Author: Ifrah Fatima, Aligarh Muslim University
To the point
The Indian legal system has traditionally upheld the sanctity of life as a paramount value protected under Article 21 of the Constitution. However, with evolving jurisprudence and changing societal attitudes towards bodily autonomy and end-of-life choices, the concept of “dying with dignity” has gradually found a legitimate place in constitutional discourse.
This article traces the legal transformation from the outright denial of the right to die in Gian Kaur v. State of Punjab to its partial acceptance in the form of passive euthanasia and Living Wills as recognized in Common Cause v. Union of India. The focus lies on how the Indian judiciary, through a rights-based approach, has carved out a legal space for terminally ill individuals to refuse artificial life support and make advance medical decisions through legal instruments like Living Wills.
By assessing judicial pronouncements, constitutional values, and practical challenges in the implementation of passive euthanasia, the article critically analyses whether India has struck the right balance between preserving life and respecting individual autonomy. The discussion also touches upon the absence of statutory backing, the evolution of procedural guidelines (revised in 2023), and the urgent need for comprehensive legislation in this field.
Use of Legal Jargon
Passive euthanasia, a term often misunderstood, refers to the withdrawal or withholding of life-sustaining medical treatment to allow a terminally ill patient to die naturally. This is distinct from active euthanasia, where a deliberate action, such as administering a lethal drug, is taken to end life an act that remains illegal under Indian criminal law, specifically under Sections 302 and 304 of the Indian Penal Code.
The cornerstone of this legal conversation is the Advance Medical Directive, commonly known as a Living Will. It is a written statement made by a competent adult declaring that in the event of an irreversible terminal condition, they should not be kept alive by artificial life-support. The recognition of this directive was cemented by the Supreme Court in Common Cause (2018), where it declared that the right to die with dignity is an essential part of the Article 21.
In such cases, terminal illness refers to a medically diagnosed condition with no reasonable chance of recovery. The law requires that a Medical Board, comprising expert doctors, must verify this condition to ensure that passive euthanasia is not misused. The case of Aruna Shanbaug (2011) was the first in India to discuss such situations, where the patient lived in a permanent vegetative state for decades.
Another crucial concept is informed consent, which means a person must fully understand the consequences of accepting or refusing medical treatment. If the patient is unconscious or incapable, decisions may be made by their legal guardian or next of kin. In cases involving vulnerable individuals, courts may invoke the Doctrine of Parens Patriae, where the judiciary steps in to protect the best interests of those who cannot speak for themselves.
The judiciary’s role in framing guidelines in Common Cause is a textbook example of judicial legislation—where courts issue binding directions in areas not yet governed by statutory law. Notably, these guidelines were simplified in 2023, making Living Wills more accessible and removing the requirement of attestation before a Magistrate. Lastly, in emergencies where a directive is absent or unclear, the Doctrine of Necessity allows doctors to act in good faith to preserve life, though it must be balanced against the individual’s prior expressed wishes.
The Proof
India’s legal stance on the right to die has undergone a gradual but important transformation. Initially, courts were unwilling to acknowledge any legal validity to euthanasia. In Gian Kaur v. State of Punjab (1996), the Supreme Court ruled that the right to life could not logically include the right to die. The judgment emphasized that life is a precious gift and that enabling a right to end it would be contrary to constitutional values.
However, a notable shift occurred in Aruna Ramachandra Shanbaug v. Union of India (2011), which marked India’s first judicial engagement with passive euthanasia. The petitioner was a nurse who had been in a vegetative state for over 40 years after a brutal assault. Though the Court did not recognize a general right to die, it did allow withdrawal of life support in exceptional cases, subject to approval from the High Court and the opinion of medical experts.
The real turning point came in Common Cause v. Union of India (2018). Here, a Constitution Bench of the Supreme Court took a progressive and humane view, declaring that the right to die with dignity is a fundamental right under Article 21. The Court emphasized that forcing someone to remain on life support against their wishes violates their dignity and autonomy. The decision also permitted the use of Advance Directives, enabling people to make decisions in advance about refusing treatment in terminal stages of illness.
Despite this progressive ruling, the initial procedure laid down by the Court for executing a Living Will was highly complex. It involved multiple stages of verification, attestation by a Judicial Magistrate, and approvals by medical boards, making it nearly impossible for ordinary people to exercise this right.
Recognizing these hurdles, the Supreme Court in January 2023 significantly simplified the guidelines. Now, an individual can draft a Living Will in the presence of two witnesses and their treating doctor. Instead of approaching a Magistrate, the document can be uploaded on a digital health portal accessible to medical institutions when needed. The revised process also streamlines the role of medical boards, ensuring that terminally ill patients can make dignified choices without legal entanglement.
Thus, from absolute rejection in 1996 to conditional acceptance in 2011, and finally to constitutional recognition in 2018, India’s legal journey on euthanasia reflects a sensitive and balanced approach. The 2023 procedural reforms further affirm the system’s commitment to making this right practically accessible. This evolution, driven primarily by judicial activism, underscores how the courts have interpreted constitutional values to keep pace with human dignity and contemporary healthcare ethics.
Abstract
This article examines the constitutional and legal development of the right to die with dignity in India, focusing particularly on the emergence and recognition of passive euthanasia and Living Wills. It traces the judicial journey from the Supreme Court’s early rejection of euthanasia in Gian Kaur v. State of Punjab (1996) to the more empathetic and progressive stance taken in Common Cause v. Union of India (2018), which acknowledged the right to refuse medical treatment as a facet of the right to life under Article 21.
In the absence of specific legislation, the Indian judiciary has played a pivotal role in shaping the legal framework surrounding end-of-life decisions. Through landmark rulings, the courts have addressed complex ethical and legal questions, balancing the preservation of life with individual autonomy, especially in cases involving terminal illness or irreversible conditions. The article further discusses how the initial procedural barriers surrounding Living Wills were eased by the Supreme Court’s 2023 revised guidelines, making them more practical and accessible to the public.
By reviewing key judgments, relevant constitutional principles, and evolving procedural reforms, the article critically reflects on whether the Indian legal system has adequately responded to the need for dignity in dying. It concludes by highlighting the continuing lack of statutory law in this area and the growing demand for a comprehensive legislative framework to provide clarity, consistency, and protection for end-of-life choices
Case Laws
Gian Kaur v. State of Punjab, (1996) 2 SCC 648
In this landmark case, a five-judge Constitution Bench of the Supreme Court held that the right to life under Article 21 does not include the right to die. The petitioners, who had been convicted for abetting the suicide of their daughter-in-law, challenged the constitutionality of Section 309 IPC (attempt to suicide). The Court overruled an earlier decision in P. Rathinam (1994) and clarified that the sanctity of life must be upheld, and that the Constitution does not recognize a legal right to end one’s life. This ruling firmly rejected the inclusion of euthanasia under Article 21 at that time.
Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454
This case involved Aruna Shanbaug, a nurse who had been in a permanent vegetative state (PVS) for over 40 years following a violent sexual assault. A plea for euthanasia was filed on her behalf. The Court, while refusing to allow active euthanasia, permitted passive euthanasia under strict guidelines, such as High Court approval and medical board recommendations. Though it did not recognize a personal right to die, this case was India’s first judicial step towards acknowledging the complexities of end-of-life decisions and set the stage for future developments.
Common Cause v. Union of India, (2018) 5 SCC 1
This was a watershed moment in Indian constitutional law where the Supreme Court recognized the right to die with dignity as a part of Article 21. The Court upheld that an individual has the autonomy to refuse life-sustaining treatment in case of terminal illness or permanent unconsciousness. It also laid down the validity and enforceability of Advance Medical Directives (Living Wills) and issued detailed procedural safeguards for their execution. This case marked the legal acceptance of passive euthanasia in India and laid the foundation for a rights-based approach to death.
Justice K.S. Puttaswamy (Retd.) v. Union of India, (2017) 10 SCC 1
Though not directly related to euthanasia, this landmark judgment on the right to privacy under Article 21 played a crucial role in shaping the reasoning in Common Cause. The Court emphasized that the right to privacy includes decisional autonomy, including matters related to one’s body and health. The principles laid down in this case strengthened the foundation for recognizing the right to refuse medical treatment and contributed to the evolution of death-with-dignity jurisprudence.
Common Cause Guidelines Simplification, Supreme Court Order dated 24 January 2023
In response to practical difficulties faced in implementing Living Wills, the Supreme Court issued revised guidelines in 2023. These simplified the procedure by removing the requirement for Magistrate-level attestation and introducing a digitally accessible system for advance directives. It also streamlined the formation of medical boards and clarified the roles of doctors and family members. This reform was a significant step in making the right to die with dignity more accessible, realistic, and humane.
Conclusion
The legal journey from the outright rejection of euthanasia to the formal recognition of passive euthanasia and Living Wills reflects the Indian judiciary’s evolving understanding of human dignity, autonomy, and constitutional compassion. While courts have made commendable progress in bridging ethical values and constitutional rights, the absence of a dedicated statute continues to pose procedural uncertainties. The 2023 guidelines have undoubtedly improved accessibility, but a comprehensive legislative framework is still essential to ensure clarity, uniformity, and protection of end-of-life choices. As society advances, the law must continue to uphold not just the right to live, but the right to die with dignity.
