Euthanasia and the Right to Die with Dignity: Analysing Constitutional Evolution and Recent Judicial Developments in India

Abstract

Euthanasia, which refers to the practice of hastening the death of a patient who is in great suffering to relieve the person from further suffering, is also known as “Mercy Killing” and presents profound moral and ethical challenges. Recently, for the first time, the Supreme Court of India allowed Passive Euthanasia for a 32-year-old man who had been in a Persistent Vegetative State (PVS) for 13 years. This article explores the concept of euthanasia, the evolving nature of Article 21 of the Indian Constitution, which now encompasses the right to die with dignity, and the judicial developments shaping this right. The article also examines the constitutionality of “Living Wills” or “Advance Medical Directives (AMD),” whether Clinically Assisted Nutrition and Hydration (CANH) constitutes medical treatment, and what course of action applies in the presence or absence of an AMD. While examining the ethical, legal, and medical dimensions of euthanasia, this article highlights the shift from mere recognition to the practical enforcement of the right to die with dignity.

I. Introduction

The word “euthanasia” has its origin in two Greek words: “Eu,” meaning “good,” and “Thanatos,” meaning “death.” It simply refers to hastening the death of a patient to relieve him from further suffering. Euthanasia, also known as “Mercy Killing,” is classified into two types. Active Euthanasia refers to using lethal substances to intentionally end a patient’s life (for example, a lethal injection). Passive Euthanasia refers to withdrawing or withholding life-saving treatment (such as ventilators or feeding tubes) to allow a person to die naturally.

Active Euthanasia is strictly prohibited in India. Passive Euthanasia, which aims to prevent further suffering of a patient in irreversible medical conditions by withdrawing life-sustaining treatment, is permitted. This protects the patient’s right to die with dignity as recognized under Article 21 of the Indian Constitution. The Supreme Court of India allows Passive Euthanasia only under certain circumstances, as long as it is in the “best interest” of the patient. Recently, the Supreme Court allowed Passive Euthanasia for Harish Rana, a 32-year-old man who had been in a Persistent Vegetative State (PVS) for 13 years. This marked the first instance in India where Passive Euthanasia was formally allowed for a patient to relieve him from an incurable and irreversible medical condition, recognising his right to die with dignity. This article examines the constitutionality of the right to die with dignity under Article 21, along with the judicial developments associated with euthanasia law in India.

II. Constitutional Framework and the Judicial Evolution of the Right to Die in India

Article 21 of the Constitution of India guarantees protection of life and personal liberty. It states that no person shall be deprived of his life or personal liberty except according to procedure established by law. Through various judgments, courts have expanded the scope of the right to life under Article 21 from mere survival to a life with dignity. This expanded scope now includes both the right to live with dignity and the right to die with dignity.

Does a Right to Die with Dignity Also Include a Right to Choose Death?
Section 309 of the Indian Penal Code, 1860 criminalised attempt to suicide. However, it was considered harsh and irrational to punish a person who is already in deep distress; such a person requires counselling and care, not criminal sanction. The Supreme Court in P. Rathinam v. Union of India[1] drew a significant parallel between fundamental rights. It reasoned that just as the right to speak includes the right to remain silent, the right to live should also include the right to not live. On this basis, the Court held Section 309 of the IPC unconstitutional and clearly stated that the right to life under Article 21 also includes a right to die.

Subsequently, in Gian Kaur v. State of Punjab,[2] the Supreme Court overruled its earlier judgment in P. Rathinam and held that the right to life does not include the right to die. The Court clarified that Article 21 protects life with dignity up to natural death, including a dignified process of dying, but does not permit the unnatural termination of life. While the Court held that Article 21 does not include a right to die, it importantly recognised that the right to die with dignity may fall within the ambit of Article 21.

III. Recognition of Passive Euthanasia: The Aruna Shanbaug Case

Aruna Ramchandra Shanbaug v. Union of India[3] was a landmark judgment in the recognition of Passive Euthanasia in India. Aruna Ramchandra Shanbaug was a nurse who worked at KEM Hospital, Mumbai. In 1973, a hospital ward attendant strangled her with a dog chain and sexually assaulted her. As a result, she suffered severe brain damage and remained in a Persistent Vegetative State (PVS) for 37 years. Pinki Virani, a social activist and journalist, filed a petition before the Supreme Court under Article 32 of the Constitution seeking to end her prolonged suffering.

This was the first case in which the Supreme Court examined the concept of euthanasia and drew a clear distinction between Active and Passive Euthanasia. The Court held that Active Euthanasia, which involves a deliberate act to end a life, is impermissible in India. Passive Euthanasia, which involves the withdrawal of life-sustaining treatment, is permitted under certain circumstances and subject to strict procedural safeguards.

The Supreme Court laid down the following safeguards to regulate the process:

1. Medical Board Consultation: Approval from a medical board of experts comprising three reputed doctors.
2. High Court Approval: Approval from two judges of the concerned High Court.
3. Family or Next Friend Consent: Approval from the family, relatives, or “next friends” of the patient.

In Aruna’s own case, however, the staff of KEM Hospital, who had cared for her over the years and were recognised as her “next friends,” did not consent to euthanasia. She therefore could not benefit from this ruling. Nevertheless, the judgment opened significant ground for the development of euthanasia law in India.

IV. Advance Medical Directives and the Right to Die with Dignity

Further judicial developments followed in 2018 with the Constitution Bench decision in Common Cause (A Regd. Society) v. Union of India.[4] In this case, the Supreme Court distinguished between Advance Medical Directives (AMD) and Living Wills, and held that AMDs are legally valid and applicable in India.

An Advance Medical Directive (AMD), as defined in Black’s Law Dictionary,[5] is “a legal document explaining one’s wishes about medical treatment if one becomes incompetent or unable to communicate.” In practical terms, it is a document through which a person can legally record their preferences regarding future medical treatment in the event they lose the capacity to communicate.

In this case, the Court held that the right to die with dignity is a fundamental right under Article 21. It also prescribed the procedure for executing a valid AMD. Key requirements include the following:

1. The person must be mentally sound and competent at the time of execution.
2. The directive must be executed voluntarily, free from any external pressure.
3. The document must be in writing and signed before the concerned authorities.
4. The person retains the right to withdraw or modify the AMD at any time, provided such withdrawal or modification is also in writing.

The Court further held that in the absence of an AMD, the “best interest” principle should guide medical and judicial decision-making. This judgment strengthened individual autonomy and dignity under Article 21, while providing a concrete mechanism for its exercise.

V. Recent Judicial Developments in Euthanasia Law

The procedural guidelines prescribed in the 2018 Common Cause judgment were criticised for being overly rigid and creating significant legal hurdles, making it difficult for ordinary citizens to execute an AMD. Recognising these concerns, the Supreme Court in January 2023 simplified the AMD procedure by modifying several requirements from its earlier judgment. This step reinforced the right to die with dignity under Article 21 and reaffirmed the individual’s autonomy in matters of medical treatment.

In March 2026, the Supreme Court in Harish Rana v. Union of India[6] allowed Passive Euthanasia for Harish Rana, a man who had been in a Persistent Vegetative State (PVS) for 13 years. The Court held that Clinically Assisted Nutrition and Hydration (CANH) constitutes medical treatment, and that its withdrawal was in the “best interests” of the patient. The Court also directed that the process of Passive Euthanasia must be dignified and humane, accompanied by a palliative and end-of-life (EOL) care plan.

This case marks a pivotal moment in the evolution of euthanasia law in India. It represents a shift from mere judicial recognition to real-life application, demonstrating that Passive Euthanasia is no longer a theoretical concept but an enforceable right capable of practical implementation to protect individual autonomy and the right to live and die with dignity under Article 21.

VI. Conclusion

Judicial developments in India relating to euthanasia have undergone significant transformation over the years. From courts initially rejecting the right to die under Article 21 to subsequently recognising the right to die with dignity, this evolution reflects a deepening understanding of life: that it does not mean mere survival, but a life lived and ended with dignity.

Through landmark judgments such as Aruna Ramchandra Shanbaug v. Union of India and Common Cause v. Union of India, the Supreme Court recognised Passive Euthanasia and the validity of Advance Medical Directives. By simplifying the procedure for AMDs, the courts have made this right more accessible to ordinary citizens. The recent decision in Harish Rana v. Union of India has decisively shifted the law from recognition to application, reflecting a humane and purposive understanding of the right to life.

However, the risk of misuse cannot be overlooked. It is essential that such decisions are taken carefully, without any malpractice, and with utmost care and respect for the patient’s dignity. While the Supreme Court has formulated procedural safeguards, effective implementation demands robust checks and oversight mechanisms. Accordingly, comprehensive statutory legislation is needed to translate this judicial framework into practice with greater clarity, uniformity, and efficiency.

References

[1] P. Rathinam v. Union of India, (1994) 3 SCC 394 (India).
[2] Gian Kaur v. State of Punjab, (1996) 2 SCC 648 (India).
[3] Aruna Ramchandra Shanbaug v. Union of India, (2011) 4 SCC 454 (India).
[4] Common Cause (A Regd. Society) v. Union of India, (2018) 5 SCC 1 (India).
[5] Bryan A. Garner (ed.), Black’s Law Dictionary (11th edn, Thomson Reuters 2019).
[6] Harish Rana v. Union of India, 2026 SCC OnLine SC 358 (India).
[7] Zia Mody, 10 Judgments That Changed India (Penguin Random House India 2013) 207.