The Supreme Court’s approval of passive euthanasia for Harish Rana has revived memories of Aruna Shanbaug, whose tragic 1973 assault led to India’s landmark euthanasia guidelines. Her case laid the legal foundation for recognizing the constitutional right to die with dignity in India.
More than five decades before the Supreme Court recently allowed passive euthanasia for Harish Rana, the tragic case of nurse Aruna Shanbaug had already shaped India’s legal debate on the right to die with dignity.
The heartbreaking incident, which took place in Mumbai in 1973, eventually led to a landmark Supreme Court ruling that introduced guidelines for passive euthanasia in India. As the Court has now permitted withdrawal of life support for Rana, the story of Aruna Shanbaug once again comes into focus for its historic impact on Indian constitutional law and medical jurisprudence.
Aruna Shanbaug was a young nurse working at Mumbai’s King Edward Memorial (KEM) Hospital. On November 27, 1973, after completing her shift, she was brutally attacked inside the hospital premises.
According to reports, Shanbaug had an altercation with a hospital ward boy, Sohanlal Valmiki. Valmiki later claimed in interviews that he had a strained relationship with her and accused her of frequently reprimanding him. He said that on the day of the incident Shanbaug refused his leave request, which led to an argument. In anger, he allegedly slapped her and left.
However, Shanbaug was later found severely injured inside the hospital. There was blood around her, and she was discovered leaning against a stool with a dog chain tightly wrapped around her neck. Medical reports revealed that she had been strangled with the chain and sexually assaulted.
The strangulation caused severe oxygen deprivation to her brain, leading to permanent neurological damage. Valmiki was later convicted of attempted murder and robbery for stealing Shanbaug’s watch and earrings, but he was not convicted of rape.
Author and journalist Pinki Virani, who later documented the incident and filed a euthanasia plea on Shanbaug’s behalf, explained a disturbing aspect of the case. She said,
“The worst part: he (Valmiki) was not sentenced for rape because he had not committed the rape vaginally; it was anal.”
The attack left Aruna Shanbaug with devastating injuries. Hospital staff later recalled that when they first discovered her, she tried to speak but could not form words. Soon afterward, she lost consciousness. The strangulation had cut off oxygen supply to her brain, resulting in irreversible brain damage. Her condition was later diagnosed as a persistent vegetative state.
Although Shanbaug’s eyes could open and she appeared to follow a sleep-wake cycle, her brain could no longer process what she saw. She suffered a brain stem contusion and cervical cord injury, which meant she could neither move her limbs nor communicate. For the next four decades, she remained bedridden and completely dependent on caregivers.
Shanbaug came from a large family with eight siblings. Over time, reports emerged that most of her family members stopped visiting her. However, the family later denied abandoning her, explaining that hospital authorities had asked them to take responsibility for her care, which they could not afford.
As a result, the nursing staff and colleagues at KEM Hospital became her primary caregivers and looked after her for more than 40 years.
At the time of the attack, Shanbaug was engaged in a relationship with Dr Pratap Desai, who also worked at KEM Hospital. In a later interview reflecting on those painful memories, Dr Desai recalled visiting her several times after the incident.
“Every time, I would try to speak to her,”
he said.
“But her condition never improved, and it became really painful to see her like that.”
Eventually, Dr Desai moved on with his life. He married in 1977, started his own clinic, and focused on what he described as “ordinary life”.
More than three decades after the attack, Aruna Shanbaug’s case reached the Supreme Court. In 2009, Pinki Virani filed a petition seeking permission for euthanasia on Shanbaug’s behalf. Virani argued that Shanbaug had been living in a permanent vegetative state for decades and that allowing her to die would end her prolonged suffering.
The Supreme Court admitted the plea and appointed a medical panel to examine Shanbaug’s condition. The panel concluded that she satisfied most of the criteria of a patient in a permanent vegetative state.
On March 7, 2011, the Supreme Court delivered a historic judgment. The Court laid down guidelines legalising passive euthanasia in India under certain circumstances. It ruled that a decision to withdraw life support should normally be taken by the patient’s parents, spouse, or close relatives. In cases where such relatives are absent, the decision could be taken by a person or group acting as a “next friend”.
In Shanbaug’s case, Pinki Virani had approached the Court claiming to be her “next friend”. However, the KEM Hospital administration opposed the euthanasia plea. The hospital argued that its staff had cared for Shanbaug continuously for decades and had developed a deep emotional bond with her. The Supreme Court agreed with this position and observed,
“…however much her interest in Aruna Shanbaug may be, it cannot match the involvement of the KEM hospital staff who have been taking care of Aruna day and night for 38 years”.
Because the hospital staff wished to continue her treatment and care, the Court rejected the plea for passive euthanasia. At the same time, the judgment created a legal framework for future cases involving patients in similar conditions. The Court also clarified that if the hospital staff later decided to withdraw life support, they could approach the Bombay High Court for permission.
The legal debate surrounding euthanasia continued to evolve in the years that followed. In 2014, the Supreme Court referred the larger constitutional question of passive euthanasia to a five-judge Constitution Bench. This development came after the NGO Common Cause filed a petition arguing that individuals should have the right to die with dignity.
The Central government opposed the proposal, warning of potential misuse and ethical complications. The government argued that the issue should be decided by lawmakers rather than the judiciary. In its submissions before the Court, the government stated,
“A doctor’s duty is to preserve life, not take it.”
Meanwhile, Aruna Shanbaug’s condition remained unchanged. In 2015, she developed pneumonia. Despite medical efforts to revive her, she passed away on May 18, 2015, after spending more than four decades in a vegetative state. The nurses who had cared for her for years performed her last rites, marking the end of one of the most tragic chapters in India’s medical and legal history.
In 2018, the Supreme Court Constitution Bench delivered another landmark ruling that significantly expanded the right to die with dignity. The Court formally recognised passive euthanasia as a part of the fundamental right to life under Article 21 of the Constitution. It also introduced the concept of a “living will”, allowing individuals to specify in advance that they do not wish to be kept alive through artificial life support if they enter an irreversible medical condition.
Explaining the principle behind the ruling, the Constitution Bench observed,
“When the sanctity of life is destroyed, should we not allow them to cross the door and meet death with dignity? For some, even their death could be a moment of celebration.”
The Supreme Court’s recent order in the Harish Rana case reflects the continuing relevance of these legal principles. Harish Rana, now 31 years old, has been in a vegetative state for 13 years following a tragic accident. In 2013, when he was a student at Panjab University, he fell from the fourth floor of a paying guest accommodation building and suffered severe brain injuries.
Since the accident, Rana has remained bedridden and completely dependent on medical support. He requires a tracheostomy tube for breathing and a gastrojejunostomy tube for feeding. His condition has shown no improvement for more than a decade.
Rana’s parents eventually approached the Supreme Court seeking permission for passive euthanasia, arguing that their son had no realistic chance of recovery and continued to suffer in a vegetative state.
While allowing the plea, a bench comprising Justice JB Pardiwala and Justice KV Viswanathan noted the tragic circumstances surrounding Rana’s condition. The Court said,
“Harish Rana was once a bright young 20-year-old boy pursuing education at Punjab University when he had a fall from the fourth floor of a building and sustained brain injuries. Harish was discharged, but a brain injury left him in a persistent vegetative state. He experiences a sleep-wake cycle and is dependent on others. The medical report shows no improvement in 13 years.”
The Court emphasised that while doctors are duty-bound to preserve life, there are situations where medical intervention can no longer serve that purpose. In such circumstances, the law must recognise the dignity of the patient and the emotional burden on families. The bench observed that although medical professionals must always attempt to treat patients,
“that duty no longer sustains when the patient has no hope of recovery”.
By allowing passive euthanasia in Harish Rana’s case and urging the government to consider enacting a comprehensive law on the issue, the Supreme Court has once again highlighted the difficult ethical and legal questions surrounding life, death, and dignity. At the same time, the legacy of Aruna Shanbaug’s tragic story continues to shape India’s evolving jurisprudence on the right to die with dignity.
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