Published On: November 3rd 2025
Authored By: Megha Kumari
ICFAI University, Hyderabad
Abstract
India in recent two decades has experienced a multitude of changes with respect to many different laws among which legalization of passive euthanasia is one of the most astounding one until now as it has been a matter of debate and controversy for years since the inception of Indian Constitution and other laws existing in India. The term euthanasia has been greatly argued since it was believed to be obstructing the ‘Article 21 of Indian Constitution’ which is being regarded as one of the pillars protecting the fundamental right of any human being. India acknowledged ‘passive euthanasia’ and ‘living wills’ under ‘Article 21 of the constitution,’ following the historic judgment of Aruna Shanbaug case in the year 2011 and Common Cause case in the year 2018, and it was applauded as a milestone in preserving individual choice and ensuring honor and dignity in life’s final stage. Yet, the promise has not materialized in practice. Complicated procedures, limited public knowledge, cultural reluctance, and medical professionals’ fear of liability and legal repercussions persist in make living wills seldom use. Even though the Supreme Court tried to streamline the process in 2023, the unavailability of clear legislation and scarce palliative care infrastructure facilities still hinder accessibility. This article examines the discrepancy which exists between concept and its execution, based on precedents, social and cultural factors, and comparative models. Apart from this, it also contends that real change requires codified law, simplified procedures, safeguard for medical practitioner, and advanced illness care so that dignity of an individual is preserved even posthumously.
Key words: Living wills; Advance directives; Passive euthanasia; Right to die; Practical challenges
“Life is Pleasant. Death is peaceful. It’s the transition that’s troublesome.” –Mathew Arnold
Prologue
Euthanasia is a Greek word that means “good death.” Euthanasia is the act of killing or allowing the relatively painless death of people or domestic animals which are terminally ill or injured out of compassion. Francis Bacon used the term “euthanasia” for the first time in a medical context in the 17th century to describe a simple, painless, and joyful death, when it was the “physician’s responsibility to alleviate the ‘physical sufferings’ of the body.”[1]
The controversy surrounding the ‘end-of-life options’ is amongst the most contentious frontiers of law, medicine, and ethics. In India, the embrace of passive euthanasia and living wills is a witness not only to a constitutional change but to a humanitarian shift to the cause of respecting individual autonomy. The Supreme Court in Francis Coralie Mullin case observed that the right to life encompasses the “right to live with human dignity,” which later was further developed in the Common Cause case, to encompass the “right to die with dignity.” Beyond the courtroom, medical ethics echoes the same sentiment: “The goal of medicine is not only to prevent death but also to allow life to end with dignity when cure is no longer possible.”[2] This two-fold acceptance underscores the fundamental dilemma of balancing legal protections with humane care, a dynamic which persists to inform India’s challenge in successfully putting advance directives in practice.
Living Wills, also called advance medical directives, are legal instruments through which an individual records their preferences for medical care in case they become incapable of making informed decisions in the future. In India, the recognition of passive euthanasia and living wills marks an important step in safeguarding personal autonomy and dignity at the end of life.
Origins and Evolution
Euthanasia is not a new concept in the human society and it finds it origin long before it entered contemporary legal and medical debates. As per Hinduism, suicide ‘atma-gatha’ is considered a purposeful action and is frowned upon when done out of selfishness or ignorance, as it accrues negative karmic effects and hinders liberation. The Dharmasutras thus strictly prohibit suicide, though certain exceptions were allowed to those who were spiritually advanced and selected their death as a voluntary, noble deed, for instance, the Pandavas’ Mahaprasthana also known as great journey or types like fasting, self-immolation, or death at sacred place, which were never equated with regular suicide. Death in Hinduism is viewed not as an end but as a process leading to liberation, and the ideal is a peaceful, conscious death, generally a “good death.” Others such as Crawford have theorized that active euthanasia can be compatible with this ideal, but others think only of enlightened spirits can freely leave the body, so euthanasia is not possible for common folk. Whereas Hinduism lays great stress on ahimsa (non-violence), even Gandhian philosophy acknowledges that unavoidable violence is not sinful, demonstrating moral flexibility. Therefore, while Hinduism is hesitant and questioning about euthanasia, it does not consider it to be completely irreligious or sacrilegious.
It was in the year 1987 when the question of ‘right to die’ first arose before the Bombay High court, and the court suggested that right to life might include right to die as well. Further the court questioned the constitutionality of section 309 of IPC, 1860 which makes attempted suicide as illegal.[3] However, in the year 1996, the Supreme Court clarified that right to life does not encompass right to die, as life is a natural right given to us, and no one has a right to end it unnaturally and thus prohibited it.[4] Later in the matter concerning a nurse named Aruna Shanbaug in 2011,[5] where the question before the Hon’ble court was whether life support could be withdrawn from a patient in a permanent vegetative state or not. While the court rejected active euthanasia, it permitted passive euthanasia subject to strict safety measures, to be carried out only with the approval of the High Court.
Thereafter, in a 2018 judgment[6] delivered in response to petition filed by the NGO Common Cause, the Court clarified the position stating that ‘right to die with dignity’ is an intrinsic part of ‘right to life under article 21 of the constitution.’ Despite these rulings, practical enforcement remains restricted. Scholars observations states that the jurisprudence reflects “a tension between protecting autonomy and preventing abuse,” therefore it requires careful balance between.[7]
Legal Foundations and Judicial Architecture
“Live with dignity is a fundamental human right.” Article 21 of the constitution states ‘no person shall be deprived of his life or personal liberty except according to the procedure established by law.’ The scope of this article has been broadened to include various other rights such as right to live with dignity, right to privacy, health, clean environment and a dignified death. This has been interpreted in various landmark cases by courts of law. Each one of those formulations has broadened its ambit to include all such aspects of life which impart meaning, purpose, and dignity to life. “Life” and “liberty” are closely interrelated terms. Liberty provides a person with the autonomy to be free to make decisions, and life without liberty would be worthless.
The directions of the Supreme Court had gradually shaped the legal and procedural framework for passive euthanasia. Initially, the withdrawal of life support was permitted but only under the strict judicial supervision, with prior approval from the High Court mandatory.
In the due course of time, the court went a step further by giving recognition to the validity of advance medical directives, though its implementation was tied to a multi- layered process including approval from two separate medical boards, consent from family members, hospital authorities, and final authorization from the High court before life support could be withdrawn.
When these directions proved to be rigid to implement, the court sought to simplify this procedure by allowing a living will to be signed before two witnesses, attested by a notary or gazetted officer, and should be kept with a district level authority. Yet, even this attempt at simplification has left behind complicated procedures and verification requirements that may continue to obstruct in the way of timely medical decisions.[8]
Status Quo Analysis
- Challenges Rooted in Traditional Indian Values
One of the most significant barriers to the practical enforcement of living wills and passive euthanasia in India lies in the deeply entrenched traditional values surrounding life, family, and death. Indian society has historically been shaped by religious and cultural narratives that regard life as sacred and death as a process governed by divine will. Hindu philosophy, for instance, emphasizes the sanctity of life as part of the karmic cycle, where suffering is often interpreted as an opportunity for spiritual growth.[9]Similarly, in many Indian communities, decisions about medical care and death are seen as collective, family-centered responsibilities rather than individual rights.[10]
This cultural emphasis on familial decision-making often clashes with the very essence of advance directives, which prioritize individual autonomy over collective choice. A patient’s desire to withhold life-sustaining treatment can be eclipsed by the family’s need to save life at all costs, causing conflict among relatives, doctors, and legal officials.[11] In addition, the stigma of talking about dying and death dissuades more people from freely preparing or filing living wills. Talk about dying is generally viewed as ominous, deterring people from anticipatory planning for terminal illness care.[12]
A further obstacle is presented by the Religious leaders and traditional moral figures. They play a significant role in influencing public opinion. The concept of Passive euthanasia is often misconceived to be a betrayal of moral obligation or as “giving up on life,” even though it is legally accepted as a choice of dignity.[13] Such religious and cultural resistances breed a climate of reluctance, both among patients who may desire to avail themselves of their right to die with dignity and among doctors who dread social censure for respecting such orders.
Thus, while the judiciary has recognized the legitimacy of passive euthanasia and living wills, the persistence of traditional Indian values rooted in sanctity, family honor, and religious morality continues to obstruct their widespread acceptance and implementation.
Further, several other operational challenges persist in translating law into practice. They are:
- Public and Professional Awareness: Despite judicial recognition, awareness among citizens and healthcare professionals remain limited. Empirical work shows that most doctors in India are unaware of how to implement advance directives in clinical settings.[14]
- Bureaucratic and Administrative Delays: Even after simplification, several state governments have been slow in appointing custodian and disseminating official procedures. This has resulted in very few living wills being executed in practice.[15]
- Cultural and Familial Constraints: Indian society traditionally emphasizes family involvement in medical decisions. Scholars argue that this collective ethos sometimes conflicts with the individual autonomy principle underlying living wills.
- Medical Ethical Dilemmas: Doctors often fear litigation if they act upon living wills without explicit statutory protection. Weak palliative care systems also create ethical concerns, as patients may resort to advance directives due to inadequate alternatives.
Comparative and Normative Perspectives
With the increasing recognition of euthanasia, there is a growing question worldwide about how to protect individual autonomy in end of life decisions and how it should be regulated and implemented. It is important to understand the approaches of different countries in this regard.
- NETHERLANDS
In 2002, the Netherlands became the first nation to legalize euthanasia and assisted suicide. Here, individual autonomy is fundamental to law and culture, making is convenient to integrate advance directives in medical care. The legislative framework permits physicians to perform euthanasia under strict conditions, like in case of a voluntary request and unbearable suffering where there is no scope for future improvements. A Dutch Supreme Court case acquitted a physician who followed an advance directive for a patient with severe dementia, confirming the legality of such directives.[16]
- CANADA
It also considers individual choice in end-of-life decisions of paramount importance. The Supreme Court in a case ruled that banning physician- assisted dying violated Charter of Rights and Freedom.[17] Subsequently, Parliament passed Bill C-14, allowing adults suffering from grievous, irremediable medical conditions to request medical assistance in dying, ensuring advance directives are requested.
- U.S.A
It also recognizes personal autonomy in medical decisions which can be seen in judicial pronouncements. In one of the cases the Court upheld patient’s right to refuse life- sustaining treatment when there is a clear evidence of their wishes.[18] While advance directives are widely acknowledged and followed, assisted suicide laws varies across states.
Roadmap Ahead
A careful way forward for euthanasia in India is to find the right balance between respecting a patient’s right to a dignified death and imposing rigorous legal controls. These are the following ways:
- Parliament must enact a comprehensive legislation consisting of procedures for passive euthanasia and living wills, reducing dependence on judicial guidelines.
- There is a need for a standardized template for documentation since it minimizes interpretative discrepancies and ensures that advance directives are utilized uniformly and properly.
- Doctors and the public should be educated because it creates trust in the system, avoids misunderstandings, and makes decisions on euthanasia knowledge-based and ethical.
- Ensuring a range of palliative care choices is essential in order that patients’ end-of-life care choices are authentic and not made on the basis of unavailability of care.
- Physicians must have legal protection when acting in good faith to promote responsible practice and avoid fear of litigation to allow medical professionals to comply with advance directives safely.
Epilogue
The acceptance of passive euthanasia and living wills in India is a critical step towards upholding the constitutional guarantee of ‘dignity under Article 21’. But as this article has also contended, the actual test lies in converting principle into practice. Existential cultural values that prioritize family and religious morality over personal autonomy remain stubbornly resistant to the implementation of advance directives. Procedural complexity, ignorance, and reluctance among the medical fraternity compound these problems.
In contrast, nations like the Netherlands and Canada, where autonomy is given cultural precedence, have secured smoother incorporation of advance directives into healthcare. The comparison highlights that India’s failure is not legal but cultural in nature, demanding a re-tuning of institutional procedures along with popular perceptions.
For India, effective enforcement requires statutory codification, uniform documentation, medical training, and most importantly, more public debate on end-of-life care. Only thereby can the right to die with dignity move from a judicial pronouncement to a working reality, reconciling ancient values with contemporary constitutional ideals.
References
[1] Francis Bacon, Francis Bacon: The Major Works 630 (Brian Vickers ed., Oxford Univ. Press 2008), https://books.google.com/books/about/The_Major_Works.html?id=QJ6vZ6CSXvUC (last visited Sept. 11, 2025).
[2] Eric Cassell, The Nature of Suffering and the Goals of Medicine (Oxford Univ. Press 1991).
[3] State of Maharashtra v. Maruti Shripati Dubal, (1987) Cr. L.J. 743 (Bom. H.C.).
[4] Gian Kaur v. State of Punjab, (1996) 2 SCC 648 (India).
[5] Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 S.C.C. 454 (India).
[6] Common Cause v. Union of India, (2018) 5 S.C.C. 1 (India).
[7] Aparna Chandra, Euthanasia in India: Reconciling Autonomy and State Interests, 14 NUJS L. REV. 67, 70 (2020).
[8]Shashi Motilal & Pratima Sen, Passive Euthanasia and Living Wills in India: Right to Die with Dignity, 35 INDIAN J. MED. ETHICS 142, 145 (2021).
[9] Anil Malhotra & Ranjit Malhotra, Euthanasia in India: A Critical Analysis of the Law and Its Implementation, 55 Indian J.L. & Just. 112, 118–20 (2019).
[10] Sanjay V. Desai, Family and Autonomy in Indian Medical Decision-Making, 39 Indian J. Med. Ethics 45, 47–49 (2017).
[11] O.P. Dwivedi, Cultural Dimensions of Law and Ethics in India: The Case of Euthanasia, 24 J. Indian L. Inst. 305, 310–12 (2015).
[12] Prasanna Kumar & Manjulika Vaz, The Challenge of Advance Directives in India: Cultural and Ethical Considerations, 44 Indian J. Med. Ethics 213, 215–16 (2019).
[13] R.S. Pathak, Religion, Morality, and Passive Euthanasia in India, 18 J. Religious & Cultural Stud. 99, 102–04 (2018).
[14] R. Rajagopal, Advance Directives in India: Seeking the Individual Within the Community, in ADVANCE DIRECTIVES ACROSS ASIA 223, 229 (Mahesh R. Lakshminarayanan ed., Cambridge Univ. Press 2022).
[15] S.C. Malik, Living Wills and the Right to Die with Dignity in India: A Critical Appraisal, 12 NALSAR L. REV. 101, 110 (2019).
[16] Dutch Supreme Court, Judgment of Nov. 27, 2019, ECLI:NL:HR:2019:1970.
[17] Carter v. Canada (Attorney General), [2015] 1 S.C.R. 331 (Can.).
[18]Cruzan v. Director, Missouri Dep’t of Health, 497 U.S. 261 (1990)
