Remembering Aruna Shanbaug whose pain changed euthanasia laws in India

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The Historical Verdict:

The Apex Court on March 9 upheld right to die with dignity and allowed passive euthanasia with guidelines. This is being considered the mile stone judgement in the history of Indian Judiciary. But this change in the mind set of the court has not happened in single day. The need to chamge the law relating to euthanasia was triggered by the the famous Aruna Shanbaug case. This is the case in which The Apex Court in 2011 permitted withdrawal of life-sustaining treatment from patients not in a position to make an informed decision. This is the first recognition of passive euthanasia.

What is the diffrence between active and passive euthanasia:
The court, while delivering its judgment, distinguished between active and passive euthanasia. Active euthanasia means killing a person through the use of lethal substance or force, and passive euthanasia means withdrawing or discontinuing medical support necessary for the continuation of life. The court rejected the plea for euthanasia for Aruna Shanbaug but legalised passive euthanasia in the country.
Who was Aruna Shanbaug:

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Aruna Ramchandra Shanbaug was a nurse in the King Edwards Memorial Hospital in Mumbai:
In 1973 Shanbaug was sexually assaulted by a ward boy, Sohanlal Bhartha Walmiki. Valmiki strangulated Shanbaug with a dog chain around her neck. She remained in a vegetative state following the assault.
The attack cut off oxygen supply from her brain and leaving her blind, deaf, paralysed and in a vegetative state for the next 42 years.

Nurses’ strike:

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Following the attack, nurses in Mumbai went on strike demanding improved conditions for Shanbaug and better working conditions for themselves. In the 1980s, the Municipal Corporation of Greater Mumbai (BMC) made two attempts to move Shanbaug outside the KEM Hospital to free the bed she had been occupying for seven years. KEM nurses launched a protest, and the BMC abandoned the plan.

What happened to Valmiki:

 

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In 1974, Valmiki was cahrged with attempted murder and for robbing Aruna’s earrings, but not for rape. The police did not take into account that she was sodomized. A trial court awards Valmiki seven years imprisonment. This is reduced to six years because he had already served a year in lock up. Valmiki walked out of jail in 1980 and still claims he did not rape Shanbaug.

On 24 January 2011, after she had been in this state for 37 years, the Supreme Court of India responded to the plea for euthanasia filed by journalist Pinki Virani, by setting up a medical panel to examine her. The court rejected the petition on 7 March 2011. However, in its landmark opinion, it allowed passive euthanasia in India.

Appeal for euthanasia in The Supreme Court:

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On 17 December 2010, the Supreme Court, while admitting the plea to end the life made by activist-journalist Pinki Virani, sought a report on Shanbaug’s medical condition from the hospital in Mumbai and the government of Maharashtra. On 24 January 2011, the Supreme Court of India responded to the plea for euthanasia filed by Aruna’s friend, journalist Pinki Virani, by setting up a medical panel to examine her. A three-member medical panel was established under the Supreme Court’s directive. After examining Shanbaug, the panel concluded that she met “most of the criteria of being in a permanent vegetative state”.

On 7 March 2011, the Supreme Court, in a landmark judgement, issued a set of broad guidelines legalizing passive euthanasia in India. These guidelines for passive euthanesia—i.e. the decision to withdraw treatment, nutrition, or water—establish that the decision to discontinue life support must be taken by parents, spouse, or other close relatives, or in the absence of them, by a “next friend”. This decision requires approval from the concerned High Court.

In its judgement, the court declined to recognize Virani as the “next friend” of Aruna Shanbaug, and instead treated the KEM hospital staff as the “next friend.”

We do not mean to decry or disparage what Ms. Pinky Virani has done. Rather, we wish to express our appreciation of the splendid social spirit she has shown. We have seen on the internet that she has been espousing many social causes, and we hold her in high esteem. All that we wish to say is that however much her interest in Aruna Shanbaug may be it cannot match the involvement of the KEM hospital staff who have been taking care of Aruna day and night for 38 years.

Since the KEM Hospital staff wished that Aruna Shanbaug be allowed to live, Virani’s petition to withdraw life support was declined. However, the court further stipulated that the KEM hospital staff, with the approval of the Bombay High Court, had the option of withdrawing life support if they changed their mind:

However, assuming that the KEM hospital staff at some future time changes its mind, in our opinion in such a situation the KEM hospital would have to apply to the Bombay High Court for approval of the decision to withdraw life support.

On 25 February 2014, while hearing a PIL filed by NGO Common Cause, a three-judge bench of the Supreme Court of India said that the prior opinion in the Aruna Shanubaug case was based on a wrong interpretation of the Constitution Bench’s opinion in Gian Kaur v. State of Punjab. The court also determined that the opinion was internally inconsistent because although it held that euthanasia can be allowed only by an act of the legislature, it then proceeded to judicially establish euthanasia guidelines. The court referred the issue to a larger Constitution Bench for resolution, writing:
In view of the inconsistent opinions rendered in Aruna Shanbaug (supra) and also considering the important question of law involved which needs to be reflected in the light of social, legal, medical and constitutional perspective, it becomes extremely important to have a clear enunciation of law. Thus, in our cogent opinion, the question of law involved requires careful consideration by a Constitution Bench of this Court for the benefit of humanity as a whole.

The staff at KEM Hospital and the Bombay Municipal Corporation filed their counter-petitions in the case, opposing euthanasia for Aruna. The nurses at KEM Hospital were quite happy to look after the patient and they had been doing that for years before petitioner Pinky Virani emerged on the scene.

At last peace came to Aruna:
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Aruna died on May 18, 2015. Aruna could only survive on mashed food. She could not move her hands or legs, could not talk or perform the basic functions of a human being. A few days before her death, Shanbaug was diagnosed with pneumonia. She was moved to the medical intensive care unit (MICU) of the hospital and put on a ventilator.

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