Euthanasia

The Terminally Ill Adults (End of Life) Bill passed by the UK’s House of Commons in June 2025, which allows passive euthanasia, has once again brought the global debate on the right to die with dignity into focus. In India, while passive euthanasia has been recognized through Supreme Court rulings, its implementation remains a significant challenge, highlighting the need for reforms that uphold the constitutional promise of dignity in death.

What is Euthanasia?

Euthanasia (or “mercy killing”) refers to the act of intentionally hastening a person’s death to alleviate suffering caused by incurable or terminal illnesses. There are two primary types of euthanasia:

1. Active Euthanasia: Directly causing a patient’s death, often through a lethal injection. This can be:

   • Voluntary: The patient consciously chooses to die.

   • Non-voluntary: The decision is made for an incompetent patient.

   • Involuntary: The patient’s consent is not obtained.

2. Passive Euthanasia: Withdrawing or withholding life-sustaining treatment (such as ventilators, feeding tubes, etc.) in cases where there is no chance of recovery, thereby allowing death to occur naturally.

Legal Status of Euthanasia in India

1. Active Euthanasia:

   • Illegal: Active euthanasia is not permitted in India. Under the Bharatiya Nyaya Sanhita (BNS), 2023, acts of euthanasia committed with the intent to cause death are categorized as culpable homicide or murder under Sections 100 and 101.

2. Passive Euthanasia:

   • Legal Recognition: Passive euthanasia is allowed under Indian law in specific circumstances.

   • Aruna Shanbaug v. Union of India (2011): The Supreme Court ruled that life-sustaining treatment can be legally withheld or withdrawn from terminally ill patients, even if they lack decision-making capacity.

   • Common Cause v. Union of India (2018): The SC recognized the right to die with dignity as a fundamental right under Article 21 of the Indian Constitution. It legalized advance medical directives (living wills) that specify conditions under which treatment may be withdrawn.

3. Supreme Court Guidelines (2023):

   • Living Wills / Advance Directives: A competent adult can draft a living will to express their wishes regarding life-sustaining treatment. The living will must be signed by the executor in the presence of two witnesses.

   • Medical Board Approval: The patient’s wishes must be confirmed by two medical boards, which must communicate their decision within 48 hours.

   • High Court Oversight: If a hospital refuses permission, the patient’s family can approach the High Court, which will form a fresh medical board to review the case.

Global Perspective

While passive euthanasia is accepted in several countries, nations like the Netherlands and Belgium have gone further by legalizing active euthanasia under strict safeguards. This includes regulations to ensure that the decision to end life is voluntary and well-informed. However, passive euthanasia remains the more widely accepted form of euthanasia in most parts of the world.

Ethical Perspectives on Euthanasia

1. Autonomy (Self-Determination):

   • The ethical principle of autonomy asserts that individuals should have the right to make informed choices about their life and death. This principle supports passive euthanasia, as terminally ill patients should have the right to refuse life-prolonging treatment.

2. Beneficence (Acting in Patient’s Best Interest):

   • Medical actions should aim to relieve suffering. Passive euthanasia aligns with this principle by removing futile and burdensome treatments, allowing for a natural and peaceful death.

3. Justice (Fairness and Equity):

   • The principle of justice advocates for equitable access to palliative care and legal safeguards. It is essential to protect vulnerable patients from coercion into euthanasia due to financial or social pressures.

Why is There a Need to Reform Passive Euthanasia in India?

Despite legal recognition, passive euthanasia faces significant challenges in India:

1. Bureaucratic Delays:

   • The 2018 guidelines for euthanasia aim to streamline the process but remain ineffective due to bureaucratic delays. The multi-tier approval process causes unnecessary suffering for terminally ill patients, contravening the constitutional promise of dignity in death.

2. Practical Inaccessibility:

   • Families and healthcare professionals often bypass formal legal processes due to their complexity. This results in informal decisions, leaving medical professionals vulnerable to legal action.

3. Low Awareness:

   • Many patients, families, and healthcare professionals are unaware of living wills or advance directives, limiting their practical use and availability for patients seeking passive euthanasia.

4. Cultural and Societal Concerns:

   • Euthanasia often faces moral opposition in India due to the cultural and religious views on the sanctity of life, with some considering euthanasia akin to murder.

5. Fragmented Healthcare System:

   • India’s uneven healthcare infrastructure, along with the lack of trained personnel and hospital-level ethics committees, makes it difficult to implement euthanasia fairly and efficiently.

What Reforms Are Needed for Passive Euthanasia in India?

1. Digitisation of Advance Directives:

   • Create a National Euthanasia Portal linked with Aadhaar to facilitate easy registration, updating, and revocation of living wills. Doctors could also validate mental capacity online, reducing paperwork and delays.

2. Hospital-Level Ethics Committees:

   • Establish ethics committees in hospitals comprising senior physicians, palliative care specialists, and an independent member. These committees should be empowered to authorize the withdrawal of life support within 48 hours, decentralizing decision-making.

3. Transparent Oversight:

   • Replace the current single-state ombudsman model with digital dashboards or state-level health commissioners to monitor euthanasia cases. Periodic audits and public reporting can build trust and prevent misuse.

4. Mandatory Safeguards:

   • Introduce safeguards such as a 7-day cooling-off period, psychological counseling, and a review of palliative care options before approving the withdrawal of treatment. This ensures that vulnerable populations (elderly, disabled, and financially dependent individuals) are protected from coercion.

5. Capacity Building & Awareness:

   • Integrate end-of-life care ethics and legal training into medical and nursing curricula. Public awareness campaigns should be conducted to normalize living wills, advance care planning, and palliative care options.

6. Streamlined Procedures:

   • Simplify the approval process while maintaining essential safeguards to ensure timely relief for terminally ill patients.

Conclusion

Reforming the framework for passive euthanasia in India is essential to align the law with the constitutional commitment to dignity in death. By addressing the bureaucratic delays, improving awareness, and introducing systemic reforms, India can bridge the gap between legal recognition and practical access to euthanasia, ensuring that terminally ill patients have the right to die with dignity.