By – Gurram Sai Ruchitha
Abstract
The topic of the “right to die with dignity” has triggered extensive legal and ethical discussions in India. In recent years, the courts have played a crucial role in shaping laws related to euthanasia. In 2018, the Supreme Court’s decision to legalise ‘passive euthanasia’ and introduce ‘living wills’ was a significant step in acknowledging an individual’s right to a dignified death. This article discusses the developments in law regarding the practice of “passive euthanasia” and whether the legalisation of passive euthanasia truly empowered individuals with the right to die with dignity, or is it a narrowly tailored concession with limited practical effect?
Introduction
‘Euthanasia’, which is also commonly referred to as “mercy killing”, means the deliberate act or practice of killing or bringing about the death of a person who suffers from a serious fatal disease that is not curable. So, instead of living under ‘palliative care’ in the hope of improving their quality of life for the rest of their lives, they choose to die on their own accord. Euthanasia has consistently been part of public scrutiny as it questions the ethics of medicine, leading to debates on whether it should be legalised or criminalised. Although euthanasia is treated as abetting suicide and is criminalised in many countries, a few nations allow it under strict conditions. India is among the nations that legally allow ‘passive euthanasia’ under strict conditions, even in the absence of a specific law or statute governing it. ‘Passive Euthanasia’ is one of the two types of Euthanasia, which allows a patient to die naturally through withdrawing or withholding life-saving treatment. The second one is ‘active euthanasia’, which entails killing a person by using any lethal substance to end the suffering of a person in a state of terminal illness. Even though both types of euthanasia involve allowing a terminally ill patient to die, the moral and ethical difference between them is ‘letting die’ and ‘killing’. Hence, “active euthanasia” is punished under Sections 103 and 105 of Bharatiya Nyaya Sanhita 2023 (BNS), unlike ‘passive euthanasia’. However, this article examines whether the legalisation of passive euthanasia in India has effectively recognised an individual’s “right to die with dignity” as a fundamental right and explores its impact on the evolution of euthanasia laws in the country.
From Criminalization to Constitutional Recognition: A Jurisprudential Journey
India’s early legal response to euthanasia was shaped by Section 309 of the Indian Penal Code, which criminalized attempted suicide and implicitly curtailed any discussion around self-determined death. However, the Supreme Court in P. Rathinam v. Union of India(1994) recognized ‘right to die with dignity’ as inherent in the ‘right to life’ under Article 21 of the Indian Constitution and deemed criminalization of attempted suicide under Section 309 of the IPC unconstitutional. But this decision was overruled in Gian Kaur v. State of Punjab(1996). It held that the ‘right to die’ is not a natural right, as no one has a right to finish their life in an unnatural way. It further held that Section 309 IPC did not violate Article 21, which meant that even medical professionals could be penalized for abetment of suicide if they withdrew life support from patients despite it being done through the patient’s consent. Even when the Law Commission of India’s 196th report in 2006 recommended enacting a law to safeguard medical professionals who were merely respecting the wishes of terminally ill patients, no legislative action was taken.
A major transformative shift happened with the Supreme Court’s decision in Aruna Ramchandra Shanbaug v. Union of India (2011), where it legalised ‘passive euthanasia’ for patients who are in a Permanent Vegetative State (PVS) and do not have the capacity to make decisions. This was limited only to patients who are stuck in a state of permanent unconsciousness with loss of cognitive function. The Court held that under Article 226 of the Constitution, High Courts have the authority to approve the withdrawal of life support for such patients, based on the recommendation of a panel of medical experts. This legal position was further reinforced in the landmark case of Common Cause v. Union of India (2018), where the Court not only affirmed the right to die with dignity as a fundamental right under Article 21, but also allowed individuals to create an ‘Advance Medical Directive (AMD) or ‘living will’. This allowed terminally ill patients suffering from irreversible conditions to specify their preferences regarding end-of-life care. The Court also established a framework for the formation of expert committees consisting of lawyers, doctors, and social scientists to oversee the implementation of living wills, thereby paving the way for a more structured and supportive approach to passive euthanasia in India. Finally, when BNS was adopted on July 1st 2024, Section 309 of the IPC was also completely removed protecting medical practitioners practicing ‘passive euthanasia’.
Implementation Challenges: The Gap Between Legal Recognition and Practical Enforcement
With the Common Cause judgment, India has joined the list of a few Asian Countries along with few European, Latin American countries that legalised ‘passive euthanasia’. Yet even this recognition is not unqualified. The procedures outlined initially required approval from a Judicial Magistrate First Class (JMFC), often making execution cumbersome. It was only in 2023 that the Court simplified the guidelines by removing this judicial layer, signalling a move toward a more patient-centred approach. These changes indicate a shift toward a more efficient approach, removing bureaucratic hurdles and making it easier for patients and families to access end-of-life care options while maintaining necessary safeguards. But how much legal evolution regarding the practice of euthanasia in India has really occurred when Kerala and Karnataka are the only two states that have implemented the Supreme Court’s order allowing ‘Right to Die’ with dignity. Only recently on January 30, 2025, the Karnataka government issued a circular to finally set up primary and secondary medical boards in hospitals for evaluating and approving requests for dignified deaths. And only in June 2025 did Kerala set up its second ‘Living Will’ counter to help patients prepare end-of-life declarations.
However, this isolated stance to only Kerala and Karnataka underscores the broader systemic gap in India’s euthanasia policy and a lack of institutional readiness. Even if the Ministry of Health and Family Welfare (MoHFW) issued draft guidelines for the withdrawal of life support in terminally ill patients, they are not binding unless officially notified and adopted into policy or law. Consequently, implementation is left to the discretion of individual states as healthcare is under the ‘State List’ and many of the states have neither issued guidelines nor established requisite institutional infrastructure yet. Hence, without a statutory or centrally binding legal framework, the guidelines are advisory at best, and fragmented implementation remains inevitable. ‘Public awareness’ is also very important, as every patient must be made aware of their right to draft a living will. With life-threatening illnesses like AIDS and cancer affecting all income groups, it is crucial to not compromise the rights of the economically disadvantaged. They should also have the right to choose between discontinuing life support to ease their suffering or continuing costly palliative care, even when there is little to no prospect of recovery .This requires public awareness campaigns by the Ministry of Health and Family Welfare. At the same time, Safeguards should also be introduced to protect patients without health insurance or financial resources from being pressured into choosing passive euthanasia out of helplessness.
Conclusion:
From penalising ‘passive euthanasia’ under ‘committing suicide’ to finally recognising it as a patient’s fundamental right to die with dignity in the 2018 landmark judgement, India has come a long way. Kerala and Karnataka, following the Supreme Court’s directives, finally recognise individuals’ fundamental rights over imposed morality while balancing medical ethics with human dignity. While this significant milestone is a step forward, its practical execution remains an evolving process. The need for widespread awareness, institutional reforms, and continuous legal directives is essential to truly uphold every individual’s choice to “right to die with dignity” to create a more humane and legally sound framework for end-of-life care.
About the Author
Gurram Sai Ruchitha is a second-year law student pursuing BBA LLB (Hons.) at O.P. Jindal Global University. The author is deeply passionate about the intersection of medicine and law, exploring how legal frameworks shape ethical medical practices.
Image Source : https://sl.bing.net/b2f4X3wDEpo
NICKELED AND DIMED 