In a historic decision, the Supreme Court on Friday declared passive euthanasia and the right of persons, including the terminally ill, to give advance directives to refuse medical treatment legally permissible. The Constitution Bench held that the Right to Life under Article 21 includes easing the process of dying in the case of a terminally ill patient or a person in persistent vegetative state with no hope of recovery.
We are glad to inform that a piece on Law and Other Things on the wrong interpretation of law regarding ‘omissions’ in the Shanbaug judgment has been cited with approval in the concurring opinion of Justice Chandrachud. The piece written by Aparna Chandra and Mrinal Satish which originally appeared in 2011 in being reposted here.
The Supreme Court’s decision this week in Aruna Shanbaug v. Union of India raises important questions about the meaning of life, death and their relationship to law and to state power. Unfortunately the judgment in the case not only fails to grapple adequately with these issues, but also betrays faulty legal reasoning and an utter disregard for the law and the legal process. It gives short shrift to important constitutional issues, and is more concerned with foreign precedents than with Indian statutes, case law, rights and process. In doing so, it gets it all terribly wrong.
The case revolves around Aruna Shanbaug, a 60 years old woman who was violently raped in 1973. She sustained severe injuries resulting in brain damage, because of which she has been in a permanent vegetative state for the past 37 years. Ms. Shanbaug is being taken care of by the staff of the KEM Hospital in Mumbai, where she was herself a nurse at the time of the attack. In 2009, a petition was filed before the Supreme Court by Ms. Pinki Virani as Ms. Shanbaug’s next friend. She sought a direction to the KEM Hospital to stop feeding Ms. Shanbaug and to let her die peacefully instead of prolonging her life. Thus the question before the Court was whether Indian law permits passive euthanasia for a person in a permanent vegetative state.
The case was filed as a petition under Article 32. Upfront the Court clarified that the petition did not make out any violation of a fundamental right; and that therefore a petition under Article 32 was misconceived. However, “in view of the importance of the issues involved” the Court decided to “go deeper into the merits of the case.” Was the Court right in disregarding issues of its own jurisdiction? Or are questions of jurisdiction merely fodder for pedantic quibbling amongst lawyers? We believe that there are virtues to being pedantic in such matters. The court is after all a wing of the state, and as such a wielder of public power. Law is one instrument of keeping a check on public power and of ensuring accountability in its exercise. The system of rule of law cannot exist in bits and pieces. It either stands together or falls. If the Court can pick and chose when and where it wants to follow the law and when it is dispensable, we will move from a system of rule of law to the rule of judges. It is a sad fact that this episode is not a one-off instance of the Court deciding that if the law is inconvenient (as opposed to unconstitutional) it can disregard the law for the purposes of its own decision-making. As Pratap Bhanu Mehta has argued, the Court has increasingly taken to acting because it can, and not because it has the legal authority to do so.
B. Taking Rights Lightly
The focus on procedure is important also because process itself is often the site for substantive violations of rights. This case itself serves as an example. In one segment of the judgment, the court discussed its appointment of a group of doctors to examine Ms. Shanbaug’s condition. Along with their report the doctors submitted a CD which contained a video showing Ms. Shanbaug’s condition. The Court screened the CD before the entire courtroom “so that all present in court could see the condition of Aruna Shanbaug.” We don’t know if the CD covered Ms. Shanbaug’s full medical examination (hopefully not) but even without it, the public screening of a video detailing the physical and mental condition of a patient lying in her hospital bed in a permanent vegetative state, is surely a violation of her privacy and dignity rights. This did not even occur to the Court, and in this, the judicial process treated Ms. Shanbaug as an inanimate object of study and pity, rather than a rights bearing citizen entitled to respect and dignity.
Taking rights out of the picture is also evident in the very framework of the judgment. The decision is based on the following (il)logical sequence:
1. If passive euthanasia is not expressly prohibited by law, it is permitted.
2. Passive euthanasia is an omission.
3. Omissions are not criminalized.
4. Therefore passive euthanasia is not criminalized.
5. Therefore passive euthanasia is permitted.
Let us examine each of these claims. Reading the judgment it appears that the Court started out from the premise that if passive euthanasia is not expressly prohibited by law, it is to be permitted. However, Article 21 already provides for a broad prohibition against the taking of life except according to procedure established by law (and here the court agreed that Ms. Shanbaug is still alive in the legal sense). Therefore, with Art. 21 as the guiding principle, the starting premise rightly ought to have been – if the taking of life is not expressly permitted by procedure established by law, it is to be prohibited. This would have shifted the focus to examining whether in Indian law there is any law that permits the taking of life in such circumstances, rather than examining whether there is a prohibition to the effect. [Should the law permit the taking of life in such circumstances- that’s a different question entirely, and we would argue that in matters of life and death and the control of the state thereon, it should be for the legislature to decide.]
C. What’s Law Got To Do With It?
Even with the Court’s starting position that passive euthanasia is permitted unless expressly prohibited, the Court did not investigate Indian law to examine whether there exists such a permission. The decision was based on the erroneous major premise that omissions are not criminalized under Indian law. The Court stated, referring to the distinction between active and passive euthanasia that:
An important idea behind this distinction is that in passive euthanasia, the doctors are not actively killing anyone; they are simply not saving him. While we usually applaud someone who saves another person’s life, we do not normally condemn someone for failing to do so. If one rushes into a burning building and carries someone out to safety, he will probably be called a hero. But, if someone sees a burning building and people screaming for help, and he stands on the sidelines – whether out of fear for his own safety, or the belief that an inexperienced and ill-equipped person like himself would only get in the way of the professional firefighters, or whatever – if one does nothing, few would judge him for his action. One would surely not be prosecuted for homicide (Atleast, not unless one started the fire in the first place)…[T]here can be no debate about passive euthanasia: You cannot prosecute someone for failing to save a life. Even if you think it would be good for people to do X, you cannot make it illegal for people to not do X, or everyone in the country who did not do X today would have to be arrested. Some persons are of the view that the distinction is not valid. They give the example of the old joke about
the child who says to his teacher, “Do you think it’s right to punish someone for something that he didn’t do?” “Why of course not,” the teacher replies. “Good,” the child says, “because I didn’t do my homework.” In fact we have many laws that penalize people for what they did not do. A person cannot simply decide not to pay his income taxes, or not bother to send his/her children to school (where the law requires sending them), or not to obey a policeman’s order to put down one’s gun.
The classic definition of a crime requires an act (actus reus) and a corresponding mental element (mens rea). Whether an act includes an omission has always been a tricky question. A.P.Simester and G.R.Sullivan in their book “Criminal Law” point out how omissions in general are not criminalized. They highlight exceptions to the rule, which include:
• Specific Statutory and common law offences. Eg: Omission to file tax returns
• When the accused and the victim have a special relationship. Eg: Parent-child.
• Duties imposed on persons assuming a particular responsibility. Eg; Doctor-Patient
Hence, in common law, a doctor will be liable for at least some omissions that cause harm to the patient. In the decision of the House of Lords in Airedale v. Bland, the Law Lords held that omissions do not constitute the requisite actus reus for homicide. In Aruna Shanbaug, the Court accepted this as true of the Indian position as well, without examining the IPC.
What then about a person in a persistent vegetative state, and therefore incapable of consenting? It is useful to refer to Section 92 of the Indian Penal Code to understand the legislative mandate. This section, in dealing with the necessity defence, says that a person can do an act which benefits another, if that other person is not in a position to consent to the act. The section in its proviso, clearly says this does not extend to causing death or doing any act which is likely to cause death of that person. Applying this section to the present context, the Penal Code provides that if a patient is not in a position to give consent, a doctor can do anything that benefits the patient, short of actions that cause death or are likely to cause death.
Returning to omissions, it is important to remember that Section 32 refers to illegal omissions. What does “illegal” mean? Section 43 of the Indian Penal Code defines the term to mean “…everything which is an offence, or which is prohibited by law, or which furnishes ground for a civil action.” It can possibly be argued that since withdrawing life support to a person in a persistent vegetative state has not been made an offence, or expressly prohibited by law (though as we have shown, that might not be the case because of Section 92), the only question that remains is whether the person or his/her “next friend” would have a ground for civil action against the doctors. This would depend on the duty of care that the doctor owes towards the patient. It could be argued that if the doctor believes that it is in the patient’s “best interests” to stop treatment or withdraw life-support, s/he might be satisfying the duty of care required. However, this is a gray area, one on which there is no clarity in Indian law. It is hence possible to argue that withdrawing life support from a person in a persistent vegetative state is not an “illegal omission.” It was open to the Court to take this interpretation. The problem with the Aruna Shanbaug decision is that it did not discuss any of these provisions. It assumed that under the Indian Penal Code, omissions cannot constitute the actus reus for murder, or for any other crime. It blindly relied on Airedale to come to this conclusion. Was this reliance justified?
The judgment ended with the Court adopting the Vishaka strategy of legislating on the issue till the legislature decides to deal with the matter. This strategy has become well entrenched in Indian law, but there is need for questioning it. By stepping into the shoes of the legislature in this manner, the court gives itself plenary legislative powers (as opposed to incidental powers of legislation that are a concomitant of adjudication) that does not appear to have much basis in constitutional theory or in law. By turning to the judiciary for legislative intervention instead of the legislature, this procedure not only creates democratic deficiencies but also weakens the entire structure of the democratic State. In this case itself, the Court requested a team of doctors to not only examine Ms. Shanbaug, but also give the court their views on euthanasia. The only other person that the Court heard, apart from the parties to the case, was the Court appointed amicus. The courtroom space privileges certain voices over others, and judges get to pick and choose whom they want to hear. It is not as if these dynamics are not present in the legislative process. The problem is that these dynamics are wired into the very structure of the court process. Are we then not better of trying to reinvigorate the legislative process rather than using courts as substitutes thereof?
Dr Aparna Chandra is an Assistant Professor of Law and Research Director, Centre for Constitutional Law, Policy and Governance at the NLU-D. She is also a part of the editorial committee for LAOT. Dr Mrinal Satish is a Professor of Law, and the Executive Director of the same Centre.