India’s Supreme Court ruled that life support can be legally removed for some terminally-ill patients in a landmark ruling that will allow “passive euthanasia” for the first time.
The judgement came during a hearing into the case of former nurse Aruna Shanbaug, who has been in a vegetative state in a Mumbai hospital since being raped and strangled with a chain while at work 37 years ago.
A plea by journalist and friend Pinki Virani to stop her being force-fed was rejected by India’s top court on the grounds that Mr Virani was not eligible to make the demand on Ms Shanbaug’s behalf.
But withdrawing life support could be allowed under exceptional circumstances, provided the request was from family and supervised by doctors and the courts, a two-judge bench in the Supreme Court said.
The ruling gives some legal clarity in India in an area that has posed legislators and judges all over the world with moral dilemmas thrown up by modern medicine which can keep alive severely injured or persons with a disability.
In the case of a person in a permanent vegetative state and unable to speak for themselves, such as Ms Shanbaug, a re-quest to withdraw life support should come from family or a spouse, the court in New Delhi ruled.
The request should then be reviewed by the local High Court, which would rely on the opinion of a court-appointed panel of three doctors who would examine the patient and speak to hospital staff.
The supervision was required to prevent “unscrupulous” family members attempting to kill off wealthy relatives, the Supreme Court said.
“The commercialisation of our society has crossed all limits,” it said. “Hence we have to guard against the potential of misuse.”
Mr Virani filed the case in the Supreme Court in 1999 asking for Ms Shanbaug to be allowed to die with dignity. Both of her parents have died and other family members have not maintained contact with her, according to the petition.
Ms Shanbaug, who is bed-ridden, blind and in a vegetative state, has spent three-and-half decades being fed mashed food and cared for by a team of doctors and nurses.
Her attacker, a ward boy at the hospital, was freed after a seven-year jail sentence.
Lawyer T. R. Andhyarujina, who was an adviser to the Supreme Court in the case, told AFP it was the first time there had been a ruling on euthanasia by the top court.
“The court has accepted the withdrawal of a life support system, but has not given the permission to inject any lethal substance,” he said.
Laws on euthanasia or assisted suicide, in which patients are helped by doctors to end their own lives, vary across the world.
In Europe, Luxembourg, The Netherlands and Belgium have legalised it under strict conditions, while in Switzerland a doctor can provide a patient who wants to die with lethal medication that the patient takes by him or herself.
In 1994, the US state of Oregon became the first in the country to legalise euthanasia for certain terminally-ill patients. The state of Montana has also legalised it and the east coast state of Vermont is considering a law.
India’s Supreme Court ruled that the nurses who have cared for Ms Shanbaug, who is now 60, at Mumbai’s KEM Hospital were the only ones who could ask for feeding to be stopped.
In the absence of any family, they were Ms Shanbaug’s “next friend” in the eye of the law, rather than Pinki Virani, and they were in favour of keeping her alive.
“We consider it as a duty to look after her. The court has recognised our efforts,” Ms Bhanuprita, a nurse at the hospital, was quoted as saying by the Press Trust of India.
Indian laws do not permit euthanasia or self-starvation to the point of death, although fasting is a part of Indian culture, made famous by independence leader Mahatma Gandhi.
The only exception to the law on self-starvation is the religious practice of “santhara,” which sees elderly believers from India’s minority Jain religion give up food and water until death.