die” began with Gian Kaur v. State of Punjab (1996), where a three-judge bench of the Supreme Court upheld the constitutional validity of the offence of abetment of suicide under the Indian Penal Code and ruled that the right to life under Article 21 does not include a right to die.Though the Top Court did not then rule on the validity of active or passive Euthanasia, it made an important observation that later influenced euthanasia jurisprudence. It noted that the right to live with human dignity would mean the existence of such a right upto the end of natural life. This also includes the right to a dignified life upto the point of death including a dignified procedure of death. In other words, this may include the right of a dying man to also die with dignity when his life is ebbing out.This observation left room for future judicial recognition of passive euthanasia and end-of-life autonomy.In 2006, the 196th Law Commission of India said that withholding life support or medical treatment of terminally ill patients does not attract criminal liability of attempt to suicide, provided it is done in the best interest of the patient.Aruna Shanbaug CaseThe debate on euthanasia in India first reached the judiciary through Aruna Shanbaug v. Union of India.Aruna Shanbaug, a nurse at King Edward Memorial Hospital, had been in a persistent vegetative state since a brutal sexual assault in 1973 deprived oxygen supply to her brain. She remained in this condition for more than four decades.In 2009, journalist Pinki Virani approached the Supreme Court seeking permission for euthanasia on Shanbaug's behalf.While the Court refused euthanasia (in 2011) largely because the hospital staff caring for Shanbaug opposed withdrawing life support, it delivered a historic ruling— passive euthanasia was legalised in India, subject to prescribed safeguards and High Court approval.At the same time, the Supreme Court had also held that passive euthanasia can be made lawful "only by legislation" and thus, the procedure prescribed by it should be followed until Parliament makes legislation on this subject.The judgment introduced the idea that in certain circumstances, withdrawal of life-support treatment may be legally permissible when recovery is medically impossible.Living Wills And Right To Die With DignityThe doctrine evolved further in Common Cause v. Union of India (2018), when a Constitution Bench of the Supreme Court comprising Chief Justice of India Dipak Misra, Justice A.K. Sikri, Justice A.M. Khanwilkar, Justice D.Y. Chandrachud and Justice Ashok Bhushan recognised that the right to die with dignity forms part of Article 21 of the Constitution.While holding that passive euthanasia is legally valid, the Top Court had said, “Though the sanctity of life has to be kept on the high pedestal yet in cases of terminally ill persons or PVS patients where there is no hope for revival, priority shall be given to the Advance Directive and the right of self-determination”.The Court had also introduced the concept of advance medical directives or “living wills.”A living will is a written document that allows a patient to give explicit instructions in advance about the medical treatment to be administered when he or she is terminally ill or no longer able to express informed consent.It includes authorizing their families to switch off life support in case a medical board declared that they were beyond medical help.The ruling significantly expanded patient autonomy by allowing individuals to retain control over end-of-life medical decisions even when they cannot communicate their wishes.Making Passive Euthanasia WorkableDespite the progressive nature of the 2018 judgment, its procedural safeguards proved extremely complex in practice. The 2018 judgment spelled out several safeguards relating to the competence of an individual to execute an advance directive and the procedure, its contents, how it ought to be recorded and preserved, when and by whom it could be enforced, where to prefer an appeal against a hospital medical board refusing permission, and the circumstances under which an advance directive could be revoked or would be inapplicable.However, soon thereafter, in 2019, the Indian Council of Critical Care Medicine moved an application before the Supreme Court, highlighting the difficulties faced by families or hospitals in executing living...

From Aruna Shanbaug To Harish Rana: How India's Passive Euthanasia Law Evolved

Akshita Saxena

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