India's Supreme Court Confronts the Reality of Passive Euthanasia: A Call for Paradigm Shift

The Supreme Court has set up a secondary medical board to examine a youth and help decide the fate of his plea for passive euthanasia. As a debate resurfaces, fulfilling conditions to earn judicial nod to a dignified death remain infeasible and demand a paradigm shift, explains CKG Nair. The Supreme Court is faced with the ground realities of implementing its earlier judgments on passive euthanasia. In an appeal seeking passive euthanasia, filed by the parents of Harish Rana, a young man in a vegetative condition for 12 years. The court, during a hearing last week, remarked, “We will have to do something now. We can’t allow him to live like this.” In 2018, the Supreme Court legalised passive euthanasia, in the Common Cause vs Union of India; but under rigorous conditions. In 2023, a five-judge Bench of the court relaxed some of the conditions. The court also emphasised that “the fundamental right to life, under Article 21 of the Constitution, also include the right to dignified death”. And a dignified life (including death) and personal liberty go together. Accordingly, every individual has been granted the right to specify the conditions under which s/he does not want to proceed with her/his life; when s/he reaches a stage/condition which is not dignified. A living will is a formal, legally valid document prepared in advance by a person in a state of full consciousness, and without any external compulsion, stating under what conditions s/he does not want to prolong life by means of medical support. Since the health/medical conditions under which the will has to be invoked are to be specified in that document, it is also called advance medical directive/s. The conditions relate to documenting and preserving living wills and enforcing them at the time of need are laborious. The governments of states and Union Territories have to notify the rules, nominate custodians for preserving copies of each will, and retrieve it when sought by the hospital authorities. In India, the concept of a living will has evolved over time with landmark judicial verdicts shaping the legal discourse on the right to a dignified death as a fundamental right under Article 21. Euthanasia and/or medically assisted deaths are legal in some countries. Switzerland, the Netherlands, Belgium, Luxembourg, Canada, Colombia, Spain , New Zealand, and Ecuador allow it although with varying criteria regarding incurable conditions, unbearable suffering, and age. A few states and territories in Australia and the US also allow it. Portugal and Uruguay have passed laws; France and the UK are at different stages of making the law. In India, crossing the first step of judicial sanctity for passive euthanasia in 2018 was a milestone. In order to implement the will, confirmation from two medical boards—a primary and a secondary medical board, the latter one with a representative of the district medical authority—is needed. In case of differences of opinion between the two boards, filing a writ petition with the high court is the only remedy, which is a tall order for many. As of mid-2025, only a few states, such as Goa, Karnataka, Kerala, and Maharashtra, have notified the rules and appointed custodians. Maharashtra did it only after a strong intervention from the Bombay High Court, when it heard a public interest litigation from a doctor who faced problems in submitting his living will to the municipal authorities. Several senior citizens known to this writer, many of them doctors in Kerala who have submitted living wills, are apprehensive about its implementation when the time comes. Now, the meaning of “medical support” has come to haunt Harish Rana (and many others). In July 2024, the Delhi High Court declined to allow his passive euthanasia on the ground that he was dependent on a “feeding tube”; not on medical equipment/support. The same issue is putting the Supreme Court in a dilemma. The ground realities of life and death need to be understood in its multi-dimensional magnitude. Medical science has made rapid advances in prolonging the lives of people; but not necessarily good health. In 2019, 10.1% of India’s population was above 60 years. The percentage is estimated to grow to 19.6% by 2050. Ensuring dignified medical care and life to such a big cohort (34 crore, assuming India’s population is 170 crore by 2050) will be a colossal fiscal and health challenge. Our approach to voluntary rights needs a paradigm shift. A voluntary right is an enabler for those who like to use it; not a weapon against others. Opposing voluntary rights is restricting individual liberty. Medical mummification of people at unbearable agony to those unlucky and to their caregivers is not the way to uphold the fundamental right to dignified life and death of citizens. A simple legal provision and easy implementation process, devoid of bureaucratisation, is the need of the people. To enable them to voluntarily choose a dignified end as part of right to life. The author is a public policy commentator