2011 (3) TMI 1729 - SC - Indian Laws

Summary

Issues Involved:
1. Euthanasia and its legal implications.
2. Determination of "brain death" and "persistent vegetative state" (PVS).
3. Legal procedure for withdrawing life support in India.
4. Role of the High Court in approving withdrawal of life support.
5. Doctrine of Parens Patriae.

Detailed Analysis:

Euthanasia and its Legal Implications:
Euthanasia is categorized into active and passive euthanasia. Active euthanasia involves the use of lethal substances to end a person's life and is illegal in India under sections 302, 304, and 306 IPC. Passive euthanasia, which entails withholding or withdrawing medical treatment to let a patient die naturally, is considered legal under certain conditions and safeguards. The court distinguished between voluntary euthanasia (with patient consent) and non-voluntary euthanasia (without patient consent, e.g., in cases of coma or PVS).

Determination of "Brain Death" and "Persistent Vegetative State" (PVS):
The court examined the medical condition of Aruna Shanbaug, who has been in a PVS for 37 years. The medical report indicated that she had some brain activity, could respond to stimuli, and did not require a heart-lung machine. The court concluded that Aruna was not brain dead but in a PVS, making her eligible for considerations regarding passive euthanasia.

Legal Procedure for Withdrawing Life Support in India:
The court laid down the legal procedure for passive euthanasia, stating that a decision to withdraw life support should be taken by the patient's parents, spouse, close relatives, or next friend, or by the doctors attending the patient. However, such a decision must be bona fide and in the patient's best interest. The court emphasized the need for High Court approval to prevent misuse and ensure that the decision is in the patient's best interest.

Role of the High Court in Approving Withdrawal of Life Support:
The High Court, under Article 226 of the Constitution, has the power to approve the withdrawal of life support for an incompetent person. The Chief Justice of the High Court should constitute a Bench of at least two judges to decide on such cases. The Bench should seek the opinion of a committee of three reputed doctors and issue notices to the State and close relatives of the patient. The High Court should give its decision speedily, assigning specific reasons based on the principle of the patient's best interest.

Doctrine of Parens Patriae:
The court invoked the doctrine of Parens Patriae, which implies that the State has a duty to protect those who cannot protect themselves. The court, as a representative of the State, must take the ultimate decision regarding the withdrawal of life support for an incompetent person, giving due weight to the views of close relatives, next friend, and medical practitioners.

Conclusion:
The Supreme Court dismissed the petition for euthanasia for Aruna Shanbaug, emphasizing that the decision to withdraw life support should be taken by the KEM Hospital staff, who have been caring for her for 37 years, or by the High Court if the hospital staff changes their mind in the future. The court laid down detailed guidelines for the legal procedure to be followed in cases of passive euthanasia, ensuring that such decisions are made in the best interest of the patient and are subject to judicial oversight to prevent misuse.