Aruna Shanbaug: The Case Behind India's Living Wills

Who was Aruna Shanbaug?

Aruna Shanbaug was born on 1 June 1948 in Haldipur, a village in Karnataka, in south-west India. Her father died when she was ten. She was the only one of her brothers and sisters to finish higher education. When she could not afford school books, she borrowed them from older students (Wikipedia).

At 17 she moved to Mumbai to train as a nurse. She joined King Edward Memorial (KEM) Hospital, one of the city's big public hospitals. She planned to marry a young doctor there and was saving money for the wedding.

On 27 November 1973, at the end of her shift, a hospital cleaner attacked and sexually assaulted her inside the hospital. She was 25. The attack cut off oxygen to her brain. She was left blind, paralysed and with severe brain damage.

Doctors said she was in a persistent vegetative state. This means the body is awake at times and the eyes may open, but the person shows no clear awareness of themselves or the world.

Her attacker was sentenced to seven years in prison for attempted murder and robbery. He was never charged with rape. At that time, Indian law did not count the kind of assault he committed as rape (BBC, 2015).

Aruna stayed in a small side room at KEM for almost 42 years. Over time her family found it hard to visit, because of money, distance and illness. The hospital's nurses became her family. They fed her, washed her and turned her, year after year. In the 1980s, city officials tried twice to move her out to free the bed. The nurses protested, and she stayed.

Every new group of nursing students was taken to meet her. They were told: "She was one of us." The doctors who examined her for the Supreme Court in 2011 wrote down that detail. They also wrote that, thanks to the nurses, she had not developed a single bedsore since 1973 (2011 judgment).

Why did her case go to the Supreme Court?

In 1998 the journalist Pinki Virani published Aruna's Story, a book about her life. In December 2009, Virani asked the Supreme Court of India to order the hospital to stop feeding Aruna.

Her petition said Aruna had been in a vegetative state for 37 years and was "virtually a dead person". It argued that keeping her alive this way went against her right to dignity (BBC, 2011).

The hospital strongly disagreed. It told the court that Aruna "accepts the food" and "responds by facial expressions". The doctors' report said she seemed to enjoy the devotional music played in her room. Staff said she smiled when she was given her favourite fish and chicken soup. The dean of KEM, Dr Sanjay Oak, said: "She means a lot to KEM hospital" (2011 judgment).

So both sides cared about Aruna. One side saw decades of suffering. The other saw a woman who was still loved and looked after every day.

What did the court decide in 2011?

The court asked three doctors to examine Aruna. They found that she met most of the criteria for a permanent vegetative state.

Justice Markandey Katju wrote the judgment, sitting with Justice Gyan Sudha Misra. He admitted how hard the question was:

"we feel like a ship in an uncharted sea" — Justice Markandey Katju, Aruna Ramchandra Shanbaug v Union of India, 7 March 2011

On 7 March 2011, the court made two decisions at once (2011 judgment).

First, it said no to Pinki Virani. The court said Aruna's true "next friend" was not a writer who had visited her a few times. It was the KEM staff, who had been "looking after Aruna for 38 years day and night." The staff wanted her to live, so her care continued. The court praised Virani's "splendid social spirit", but said the staff should decide.

Second, it opened a door for other families. The court said that passive euthanasia could be lawful in India. This means withdrawing or not starting treatment that keeps a person alive, such as a breathing machine. Active euthanasia, where a doctor acts to end a life, stayed a crime. So did helping someone end their own life.

Think of it this way. Passive euthanasia is like no longer holding a door open. Active euthanasia is like closing the door yourself. Many legal systems treat these two acts very differently. Our guide to euthanasia, assisted suicide and MAID explains the terms.

The court set strict rules. Family members, a "next friend" or the doctors could ask to stop life support. But a High Court had to approve each case, after its own panel of three doctors examined the patient. Why so careful? The judges feared that "unscrupulous persons" might misuse the process to inherit a patient's property. These rules would apply, the court said, until Parliament made a law.

The nurses celebrated the verdict with sweets. Matron Archana Jadhav, who had been a nursing student in 1973, told the BBC: "We are extremely happy at the verdict." India's law minister called for "a serious debate" (BBC, 2011).

What happened to Aruna after the ruling?

Her daily life did not change. The nurses kept caring for her, and the hospital celebrated her birthdays.

Aruna Shanbaug died on 18 May 2015, aged 66. The nurses and hospital staff performed her funeral. Pinki Virani told the BBC:

"My broken, battered baby bird finally flew away. And she gave India a passive euthanasia law before doing so." — Pinki Virani, author of Aruna's Story (BBC, 2015)

How did India's law change after Aruna's case?

2012: Law Commission report. India's Law Commission, which advises the government on new laws, supported passive euthanasia in its 241st report. Parliament passed no law.

2014: Doubts about the 2011 ruling. In 2005 a charity called Common Cause had asked the Supreme Court to recognise a "right to die with dignity". In February 2014, three judges said the Aruna ruling contradicted itself. It said only Parliament could allow euthanasia, then made its own rules anyway. They sent the question to a larger bench of five judges (Wikipedia).

2018: Living wills become legal. On 9 March 2018, all five judges in Common Cause v Union of India agreed that the right to life in Article 21 of India's Constitution includes dignity in dying. Justice D.Y. Chandrachud wrote that "a constitutional expectation of providing dignity in death is protected by Article 21" (2018 judgment).

The court allowed adults to make a living will, also called an advance medical directive. A living will is like a letter to your future doctors. It says what treatment you would refuse if you become terminally ill or permanently unconscious and cannot speak for yourself. The judges also criticised the Aruna ruling. Justice Chandrachud said it had put the interests of doctors and carers above the interests of the patient. The head of Common Cause called it "a landmark judgement" (BBC, 2018).

2023: Simpler rules. The 2018 process was so slow that very few people could use it. A magistrate had to sign every living will, and doctors on the medical boards needed 20 years of experience. In January 2023 the Supreme Court made it simpler (Supreme Court Observer):

• A living will is signed in front of two witnesses and attested by a notary or gazetted officer (a senior government official).
• Two medical boards, each with at least three doctors with five years' experience, review the case. They should decide, if possible, within 48 hours.
• A magistrate is only informed after the boards agree, instead of approving each step.

2026: The first court-approved case. Harish Rana was an engineering student who suffered a severe head injury in 2013. He stayed in a vegetative state for more than 12 years. His parents cared for him and spent all their savings. He had no living will. On 11 March 2026, the Supreme Court allowed his life-sustaining treatment to be withdrawn. It was the first time an Indian court had approved this for a person (Al Jazeera). The court said withdrawal must not mean "abandonment", and that palliative care must continue (Supreme Court Observer). He died later that month, aged 31 (BBC, 2026). The court again asked Parliament to pass a law (OHRH).

To compare India with other places, see our guide to countries where euthanasia is legal.

Why do supporters say the rulings were right?

• Choice and dignity. Supporters say adults should be able to refuse treatment that only makes dying longer. The 2018 court said that refusing treatment "cannot amount to suicide". It lets an illness take its natural course.
• Less suffering for families. Mumbai doctor Nikhil Datar campaigns for living wills. He told the BBC that families often keep a patient in hospital because they cannot cope at home, and doctors feel unable to stop treatment, "so the patient ends up suffering with no way to express their wishes" (BBC, 2025).
• Judges cannot do it alone. Supreme Court lawyer R.R. Kishore wrote in 2015 that the 2011 ruling "did not offer much relief" to many people in "unbearable and irreversible agony". He argued that Parliament, not judges, should write clear rules (Indian Journal of Medical Ethics).

What are the concerns of critics?

• Religious voices. After the 2018 ruling, the Catholic Bishops' Conference of India said the Church "rejects any proposal concerning active euthanasia as well as passive euthanasia". It warned that legalising euthanasia "would place the lives of vulnerable people at risk". It also said that refusing burdensome treatment is acceptable when death is near, as long as normal care continues (Vatican News). See what different religions say about euthanasia.
• Disability rights. Writing about the Harish Rana case, former Supreme Court law clerk Raghav Sengupta warned that the language of "dignity" might "validate ableist intuitions about whose suffering counts". Ableist means assuming that disabled lives are worth less. He asked for clear limits, so the rules cover only people with no awareness, not people living with severe but conscious disability (Verfassungsblog).
• Money and pressure. The 2011 judges feared that relatives might misuse the process for property. Harish Rana's parents spent all their savings on his care. Critics worry that such costs could put quiet pressure on families, and on older or disabled people.
• Too little palliative care. Palliative care is care that controls pain and other symptoms. Supreme Court lawyer Shambhavi Singh notes that less than 4% of the 7 to 8 million Indians who need it can get it. She writes that a right to a dignified death without this care "risks becoming a right in name only" (OHRH). Our section on palliative care and how it differs from euthanasia explains what this care involves.
• The carers' view. For 42 years, the KEM nurses showed that a person in Aruna's condition could still be loved and cared for. A senior nurse asked: "How can anybody think of taking her life?" (Wikipedia).

Ask yourself: who should speak for a person who cannot speak? The family who loves them, the nurses who care for them, a doctor, or a judge?

What does Aruna's case mean for families today?

Aruna never said what she would want. Neither did Harish Rana. In both cases, other people had to guess, and courts had to decide. A living will is the clearest way to keep that decision in your own words.

If you live in India, here are practical steps. Our section on patient rights and advance directives explains the general ideas behind them:

• Talk first. Tell your family what matters to you. What would make life still worth living? What would you not want? Our guide on how to talk to your family about end-of-life wishes has opening lines you can use.
• Write it down. Any adult can make a living will. Sign it in front of two witnesses and have it attested by a notary or gazetted officer. See our guides to advance directives and living wills and how to write a living will.
• Name someone to speak for you. See how to choose a healthcare proxy.
• Find your custodian. State governments must appoint officials to keep copies of living wills. Maharashtra has named about 400 custodians, and Goa and Karnataka have taken steps too, but many states are still behind (BBC, 2025). Ask your local municipal office or hospital.
• Share copies. Give copies to your family and your doctor. A living will that nobody can find cannot help you.

A living will is not only for refusing treatment. Dr IP Yadev, a surgeon in Kerala, told the BBC about a man who used his will to ask for full life support. His only son lived abroad, and he wanted to live until his son could see him. A living will can record any choice, as long as it is yours.

Aruna Shanbaug never chose to become famous. Her long life in one hospital room changed India's law and gave families a way to be heard. Read more landmark stories in our guide to famous euthanasia and right-to-die cases, including Karen Ann Quinlan in the United States.

If you could not speak tomorrow, who would speak for you, and would they know what to say?