Sarmishtha Chakrabortty v. Union of India (2017)

Introduction 

This is a landmark judgment addressing the constitutional rights of pregnant persons to terminate pregnancy beyond the statutory limit where continuation poses severe mental injury and the foetus has life-threatening abnormalities requiring multiple high-risk surgeries with poor survival prospects. 

Facts 

• Sarmishtha Chakrabortty and her husband filed a writ petition under Article 32 of the Constitution seeking direction for constituting a medical board and termination of pregnancy. 
• The first petitioner was at 25 weeks of pregnancy when the case was heard, having previously suffered a stillbirth at seven and a half months in 2015. 
• The Supreme Court constituted a Medical Board at IPGMER-SSKM Hospital, Kolkata, comprising seven specialists including gynecologists, radiologists, cardiologists, neonatologists, and cardiac surgeons. 
• Fetal echocardiography revealed complex cardiac abnormalities: Tetralogy of Fallot, large perimembranous VSD with inlet extension, aorta from left ventricle overriding the VSD, pulmonary atresia, and duct/MAPCA dependent pulmonary circulation. 
• The Medical Board unanimously opined that the child, if born alive, would require multiple staged cardiac corrective surgeries with high mortality and morbidity at every stage.  
• The Board concluded that the patient faced threat of severe mental injury if pregnancy continued and recommended termination as a special case despite exceeding 20 weeks. 
• The petitioner spontaneously expressed her wish not to continue the pregnancy in view of detected fetal cardiac anomalies.

Issues Involved

• Whether termination of pregnancy should be permitted beyond 20 weeks where the foetus has severe cardiac abnormalities requiring multiple high-risk surgeries and continuation threatens severe mental injury to the mother? 
• What factors should guide courts in permitting medical termination of pregnancy in exceptional cases involving fetal abnormalities incompatible with normal life and maternal mental health concerns? 
• Whether the reproductive choice of a woman and her right to bodily integrity under Article 21 extend to terminating pregnancy in cases where the Medical Board certifies special circumstances warranting such intervention?
  

Court's Observations 

Right to Reproductive Choice:

• The Court invoked Suchita Srivastava v. Chandigarh Administration(2009), emphasizing that a woman's right to reproductive choice is an inseparable part of personal liberty under Article 21. She has a sacrosanct right to bodily integrity.  

Case-Specific Assessment

• The Court noted that cases of this nature must rest on their own facts, depending upon the Medical Board report and requisite consent under the Medical Termination of Pregnancy Act, 1971.
  

Maternal Mental Health:

• The Court found that the Medical Board clearly revealed the mother would suffer mental injury if pregnancy continued, and there would be multiple problems if the child was born alive.
  

Distinction from Other Cases: 

• The Court distinguished cases where termination was denied (Savita Sachin Patil and Sheetal Shankar Salvi) on grounds that those involved uncertain prognosis or no danger to mother's life, whereas this case involved clear medical opinion of severe mental injury and high mortality risk for the child.

Ratio Decidendi:

• The ratio decidendi established that where a Medical Board certifies pregnancy continuation poses threat of severe mental injury to the mother and the foetus has complex life-threatening abnormalities with poor survival prospects requiring multiple high-risk interventions, termination may be permitted beyond statutory limits as a special case, recognizing the woman's fundamental right to reproductive autonomy and bodily integrity under Article 21. 

Conclusion 

The Supreme Court allowed the petition and directed medical termination of pregnancy at IPGMER-SSKM Hospital, Kolkata, to be carried out forthwith. The Court emphasized that the decision was based on the comprehensive Medical Board report confirming severe fetal cardiac abnormalities, high mortality and morbidity risks, and threat of severe mental injury to the mother.