Issues raised:

1. In a person who is in a permanent vegetative state (PVS), should

withdrawal of life sustaining methods i.e placement of an artificial feeding tube(in this case) be
permissible or 'not unlawful' ?

2. If the patient has previously expressed a wish not to have life-sustaining treatments in case of
futile care or a PVS, should his/ her wishes be respected when the situation arises? Further, can
death be in best interest of the patient?

3. If the patient is in PVS and unable to communicate his wish, should wishes of family or next
kin to withdraw futile life sustaining elements be fulfilled?
4. Who should take decisions on behalf of Aruna Shanbaug who is in a PVS and has been
abandoned by her family and looked after for the last 37 years by staff of KEM hospital?

Judgement with logical reasoning-

1) The Hon’ble Division Bench of the Supreme Court of India, comprising Justice
Markandey Katju and Justice Gyan Sudha Mishra, delivered the historic judgment on
March 7, 2011 where the court declared that it cannot be said that Aruna Shanbaug is
dead. The reasoning which the court gave was on the basis of the definition of ‘brain
death’ under the Transplantation of Human Organs Act, 1994. The court laid a difference
between brain dead and PVS where the brain stem continues to work and some reactions
may occur though there is very remote possibility of regaining consciousness so even
when there is no response as such but the person is able to respirate, he cannot be said to
be dead as mere “breathing” would enable him to be “alive.
The court further added that Aruna Shanbaug had feelings and she produced stimulus as she
recognizes presence of persons around her, makes vocal sound, waves hand, smiles at her
favourite food, would show the disturbed state when too many people are around and would
soothe herself when touched gently. She was also being able to breathe without support
machines. Since she met most of the critera of a person being in PVS, she was declared the same
however it was noticed that she had been stable for many years and thus terminating her life
would be unjustified.
 2) Further, the court said that there is no provision in our country for the
legal procedure for withdrawing life support to a person in PVS when he
is incompetent to make such a decision so the court agreed that passive
euthanasia should be permitted in the country in the situation so
required and hence the court followed the technique used in Vishakha’s
case (supra) and laid down the law which would be continued to be in
function until Parliament makes the law on the subject.
i) A decision has to be taken to discontinue life support either by the
parents
or the spouse or other close relatives, or in the absence of any of them, such
a
decision can be taken even by a next kin. It can also be taken by the doctors
attending the patient. However, the decision should be taken bona fide in the
best interest of the patient.
In the present case, court noted that Aruna Shanbaug's parents are
dead and other close relatives have left her ever since she was in such a
state. So, it is the KEM hospital staff, who have been not only her guardian
but have been caring day and night for so many long years, so they would be
considered next kin of her and not Ms. Pinky Virani who has only visited
her on few occasions and written a book on her and thus have no locus standi
in the court, however the court recognized her involvement and appreciated
her Hence it is for the KEM hospital staff to take that decision. The KEM
hospital staff have clearly expressed their wish that Aruna Shanbaug should
be allowed to live, hence she should not be allowed euthanasia.
ii) Even if a decision to withdraw life support is taken by family or next
kin, it still requires approval from the High court.