PASSIVE EUTHANASIA IN INDIA: HUMANISING THE FINAL CHOICE

PASSIVE EUTHANASIA IN INDIA: HUMANISING THE FINAL CHOICE

 

Introduction: The Global and Indian Context

The ongoing debate in the United Kingdom surrounding the Terminally Ill Adults (End of Life) Bill, 2025 has reignited one of humanity’s most profound ethical questions: should individuals have the right to determine how they wish to face death? Across the world, conversations on euthanasia reflect the tension between preserving life and preventing needless suffering. In India, the discourse has evolved in a distinct direction, not towards legalising active euthanasia, but towards ensuring that passive euthanasia is administered with empathy, fairness, and accessibility. The issue sits at the intersection of medical ethics, individual autonomy, and constitutional morality, making it both sensitive and significant in a democratic society.

 

Understanding Passive Euthanasia

Passive euthanasia refers to the deliberate decision to withhold or withdraw medical interventions that artificially prolong life when a patient’s recovery is medically impossible. Unlike active euthanasia, it does not involve a direct act to cause death but allows nature to take its course while preventing further suffering. The rationale behind this practice is rooted in the principle of dying with dignity — that no individual should be forced to endure prolonged agony when medical science can offer no cure. By emphasising compassion and autonomy, passive euthanasia aims to ensure that medical treatment remains a means to heal, not to extend suffering without purpose.

 

Legal Evolution and Landmark Judgments

For much of India’s post-independence history, euthanasia was a legal taboo. Even attempting suicide was a criminal offence under Section 309 of the Indian Penal Code (IPC). This rigid stance began to soften after the historic case of Aruna Shanbaug v. Union of India (2011), which marked a turning point. The Supreme Court, while responding to the tragic circumstances of a nurse who had remained in a vegetative state for decades, acknowledged passive euthanasia under stringent judicial control. The judgment differentiated between active euthanasia (unlawful) and passive euthanasia (conditionally permissible), stating that “life without dignity” falls outside the protection of Article 21.

The evolution deepened with the Common Cause v. Union of India (2018) verdict. The Supreme Court declared that the Right to Die with Dignity is an essential aspect of the Right to Life under Article 21. It also recognised Advance Medical Directives or Living Wills, enabling individuals to express their end-of-life treatment preferences. Detailed procedures for withdrawal of life support, including medical board reviews and judicial oversight were laid down to prevent abuse.

In January 2023, the Court streamlined these processes, making the framework more practical and humane. It authorised hospital-level ethics committees to approve decisions, reducing bureaucratic bottlenecks while retaining essential safeguards through dual medical evaluation.

 

Present Legal Framework: Procedures and Safeguards

Under the current framework, any adult of sound mind may prepare a Living Will, specifying conditions under which life-sustaining treatment may be withheld. This document must be signed before two witnesses and attested by a Judicial Magistrate of the First Class (JMFC).

When a terminally ill patient’s condition becomes irreversible, the hospital must establish a primary medical board comprising three senior doctors to assess the patient’s medical status. The findings are reviewed by a secondary board headed by the District Chief Medical Officer. The JMFC then verifies the authenticity of both the Living Will and medical opinions before approving withdrawal of life support.

If a Living Will does not exist, close relatives or the attending medical team can apply for authorisation through the same two-tier process. The 2023 modifications eliminated the requirement for district collector approval, delegated authority to hospital ethics committees, and maintained medical review safeguards to ensure the patient’s protection and procedural integrity.

 

Challenges and Limitations of the Current System

Despite legal validation, the practical application of passive euthanasia in India remains fraught with difficulties.

  • Cumbersome Bureaucracy: The multilayered process often leads to procedural delays, preventing timely relief to terminally ill individuals.
     
  • Limited Awareness: Both citizens and medical practitioners frequently lack understanding of Living Wills and how to implement them.
     
  • Emotional Barriers: Families struggle with guilt, religious hesitation, and societal taboos surrounding death, often deterring them from providing consent.
     
  • Institutional Deficiencies: Many hospitals lack the requisite ethics committees, palliative care specialists, or proper documentation systems.
     
  • Legal Ambiguity: Physicians remain apprehensive due to fears of criminal prosecution under IPC provisions or medical negligence claims.
     

The result is a disconnect between law and practice, where a legally recognised right often fails to translate into real-world relief.

 

Ethical, Constitutional, and Philosophical Dimensions

The philosophical foundation of passive euthanasia lies in the ethical triad of autonomy, non-maleficence, and dignity. The Supreme Court’s interpretation of Article 21 extends beyond the right to live, it encompasses the right to a life and death that uphold human dignity.

From a moral standpoint, the act of allowing death in hopeless medical conditions aligns with compassion rather than cruelty. Indian philosophical traditions, across faiths, have long recognised the naturalness of death. Concepts like prayopavesa and sallekhana in Hinduism and Jainism reflect an acceptance of death as a conscious, peaceful transition when life’s purposes are fulfilled.

The judiciary has consistently drawn a clear ethical boundary between “allowing to die” and “causing death,” ensuring that legal compassion does not blur into moral negligence. Furthermore, Article 47 of the Constitution obligates the State to provide accessible palliative and end-of-life care, making dignified death part of public health responsibility.

 

Comparative Global Perspectives

Across the world, the legal landscape of euthanasia varies widely. Countries like the Netherlands, Belgium, and Canada permit both active and passive euthanasia under strict regulation, while nations like the United Kingdom and Australia continue to refine their legal and ethical positions through parliamentary debate.

For India, where healthcare infrastructure and ethical oversight are still developing, the immediate focus should remain on strengthening passive euthanasia rather than pursuing active forms. A procedural model that ensures compassion, simplicity, and accountability will better align with India’s moral and social fabric.

An effective Indian framework must therefore blend spiritual acceptance of mortality with constitutional respect for autonomy, creating a balanced system that honours both life and the right to end suffering humanely.

 

Roadmap for Reform: Strengthening the Framework

To bridge the gap between law and practice, India must advance in the following directions:

  1. Digital Advance Directives:
     Launch a National Euthanasia and Living Will Portal integrated with Aadhaar to enable secure registration, modification, or withdrawal of Living Wills. Include provisions for mental competence certification and digital signatures to minimise paperwork.
     
  2. Mandatory Hospital Ethics Committees:
     Require every tertiary hospital to form an ethics committee comprising senior physicians, palliative experts, and a neutral observer. These committees should review and approve requests within 48 hours, ensuring both compassion and accountability.
     
  3. Transparent Oversight Systems:
     Establish state-level health commissioners or monitoring dashboards to audit decisions, track timelines, and publish annual transparency reports.
     
  4. Safeguards and Counselling:
     Introduce a brief “cooling-off” period before final withdrawal, mandate counselling for families, and protect vulnerable patients from coercion or economic pressure.
     
  5. Awareness and Training:
     Include end-of-life ethics and patient rights in medical and nursing curricula. Partner with NGOs, media, and local health missions to promote awareness about Living Wills and palliative options.
     

 

Conclusion: Dying with Dignity as a Constitutional Promise

India’s journey with euthanasia is not about the legalisation of death but the humanisation of dying. Passive euthanasia represents a moral, medical, and constitutional acknowledgment that dignity must accompany a person not only through life but also in their final moments.

By digitising processes, empowering hospitals, and fostering ethical awareness, India can transform passive euthanasia from a symbolic legal provision into a compassionate healthcare reality. The nation’s approach must remain one of empathy, ensuring that every citizen possesses not only the right to live with dignity but also the right to die with it, peacefully and humanely.

In doing so, India will affirm that true dignity transcends the boundaries of life itself, extending into the realm of death, where compassion and autonomy stand as the final guardians of humanity.