PASSIVE EUTHANASIA IN INDIA

08.10.2025

PASSIVE EUTHANASIA IN INDIA

Context

The recent debate in the United Kingdom over the Terminally Ill Adults (End of Life) Bill, 2025 has revived a global ethical discussion on the right to die with dignity. For India, the issue is not about introducing active euthanasia but about strengthening the existing framework for passive euthanasia — ensuring that it is humane, transparent, and accessible to those in need.

Passive Euthanasia

Definition: Passive euthanasia refers to the withdrawal or withholding of life-sustaining treatment for a terminally ill patient when medical recovery is no longer possible. This allows death to occur naturally, avoiding unnecessary suffering.

Purpose: The concept aims to safeguard a patient’s right to die with dignity, preventing prolonged agony in cases where life support serves no curative purpose. It recognises autonomy and compassion as central to medical ethics.

Legal Evolution and Key Judgments

Early Position:
 Until 2011, euthanasia was entirely prohibited in India, and attempt to suicide was punishable under Section 309 of the Indian Penal Code (IPC).

Aruna Shanbaug v. Union of India (2011):

• Recognised passive euthanasia under strict judicial supervision.
   
• Allowed withdrawal of life support in exceptional cases, subject to High Court approval.
   
• Differentiated between active (illegal) and passive (conditionally legal) euthanasia.
   
• Affirmed that a life without dignity does not fall within the constitutional protection of Article 21.
   

Common Cause v. Union of India (2018):

• Declared that the Right to Die with Dignity is an integral part of Article 21 – Right to Life.
   
• Legalised Advance Medical Directives (Living Wills), allowing individuals to record their end-of-life choices.
   
• Established comprehensive guidelines for authorising passive euthanasia.
   

Present Legal Framework

Advance Directive (Living Will):

• Any adult of sound mind can prepare a living will stating when medical treatment should be withheld.
   
• It must be signed in front of two witnesses and attested by a Judicial Magistrate First Class (JMFC).
   

Medical Board Evaluation:

• A hospital forms a primary medical board of three senior doctors to certify that the patient’s condition is irreversible.
   
• The decision is reviewed by a secondary board led by the Chief Medical Officer (CMO) of the district.
   

Magisterial Oversight:

• The JMFC verifies the authenticity of the living will and the medical opinion before authorising withdrawal of life support.
   

In Absence of Living Will:

• Family members or the attending doctors may approach the court for permission, which follows the same two-tier medical evaluation.
   

Simplification by Supreme Court (January 2023):

• Removed the need for district collector approval.
   
• Empowered hospital-level ethics committees to authorise decisions.
   
• Retained the two-board review to prevent misuse or coercion.
   

Why the Current System Falls Short

• Administrative Delays: Multi-layered clearance procedures often defeat the purpose of providing timely relief to terminally ill patients.
   
• Low Awareness: Both the public and many medical practitioners remain unaware of the procedure for recording or implementing living wills.
   
• Emotional and Ethical Burden: Families experience moral guilt and financial pressure, discouraging formal consent.
   
• Institutional Gaps: Many hospitals lack ethics committees or trained palliative-care units to implement the law fairly.
   
• Legal Uncertainty: Doctors often hesitate to act, fearing criminal liability under IPC or medical negligence laws.
   

Ethical and Constitutional Dimensions

• Right to Dignity: The Supreme Court’s interpretation of Article 21 includes the right to live — and die — with dignity, free from prolonged suffering.
   
• Ethical Balance: Passive euthanasia reflects the principles of autonomy (respect for patient choice) and non-maleficence (avoiding harm).
   
• Judicial Caution: Courts maintain a clear line between “allowing to die” and “causing death,” ensuring moral restraint.
   
• Philosophical Acceptance: Indian spiritual thought views death as a natural transition, supporting conscious acceptance rather than denial of mortality.
   
• State Responsibility: Under Article 47, the State has a duty to ensure accessible palliative and end-of-life care as a part of public health policy.
   

Comparative Perspective

Global Experience:

• Nations like the Netherlands and the U.K. have advanced end-of-life laws supported by strong healthcare systems and ethical oversight.
   
• India, with its limited medical infrastructure, must prioritise procedural simplicity and ethical clarity before considering active euthanasia.
   

Indian Pathway:

• The focus should remain on improving the passive euthanasia framework — making it effective, compassionate, and free from bureaucratic hurdles.
   
• A balanced model combining compassion with caution can operationalise the right to die with dignity without crossing ethical limits.
   

Roadmap for Reform

1. Digital Advance Directives:

• Create a National Euthanasia Portal linked to Aadhaar, enabling citizens to register, modify, or withdraw living wills online.
   
• Include medical certification of mental competence and digital authentication to replace cumbersome paperwork.
   

2. Hospital-Level Ethics Committees:

• Mandate every major hospital to establish a committee of senior physicians, palliative experts, and an independent observer.
   
• Allow decisions on withdrawal of life support within 48 hours, ensuring speed and accountability.
   

3. Transparent Oversight:

• Replace ad hoc mechanisms with State-level health commissioners or digital monitoring dashboards.
   
• Conduct random audits and publish annual public reports to maintain trust and transparency.
   

4. Safeguards and Counselling:

• Impose a seven-day cooling-off period before final withdrawal decisions.
   
• Require mandatory counselling of patients and families by palliative-care specialists.
   
• Protect vulnerable individuals from emotional or financial coercion.
   

5. Capacity Building and Awareness:

• Integrate end-of-life ethics into medical and nursing education.
   
• Conduct public campaigns explaining living wills, palliative care, and patients’ rights.
   
• Partner with NGOs and local health missions to foster open dialogue in communities.

Conclusion

India’s journey on euthanasia is not about legalising death but about humanising the process of dying. Passive euthanasia, when guided by compassion, autonomy, and dignity, aligns with India’s constitutional and moral ethos. By embracing digital tools, empowering hospital ethics committees, and raising public awareness, the country can transform passive euthanasia from a symbolic legal right into a practical, humane reality—ensuring that every citizen has the right not only to live with dignity but also to die with it.