December 7, 2022

India’s Supreme Court allows “passive euthanasia”

Aruna Shanbaug, the brain-damaged woman who has lived in a Mumbai hospital for 38 years, should continue to live, the Supreme Court of India has ruled. Since the hospital staff are effectively her “next of kin”, a request for euthanasia made on Aruna’s behalf by activist Pinki Virani was turned down.

 

Aruna Shanbaug, the brain-damaged woman who
has lived in a Mumbai hospital for 38 years, should continue to live,
the
Supreme Court of India has ruled. Since the hospital staff are
effectively her
“next of kin”, a request for euthanasia made on Aruna’s behalf by
activist
Pinki Virani was turned down.

The nurses at King Edward Memorial Hospital
had fiercely resisted an attempt by an
activist to remove Aruna’s feeding tube so that she can starve to death.
The
justices praised their dedication in their judgement.

“The whole
country must learn the meaning of dedication and sacrifice from the KEM
hospital staff. In 38 years Aruna has not developed one bed sore,” the
judges
said. They praised “their noble spirit and outstanding, exemplary and
unprecedented dedication in taking care of Aruna for so many long years.
Every
Indian is proud of them.”

The Supreme Court has created an important legal
precedent, but it may have failed to clarify some important issues. At
the
beginning of their judgement,
Justices Markandey Katju and Gyan Sudha Misra acknowledged that
“we feel like a ship in an
uncharted sea, seeking some guidance by the light thrown by the
legislations
and judicial pronouncements of foreign countries”.

The main outcome was two conditions for
legal “passive euthanasia”. In this they basically followed the
reasoning of
the UK House of Lords in the famous 1993 Anthony Bland case (Airedale
National Health Service
Trust v Bland [1993] AC 789) which allowed doctors to
withdraw all life support from a person in a permanent vegetative state,
including nutrition and hydration.

As for the case in hand, they decided that Aruna
Shanbaug’s surrogate decision-maker was the King Edward Memorial
Hospital which
had adamantly supported continuing palliative care for the woman.
Therefore,
they dismissed a petition to withdraw Aruna’s hydration and nutrition so
that she
would die through starvation.

In the future, they said, “life support”
can be withdrawn provided that a close relative or “next friend” or even
the
doctors request it. However, approval must be sought from one of India’s
21
High Courts to ensure that the decision is in the best interest of the
patient.
This, the justices insisted is essential. “We cannot rule out the
possibility that
unscrupulous persons with the help of some unscrupulous doctors may
fabricate
material to show that it is a terminal case with no chance of recovery.
There
are doctors and doctors. While many doctors are upright, there are
others who
can do anything for money.”

Surprisingly, in a judgement of such
importance, the justices insisted on using the ambiguous and
controversial term
“passive euthanasia”. They apparently mean withdrawal of treatment to
allow a
patient to die of the underlying cause of his or her disease. Many
authorities
would simply call this withdrawal of burdensome treatment rather than
euthanasia, in which the intention is to kill the patient. And does
“life
support” include simple hydration and nutrition? The
Court may have
to revisit this thorny issue to settle these questions.

Michael Cook
euthanasia
India