Justice K. Kannan (Retd.), is a former HC Judge and author of the book: Medicine and Law, (2025) 2nd edn, Thomson Reuters. Available at: https://amzn.in/d/02RUSmj https://bharatlawhouse.in/…

I. Introduction: Legal Foundations and Judicial Milestones

India’s legal journey on end-of-life care has evolved gradually, beginning with cautious judicial forays into passive euthanasia and advancing toward the promise of patient-driven advance directives. Despite successive Supreme Court pronouncements—from Aruna Shanbaug v. Union of India (2011)[i] to Common Cause v. Union of India (2018)[ii] and its procedural refinement in the 2023 K.M. Joseph-led bench ruling[iii]—the system remains burdened by procedural hurdles that too often deny timely relief to patients suffering from irreversible, terminal conditions. As India confronts a future with an aging population and growing access to medical technology, it must seize the opportunity to harness digital systems, empower hospital ethics committees, and establish medical ombudsmen to deliver a humane, transparent, and efficient end-of-life care framework.

II. The Active-Passive Euthanasia Distinction

The distinction between active and passive euthanasia lies at the heart of this debate. Active euthanasia, which involves the deliberate administration of life-ending substances by medical professionals, remains illegal in India. It is resisted on moral, religious, and ethical grounds. Passive euthanasia, by contrast, permits the withholding or withdrawal of life-sustaining interventions such as ventilators, dialysis, and artificial nutrition when they merely prolong the dying process. In many jurisdictions globally, including Canada, the Netherlands, Belgium, and certain U.S. states, assisted dying is recognized under stringent regulations. India, however, has confined legal euthanasia to the passive form, grounded in the understanding that permitting natural death in the face of futile medical intervention aligns with the right to dignity enshrined in Article 21 of the Constitution.

III. Constitutional Ethics and Core Safeguards

The Indian constitutional framework implicitly safeguards the right to die with dignity as part of the broader right to life. Any legal regime allowing passive euthanasia must rest on three essential principles. First, it requires the patient or their legally authorized representative to give informed consent after a full understanding of the prognosis, treatment options, and the implications of refusing life-sustaining treatment. Second, such consent must be voluntary, free from coercion, undue influence, or familial pressure. Third, the patient must possess the requisite mental competence to make the decision, ensuring that only individuals capable of understanding the implications may execute an advance directive.

IV. Procedural Complexities in the Present Regime

Although the Supreme Court has recognized the validity of living wills and advance directives, the procedural apparatus supporting them remains unduly complex. The process currently mandates the drafting of a living will, witnessed and notarized, and reviewed first by a hospital medical board, then by a district-level board. In cases of disagreement or complexity, judicial or quasi-judicial bodies are drawn into the process. For patients approaching death, often in severe pain and diminishing capacity, such a layered and bureaucratic process may fail to provide timely relief, rendering the right meaningless in practice.

V. Towards a Streamlined, Technology-Driven Framework

A humane response requires the construction of a more accessible, technologically driven framework built upon four pillars. The first involves the creation of a digital registry for advance directives. Such a system, integrated into the National Health Stack, should enable individuals to draft, register, amend, or revoke their directives through an online portal. Linking this system to Aadhaar would allow for biometric authentication and prevent fraud. A treating physician’s certification of the patient’s mental capacity and voluntariness should replace the need for review by multiple boards.

The second pillar entails the empowerment of hospital ethics committees to act as the primary reviewing authority. On hospital admission, an internal committee composed of senior medical professionals and an independent member would review the directive and assess whether it aligns with the patient’s medical condition. The decision should be rendered within forty-eight hours to prevent undue delay.

Third, oversight should be exercised by a state-level medical ombudsman. Instead of subjecting every case to judicial scrutiny, only exceptional cases—such as those involving last-minute amendments or suspect directives—would be flagged for review. Patients or family members should be allowed to file appeals within seventy-two hours, preserving the right to due process.

Fourth, mandatory safeguards should be incorporated. These include a seven-day cooling-off period between the registration and activation of an advance directive, the inclusion of mandatory tele-counselling to confirm mental capacity and intent, and consultation with palliative care specialists to ensure that the patient is not opting out of potentially effective comfort measures.

These four measures, taken together, would balance the goals of autonomy, safety, and accessibility, while eliminating unnecessary bureaucratic complexity.

VI. Comparative Jurisprudence: The UK Assisted Dying Bill

The recent legislative developments in the United Kingdom offer a contrasting perspective on assisted dying. In June 2025, the UK House of Commons passed the Terminally Ill Adults (End of Life) Bill by a narrow margin. This legislation allows for physician-assisted dying for adults who are mentally competent and have a prognosis of fewer than six months to live. The process mandates two independent medical assessments, a reflection period, and oversight by a multidisciplinary Assisted Dying Review Panel. The Bill also criminalizes coercion, respects the conscience rights of objecting medical professionals, and establishes an Assisted Dying Commissioner to oversee implementation. Although passed in the Commons, it remains under consideration by the House of Lords and is not yet in force.

VII. Why the UK Model is Unsuitable for India

While the UK law represents a carefully designed framework, it cannot be seamlessly imported into the Indian context. First, the UK model legalizes active euthanasia, a significant departure from the Indian legal position which restricts itself to passive withdrawal. The Indian judiciary has been cautious in distinguishing between omission and commission in medical contexts.

Second, the UK’s robust healthcare infrastructure, marked by near-universal registration with general practitioners and accessible institutional support, cannot be assumed in India, where rural populations and resource-deficient hospitals face systemic challenges.

Third, cultural and religious diversity in India plays a critical role in end-of-life decision-making. Strong familial bonds and community-driven ethical codes mean that active euthanasia, even under strict safeguards, might provoke social discord.

Fourth, the risk of coercion and misuse in India is elevated by socio-economic inequality, weak regulatory mechanisms, and disparities in legal literacy. Without uniformly strong institutions, vulnerable individuals could be pressured into decisions that do not reflect their true wishes.

VIII. Policy Recommendations and Ethical Imperatives

India must therefore focus on perfecting its passive euthanasia regime rather than contemplating an active one. Reform efforts must seek to democratize access to end-of-life care options, particularly for those in underserved regions.

The proposed protocol offers several practical advantages. A digital framework can extend access to remote areas, enabling patients to register directives without burdensome travel or legal expense. Biometric authentication and auditable data trails will enhance accountability and prevent manipulation. A single-tier review structure, with rapid timelines and focused oversight, will bring relief to suffering patients without compromising safeguards. Most importantly, this model respects the inherent dignity of human life while acknowledging the individual’s right to forgo futile treatment.

IX. Conclusion

To fulfill the promise made in judicial pronouncements and the Constitution alike, India must revise its regulatory framework on passive euthanasia to make it more responsive, compassionate, and modern. As the UK moves toward legalizing assisted dying through legislation, India must draw lessons while remaining rooted in its own social, ethical, and constitutional landscape. Reforming passive euthanasia is not merely a technical or legal challenge but a moral imperative that upholds the autonomy and dignity of terminally ill individuals.

Author: K. Kannan, Medicine and Law, (2025) 2nd edn, Thomson Reuters. Available at: https://amzn.in/d/02RUSmj https://bharatlawhouse.in/…

Endnotes

[i] Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454.

[ii] Common Cause (A Regd. Society) v. Union of India, (2018) 5 SCC 1.

[iii] Common Cause v. Union of India, modified procedure as per Supreme Court order dated January 24, 2023 (per K.M. Joseph, J.).