Authors:

Nimisha Sharma, Prachi Dhruw, Hina Katariya, A. Neelufer Naaz, Manya Sharma

ABSTRACT

This paper analyses the practice of euthanasia from a legal, ethical and comparative perspective, primarily focusing on the Indian legal context while also incorporating the global perspectives on the subject matter. It discusses the judicial evolution of the legalization of passive euthanasia in detail and unfolds with early interpretations of Article 21 of the Indian Constitution and the varied views on the ‘right to die’ conundrum expressed in cases such as Maruti Shripati Dubal, P. Rathinam and Gian Kaur. It also significantly highlights a transformative shift in the Aruna Shanbaug case, through Common Cause vs. Union of India and finally culminates in Harish Rana v. UOI, wherein the Supreme Court formally recognised the right to die with dignity and acknowledged passive euthanasia for including advance directives, which thereby, marked a significant constitutional milestone in the legal history. 

The paper further explores the contentious distinction between active and passive euthanasia, while focusing on the moral, legal and practical debates around mercy killing vs. letting die, voluntarily. It also confesses utilitarian analyses that helps us evaluate outcomes for the PVS or terminally ill patients, the families, medical professionals and impact on society. It also, meanwhile distinguishes passive euthanasia from physician assisted suicide using the study of a few international models, such as the Benelux, Swiss and U.S. legal frameworks. The paper also engages with dissenting judicial opinions, ethical concerns and socio-religious opposition in the country of India. It also discusses potential misuse, healthcare inequality and the concept of patient bodily autonomy. The religious and cultural perspectives play a significant role in disarranging what is accepted and what is not, and gives sanctity of life an upper hand over individual choice. The paper, thus, reflects how euthanasia is a deeply contested domain, questioning the law surrounding morality and societal realities surrounding the legalisation of mercy killing, further, converging to show the need for a cautious but also a compassionate, humane and thoughtful approach.

Keywords: passive euthanasia, mercy killing, Article 21 of the Indian Constitution, right to life, right to die with dignity

INTRODUCTION 

I. EVOLUTION OF EUTHANASIA THROUGH A JUDICIAL LENS

Fundamental Rights are the cornerstones of the Indian Constitution, among which Article 21, explicitly connotes the ‘Right to Life and Personal Liberty’ providing that “no person shall be deprived of his life or personal liberty except according to the procedure established by law”. However, a question distinctively arises — whether the right to die is included in Article 21 in the Indian Constitution, absolutely? This exhilarates multiple assenting and dissenting answers, parallel to each other.

(A) Early Judicial Stance

The earliest judicial interpretation for the right to die eventuates in the case of State of Maharashtra v. Maruti Shripati Dubal, where the Bombay High Court had affirmed the right to die to be covered under the purview of Article 21 of the venerable Constitution of India, further, remarkably striking down the Section 309 of the Indian Penal Code, declaring it unconstitutional, which deliberately penalised the attempt to suicide under the national laws.

Later, the Supreme Court, in the case of P. Rathinam v. UOI, a division bench ruled that the ‘right to life’ also covers the right to not live against an individual’s will. Furthermore, the hon’ble apex court also held that compelling a person to continue living in conditions antithetical to their dignity, ab initio, violates Article 21, thereby making it essential to decriminalise ‘attempt to suicide’ and to give a constitutional backup to personal autonomy over decisions related to one’s own life.

This stance forwarded, initiating itself in the case of P. Rathinam and later was overturned by a constitutional bench in the case of Gian Kaur v. State of Punjab. Herein, the bench held that the right to life does not include the right to die. The court drew a distinction by quoting, “The right to die with dignity at the end of one’s natural life is not to be confused or equated with the right to die an unnatural death curtailing the natural span of life,” which meant that the right to live with dignity could not extend to the right to end life, pertinently. 

According to Justice J.S. Verma, “The right to life is a natural right embodied in Article 21 but suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of right to life.” Talking about the constitutional rationale this judgment established that Article 21 protects natural life and excludes suicide, but at the same time didn’t bar courts to allow a dignified death at the end of one’s life.

(B) The Turning Point

In the case of Gian Kaur, an introduction to the right to die under passive euthanasia was significantly came to the forefront of Indian legal history. Later, another case, that of Aruna Shanbaug v. UOI, came to be regarded as one of the most important judgments regarding euthanasia in India. This case comprised a petition filed by journalist Pinki Virani, on behalf of Aruna Shanbaug, regarding withdrawal of her life support following the public recognition nationwide.

The Supreme Court declined the specific relief requested, to respect the wishes of KEM hospital staff which was keeping the plaintiff’s subject alive, so they can continue to take care of her until her natural death. However, Justice Markandey Katju’s judgement created a pathway towards the historic legalization of passive euthanasia. He stated that passive euthanasia, meaning the withholding of life sustaining treatment to be held legally permissible, while active euthanasia which means giving of lethal substances to cause voluntary death to still be considered legally impermissible. The reasoning of the court was consistent with the obiter in the Gian Kaur case and held that the High Courts have the authority to permit passive euthanasia through a parens patriae jurisdiction, and laid down rules regarding the process, in toto, providing India’s first legal recognition of passive euthanasia.

Consistently, the Law Commission of India also produced several works and studies debating the right to die with dignity under a constitutional purview. The final report submitted as the ‘196th Report’ of 2006, in which they explicitly recommended a statutory framework for end of life decisions. Following the Aruna Shanbaug judgement, it was produced in their 241st Report (2012) titled “Passive Euthanasia – A Relook”, which recommended legal acceptance of advance medical directives, surrogate decision-making frameworks, and formation of significant medical boards for its adjudication. The report affirmed that the patient autonomy and the State’s interests must be balanced, indicating a prominent shift where letting a person die naturally by withdrawing treatment & supplements became legally different from an active life termination.

(C) Formalisation Of Passive Euthanasia

In Common Cause v. UOI, 2018, The constitutional bench remarked that the right to die with dignity is covered under the legal constraints of Article 21 of the Constitution. Referring to Gian Kaur and the principles derived from Aruna Shanbaug, the court removed its ambiguity and highlighted the right to autonomy and dignity of the body. They held that competent adults may refuse medical treatment including life sustaining support and recognising advance directives, and a written will made by the person while they were mentally stable and competent to make decisions, as a valid instrument for expressing choices.

To give this effect, the court issued notable procedures for registering the directives before a magistrate, for which the evaluation of circumstances by medical board was required, and authorised the High Courts for the same. These directions are considered a binding law until the Parliament’s authorized act, thus widening this right, overstating its effect.

In 2023 Common Cause, The court revised the framework which was issued in its 2018 decision and simplified the procedures to make them more practical and reduce the burden on families and medical institutions. Some unnecessary formalities were removed from the framework so that one can rely on the ‘advance directives and end of life decisions’ without countering administrative interventions.

Both frameworks produced, in 2018 and in 2023, are one of the most comprehensive judicial developments of euthanasia in the country. The placement of these advance directives straight under Article 21, altered the framework around passive euthanasia from a rule of requiring court permission to a standard legal right defining clear steps to be taken so that personal choice and legal safeguards can be maintained during the procedure.

II. DISTINCTION BETWEEN ACTIVE AND PASSIVE FORMS OF EUTHANASIA AND FOREIGN POLICIES

In contemporary times, passive euthanasia is sometimes and in some countries, regarded as permissible and active euthanasia, contrarily, is largely impermissible. This creates a temporary moral distinction between functional killing and letting die. Whereas, letting someone die is considered acceptable in some cases, killing is always considered blatantly absurd in our society.

(A) Active Vs. Passive Euthanasia

A clear example of active Euthanasia is using a lethal injection and an example of passive euthanasia is turning off the ventilator. Hence, the key difference between active and passive euthanasia is one of act and omission. Passive Euthanasia has been heavily criticised by the House of Lords Select Committee on Medical Ethics and British Medical Association. Their argument that the term “passive euthanasia” is misleading and that withdrawing treatment is often not intended to kill, but to stop burdensome or unfruitful treatment, hence creating a distinctive confusion.

The European Association of Palliative Care, by taking stronger stance, claimed that passive euthanasia is a contradiction to its reference, i.e., Euthanasia is a deliberate and intentional act of killing and hence, must be active by default in its definition, and, that passive Euthanasia is logically and performatively impossible. Their view is that ‘one can never “passively kill” the other person’. This debate matters because it affects medical decisions in the ICUs, the legal frameworks surrounding euthanasia, doctors’ ethical responsibilities and patient’s autonomy and dignity rights. 

Passive Euthanasia leads to slow death with painful processes such as starvation, dehydration, suffocation, toxin buildup, which often prolongs the suffering. Active Euthansia, on the other hand, is quick, painless and controlled, performed through the injection of pentobarbital, a lethal drug, by an experienced medical practitioner to induce unconsciousness and gradual death of the patient. The real reason why passive euthanasia is preferred over active euthanasia is that it protects doctors from legal consequences associated with implied active ‘killing’ on a vulnerable person. Hence, the preference of passive euthanasia over active euthanasia, while a patient-centric decision, is also a decision that is centered on the doctor’s protection. 

When a doctor agrees to perform Euthanasia, they believe that ending of life substantially leads to a better outcome for the aggrieved. The patient, their family, involvement of medical staff and societal norms, are all considered. This reflects a utilitarian reasoning according to which, the focus is on maximising the overall well being of the sufferers as well as the ones connected, and by minimizing the suffering. 

The principle of act utilitarianism, as pinned by Jeremy Bentham, is – that an action is right if it produces the greatest utility among the other options that are available. The focus is on individual acts and their immediate consequences. Contrarily, the principle of rule-utilitarianism is – that an action is right, if it follows rules that maximises the overall utility. The focus is on general rules and not on isolated acts. 

It is assumed that both active and passive euthanasia are legally and morally permissible but active euthansia leads to quick death, minimal pain and also preserves dignity of the individual. For families, it avoids prolonged trauma and psychological suffering. It relieves the medical staff of emotional burden and gives a sense of closure. For society, the resources such as ICU beds, staff time and equipment are freed. This, hence, leads to maximum utility for all parties involved.

Passive Euthanasia, on the other hand, causes slow, painful death for the patient, for the family. They have to witness prolonged suffering and long lasting emotional trauma, for medical staff, continued distress and they are forced to prolong suffering. For society, the resources are wasted on unwanted treatment and the opportunity cost is that other patients are deprived. Hence, according to Bentham’s calculus, taking into consideration factors like intensity, duration, certainty and extent, active euthanasia ends up scoring higher.

Now, to evaluate, using rule-utilitarian analysis, the rule for active euthanasia is “act in ways that best benefit others.” Comprehensively, the rule for passive euthanasia is, “refrain from acting even when action could help.” The core issue, here, is that the passive rule ignores the consequences and active rule focuses on maximising welfare. The conclusion according to rule utilitarian analysis, thus, is that active euthanasia maximises general happiness whereas passive euthanasia, comparatively, produces less utility. Hence, the rule utilitarianism supports active euthanasia.

(B) Distinction From Physician Assisted Suicide

A Physician-assisted suicide refers to a doctor prescribing life ending drugs but it’s the patient that administers them, whereas, in case of active euthanasia, the doctor himself administers the drugs to end life. In Europe, assisted suicide is legal in Netherlands, Belgium, Luxembourg and Switzerland. In the USA, it is legal in Oregon, Washington and Montana. There are three legal models of assisted suicide, which include Benelux model, which is followed in Netherlands, Belgium and Luxembourg, Swiss Model and the US model, which is followed in Oregon, Washington and Montana. The Benelux model is the most permissive and structured system of all. This model is based on doctor-patient relationship which allows for assisted suicide and euthanasia and the illness need not always be terminal. The conditions under this model include that the patient has to voluntarily make, and properly consider the request and the doctor must give proper and complete information to the patient about the conditions and alternatives, and if there is no such alternative, then the doctor must confirm that no reasonable alternative exists. The doctor must, additionally consult another independent doctor and report the case to the authorities. 

The Swiss model is a remarkably unique and liberal but an indirect system. The legal basis of this model is Article 115 of the Swiss Penal Code (1918) wherein, assisted suicide is not considered illegal, provided it has not taken place for selfish motives. There is no need for a doctor-patient relationship and it is not mandatory that a licensed physician must be present at the time of death. Under this model, the right to die groups assist patients and doctors to prescribe lethal drugs, such as sodium pentobarbital. However, the court requires that the patient is mentally competent and the decision is self determined and stable.

The U.S. model has taken a more restrictive and cautious approach by allowing only physician assisted suicide. The features of this model are that the patient must be above 18 years old, must have terminal illness and must be mentally competent. The procedure under this model is an oral and a written request, by which, two doctors must confirm the diagnosis and of voluntary decision, and the patient must be properly informed about prognosis, risks and alternatives, such as hospice, palliative care, etc. Some common safeguards across all these systems are free consent, mental competence, medical confirmation and compulsory reporting of requirements. These reporting systems are mandatory in the countries such as the Netherlands, Belgium, Luxembourg, the States of Oregon & Washington in the USA, however, not clearly regulated in Switzerland and Montana.

Assisted deaths account for 0.1% to 2.9% of global deaths. The highest number of cases of assisted suicide are in the European countries and is comparatively lower in the United States, making cancer patients, ages 60-85, the most common people among choosing assisted suicide. The distinction between euthanasia and assisted suicide reflects a moral divide, since proponents of assisted suicide may justify both practices and argue that these practices relieve the person of unbearable suffering. However, opponents may also argue that euthanasia ends up crossing a more serious ethical boundary and transforms the physician’s role from a saver of life to an end-er of life.

Legal systems across the world regulate euthanasia more strictly because of a physician’s direct involvement. The distinction between euthanasia and assisted suicide is not merely technical but deeply philosophical, which involves considering who performs the final act and how society evaluates the means that is used to achieve the shared end and the final goal of relieving the suffering.

III. LEGAL AND ETHICAL DISSENT, AND SOCIAL CRITICISM 

The Supreme Court of India in Common Cause v. Union of India (2018), a five judge bench issued a ruling on euthanasia where the bench affirmed that the right to die with dignity is also an integral part of Article 21 of the Indian Constitution. However, this judgment received a lot of opposition, not only from within the court, but also from the religious, medical, and social sectors of Indian society.

(A) Dissenting Opinions In Landmark Rulings

In India, the discussion over euthanasia didn’t originate with the Common Cause (supra) case but traces back to the Gian Kaur v. State of Punjab (1996) and even in the deeper past. In the 2018 Common Cause, a five-judge Bench clearly held that Article 21 guarantees the right to life, and that right does not expressly include the right to die. The bench, here, overruled its earlier judgment in the P. Rathinam (1994), which had a contrary disposition, from what was held in the Gian Kaur case. And for the next decade, Gian Kaur’s judgment was the law.

Subsequently, in the 2011 case of Aruna Shanbaug, passive euthanasia was being permitted through judicial guidelines, despite Gian Kaur case indicating that such matter required legislation backing. In the Shanbaug case hon’ble court tried to interpret Gian Kaur judgment as leaving limited scope for passive euthanasia. However in 2014 the same matter referred to a larger bench and that bench observed that the Shanbaug judgment was “partially anchored in a wrong interpretation.”⁵ That’s the Supreme Court acknowledging that the earlier bench misinterpreted the law.

Justice Chandrachud’s concurrence as the most interesting internal critique appears in the Common Cause. J. Chandrachud agreed with the final outcome of the case; however, he expressed concern that the Shanbaug case ruling had substantially dealt with Aruna Shanbaug as an individual without any formal legal authority, where Aruna remained in a permanent vegetative state for over three decades, yet the court essentially decided her fate based on input from the nursing staff of KEM Hospital. Justice Chandrachud also emphasized that her subjectivity, her dignity as the actual subject of the case, was erased. He also criticized the majority’s reference in this case as beings from the Nazi war crime trials. He carefully drew a hard line between voluntary passive euthanasia and involuntary euthanasia, noting that the latter would amount to homicide under the guise of medical treatment. Earlier Judgments had, to some extent, blurred this distinction.

Justice Bhushan, in his concurring opinion, expressed concern with the idea of advance directives operating without legal framework by parliaments. Although his concern less highlighted but raised legitimate questions in court was, in effect, stepping into a legislative role in an area as sensitive as euthanasia. That raises another issue of accountability and uniformity.

(B) Potential For Misuse And Vulnerability Of Terminally Ill Patients 

The practical reality of the Indian healthcare system impacts the euthanasia debate. According to a WHO (2023) Report, India has 0.7 hospital beds per 1,000 people. Data collected from the ministry of Home affairs indicates that nearly 75% of doctors are in urban areas serving 30% of the population. In contrast, rural areas where nearly 7.69% people need palliative treatment. In urban areas it is 3.34%.

According to Indian Journal of Palliative Care (2023), it has been suggestively noted that individuals aged 60 and above, that are nearly 37.86% of the population need intensive palliative treatments, the majority of which is residing in rural areas. This data highlights the situation of the Indian healthcare system and challenges faced by terminally ill patients making life or death decisions of implementing euthanasia. The legal inconsistencies further complicate this issue. 

The Oxford University Journal in law explains that the Mental Healthcare Act, 2017 of India, notes the decriminalization of suicide attempt, which in theory allows a physically capable individual to end their life. However, a physically dependent person or paralysed person cannot exercise the same rights without assistance, legal approval, or compliance with procedures such as living will. This creates unequal treatment among patients facing different terminal illnesses.

Demographically, projections by census data indicated that by 2050, the Indian population aged 60 and above will rise from 100 million to 300 million, while access to healthcare and social security is merely 18% of total populations. Concern has been raised by the National Human Rights Commission regarding inadequate infrastructure for persons with disabilities and India has nearly 2.68 crore population with disabilities. This factor indicates that euthanasia cannot be examined in isolation without tackling healthcare system limitations.

Further debate over autonomy of life and euthanasia most of the arguments which supported euthanasia are based on the assumption that patients exercise free and informed consent. However The Indian medical association 2018 has pointed out that patients in clinical settings are often not in equal positions to make decisions, as the process is largely framed and guided by medical professionals. It is also to be noted that the high cost of prolonged medical treatment imposes a heavy economic burden on patients and families. In addition, social dependency and lack of adequate support system further limit the ability to make independent decisions. Therefore, what appears as consent may not necessarily reflect genuine autonomy when it is constrained by so many different factors.

It is also relevant to note that in subsequent proceedings related to Common Cause Case 2023, Court observed that no substantial reforms had been made regarding advance medical guidelines since 2018, indicating need for updated guidelines with contemporary healthcare issues.

(C) Religious And Social Opposition: Sanctity Of Life Vs. Living Autonomy  

The judgment of 2018 also faced significant opposition from various religious communities. The catholic church rejected both active and passive euthanasia, stating that Article 21 cannot include the right to die. In Islam, human life is considered to belong to God, and therefore it must end naturally without human intervention (Surah Al-Isra-17:33 – Quran.com, 2024). In Hinduism perspective may differ internally, but it broadly emphasizes Dharma, Karma, and spiritual way of living and ending life (Bhagavad Gita, Ch.2 Explained).

This clearly creates conflict between Article 21 and Article 25 of the Indian Constitution. While Article 21 recognised personal dignity of life and death of an individual, and Article 25 protects freedom of religion. In Indian society, decisions related to life and death heavily influenced by family, religion and social structure, there is a high probability of individual choice override by society and religious beliefs.

The sanctity argument gains doctrinal strength here: a person holding genuine religious conviction that life belongs to God or must follow its natural course is not merely expressing personal preference — they are exercising a fundamental right under Article 25. When the state recognizes a constitutional right to die (Article 21 autonomy), it must simultaneously decide whether Article 25 protections for sanctity-of-life conviction operate at the same doctrinal level or are subordinate to it.

The Common Cause judgment does not address this directly. It treats the autonomy framework as constitutionally sufficient once informed consent is established. But a symmetrical analysis would ask: if Article 25 is genuine, does it protect not only a person’s right to refuse euthanasia for religious reasons, but also the state’s role in preserving life for citizens who hold sanctity-of-life beliefs? The current framing treats Article 25 opposition as social background rather than a competing constitutional claim.

Stephen Fernandes commented that “the state is offering people the right to die at the precise moment it should be investing in the right to live with dignity,” which suggests that the state should focus on improving healthcare infrastructure and support systems.

This also sheds light on evolving medical science, as conditions which look irreversible in present, may become treatable in future. So decisions relating to euthanasia require cautions, as present limitations may not be a permanent issue. Having examined the dissenting opinions and social opposition, it becomes necessary to trace how Indian jurisprudence on euthanasia has changed through the evolving judicial interpretation.

IV. CONSTITUTIONAL LANDSCAPE OF INDIA

The constitutional landscape of euthanasia in India reflects the manner in which Article 21 of the Indian Constitution has been judicially interpreted to issues such as euthanasia, living wills, bodily autonomy, and dignified death has been addressed in courts. Euthanasia is consists of the legal rules, medical ethics and individual rights. At the core it is the debate between how valuable life is and how much liberty you have to make decisions about yourself, your body, or even end of life as well, which is related to Article 21 of the Indian Constitution .

The constitution aims to protect and preserve life not the right to die over time, the courts interpreted Article 21 as the right to live with dignity which has sparked a question due to this expansion.The right to live with dignity also implies the right to die with dignity by the self – determination and the role of the State in protecting its citizens ensuring both life protection and respect for dignity.

(A) Constitutional Validity Of Euthanasia Regarding Art. 21 Of The Indian Constitution

In India, the eventual question about constitutional validity of euthanasia can be decided based on the evolving interpretation of Article 21. Initially, interpretation of Article 21 underwent significant development from Maneka Gandhi v. Union of India (1978) to the Common Cause case. However, an alternative constitutional interpretation maintains Article 21 was originally intended to safeguard life rather than facilitate its termination. According to this view, recognising an extensive right to die may dilute the State’s constitutional obligation to preserve life, particularly in a developing society characterised by unequal access to healthcare, Consequently, constitutional adjudication must ensure that recognition of autonomy does not undermine the protective purpose of Article 21 itself.

The court adopted a broader interpretation of life and personal liberty. Since then Article 21 has included the dignity, privacy, bodily integrity, and bodily autonomy, which include recognising the right to end of life. As the Hon’ble Court quoted that, “No person shall be deprived of his life or personal liberty except according to procedure established by law.” Hence, the constitutional basis evolved to recognise individual autonomy.

Subsequently, in the Aruna Shanbaug case, the Supreme Court recognised passive euthanasia with certain limits subject to legal jurisdiction. The court rejected the right to active euthanasia, but permitted withdrawal of life sustaining treatment in certain cases such as permanent vegetative state (PVS). This was a crucial shift from strict reservation of life to a balanced approach incorporating dignity and medical reality of society.

The judicial precedent was further supported by the Law Commission Report (196th and 241st Reports) which recommended end of life decisions, passive euthanasia and medically advanced medical directiveness to sustain life artificially, with a statutory framework to prevent potential misuse in situations such as persistent vegetative states or terminal illness.

• Constitutional Theory of Dignity

The Constitutional recognition of euthanasia cannot be understood merely through judicial precedents; it must also be examined through the constitutional theory of dignity. The Supreme Court has progressively interpreted Article 21 as protecting not only biological existence but also the intrinsic worth of every individual. This transformation began with Maneka Gandhi v. UOI, where Article 21 was interpreted expansively to include fairness, reasonableness and substantive liberty. The principle was further strengthened in Justice K.S.Puttuswamy (Retd.) v. UOI, which recognised dignity, privacy and bodily integrity as inseparable constitutional values.

Building upon these developments, Common Cause v. UOI acknowledged that preserving dignity extends to end -of-life decisions, thereby recognising that an individual may refuse life-sustaining medical treatment. Consequently, dignity under Article 21 is no longer confined to protecting life but encompasses respect for bodily integrity, informed consent and decisional autonomy throughout the course of life, including its final stages.

(B) The Doctrine Of Personal Autonomy And Bodily Integrity Synchronous With Biomedical Ethics (K.S. Puttaswamy Judgment)

The doctrine of autonomy and bodily integrity plays a fundamental role in euthanasia jurisprudence. 

This doctrine of personal autonomy was laid down in Justice K.S. Puttaswamy (Retd.) v. Union of India, where privacy was recognised as an intrinsic facet of Article 21, ensuring protection of privacy, dignity and bodily autonomy and informed consent. The Principle of informed consent extended directly to medical law. An individual has the right to refuse any medical treatment, including life sustaining treatments. Which also aligns with global bioethical principle and recognised individual autonomy over life.

• Personal Autonomy Theory

Constitutional autonomy under Article 21 extends beyond privacy to include decisional autonomy, that is, the freedom of individuals to make fundamental choices concerning their own bodies and medical treatment. In the context of euthanasia, autonmy encompasses informed consent, refusal of unwanted medical intervention, bodily integrity and contol over end of life decisions. Nevertheless, constitutional autonomy is not absolute. The state retains a legitimate constitutional interest in preserving life, preventing coercion and protecting vulnerable individuals. Accordingly, the jurisprudence of euthanasia reflects a constitutional balance between individual self-determination and public interest rather than an un restricted right to choose death. 

In practical terms this is reflected in the concept of Foregoing of Life Sustaining Treatments (FLST). Where the patient has the choice of refusing artificial support such as a Feeding mechanism, ICU, Ventilators etc. FLST is not an act intended to cause death, but recognising individual autonomy to decide, rather compelling them to undergo medical treatments.

Further, in K. S. Puttaswamy case, also held by the Hon’ble Court that the individual has the right to make personal choices including medical decisions, refusal of treatment, and the end of life choice. As the individual autonomy over life is protected under Article 21. which also directly applies to euthanasia for medical interventions. Hence, no treatment can be forced without free and informed consent.

Constitutional scholars increasingly recognise autonomy as a foundational value underlying Article 21. While some scholars argue that respect for decisional autonomy necessarily includes the freedom to refuse life-sustaining treatment, others caution that constitutional autonomy cannot be interpreted in isolation from the state’s obligation to protect vulnerable persons. This academic debate reflects the continuing tension between liberal constitutionalism, which prioritises individual choice and welfare constitutionalism which emphasises the protective roe of the state.

In such practical terms, India has historically struggled with the palliative care gap. As per WHO reports and studies published in the Indian Journal of Palliative Care, nearly 5 to 6 million people in India require palliative care but only less than 2% have access to such services. This empirical evidence demonstrates that the practical exercise of decisional autonomy depends not only upon constitutional rights but also upon the availability of adequate health care services. Without meaningful access to palliative care, patient decisions regarding euthanasia may be influenced by inadequate medical support rather than genuine autonomous choice. 

(C) Legal Recognition Of Advanced Medical Directives And Procedures Under Introduction Of Living Wills

The recognition of advance directives and living will further strengthen the autonomy of the individual under Article 21. This is also recognised by the Court in Common Cause v. Union of India (2018), where the Supreme Court held that, right to die with dignity is a part of Article 21. The Court also affirmed that an individual has the right to refuse unwanted treatment and such choice may be exercised in advance through living wills or any other advance directives. 

In legal terms, an advanced directive does not possess an absolutely binding force but it is a conditionally enforceable instruction. Execution of advance directives depended upon verification by medical authority and compliance with procedure prescribed by the Courts. Thereby preventing it from functioning as a self-executing expression of patient will. However, individuals may execute a living will for future states of incapacity. While this provides autonomy to individuals; however, this autonomy remains mediated through institutional mechanisms, particularly medical boards. which act as a legal threshold in determining whether the directive may be implemented in a given case. In Common Cause Case (2023), Supreme Court removed the requirement of attestation before a JMFC. and reduced the number of medical boards from two to one. Thereby easing the process of obtaining a certificate.

Significantly, the legal force of advance directives remains judiciary derived than statutory enacted, as the framework continues to be governed by court prescribed guidelines in absence of comprehensive legislative framework, raising concern over consistency, uniformity and implementation. Thus, the recognition of advanced directiveness marks an important constitutional development throughout its process, however, its practical relevance ultimately depends on the procedural mechanism governing it and its implementation. 

The decision in Common Cause v. UOI directed a constitutional transition from viewing Article 21 solely as a guarantee of life towards recognising dignity and decisional autonomy as integral constitutional values. However, the court simultaneously imposed extensive procedural safeguards, reflecting that autonomy under Article 21 is not absolute but must be balanced against the state’s obligation to protect vulnerable individuals. 

V. PROCEDURAL FRAMEWORK, JUDICIAL REASONING AND IMPLEMENTATION

In significance of the jurisprudential timeline on Euthanasia, which, for the nation, constitutionalizes the ‘right to life’ as one of the fundamental rights and an essential of the legal framework of the Indian Constitution under the Article 21. The provision has been of the utmost importance in defining the similitude between ‘right to life’ and ‘right to live with dignity’, thus a remarkable parallelism with “right to die with dignity” in the purview of mercy killing, else, passive euthanasia.

On account of Gian Kaur v. State of Punjab, the court addressed this core underlying issue reflecting that vide Article 21 and 19 of the Constitution of India, the right to life which is a natural right providing protection of life with dignity up to the death, entirely contrasts the right to die which could only be reduced to the negatives of assisted suicide, for which the IPC penalizes under its Section 306. Thus, overruling the judgment of P. Rathinam v. Union of India (1994) where the honorable court allowed the petitioner the right to “not live”. The constitutionality of Section 306 was also upheld in both of the cases, further complicating the issue of withholding or withdrawal of medical assistance, which is substantially regarded as amounting to attempt to suicide.

Later, as demonstrated in the judgment of Aruna Ramachandra Shanbaug v. Union of India & Ors. wherein the learned Hon’ble Judge Markandey Katju, for the key issue, whether right to life should equal right to die, reiterated the statutory interpretation regarding Article 21 in the precedent set in Gian Kaur case. However, the status of Sec. 309 of the IPC, despite its constitutional validity, should be revised to be decriminalized in the light of passive euthanasia following that the victim rather needs help than punishment.

(A) Analysis Of The Supreme Court Guidelines (Common Cause, 2018) And The Amendment Of 2023 In Contrast With The Legislative History

It is pertinent to mention the landmark judgment of Common Cause v. Union of India (2018) for its progress on the judicial reasoning for allowing the PIL to bargain for the end of life taking into account the bio-medical ethics for justifying the doctrine of beneficence. It is with this matter that the SC considered that continual medical assistance for the mere state of aliveness is for no beneficial interests of the patient as prayed by the representative of the petitioner here. 

The aggrieved in question was judicially accepted in no state of giving informed or implied consent making it impossible for the bench to give consideration to his intent for continuing living with dignity or to rest with it. This encouraged the bench to establish a set of standard rules for the medical board to request permission with authorities for the implementation of medical assistance in case of PVS patients that are not in a position to give consent to the supplementary procedure. The statutory policies here intended to safeguard the autonomy of the human body in a humane context in lieu of the concrete statutory interpretation, holding the right to dignity to be of paramount importance for life or death consideration.

This, however, followed by the review petition for the same case, wherein the Supreme Court, after due consideration in Common Cause v. Union of India (2023), overruled the decision from Common Cause (2018) (supra). The constitution bench held that the medical board doesn’t have to go through the rigorous procedures of confirmation from several authorities when supporting the terminally ill with further medical assistance.

Constitutional Analysis:

The constitutional importance of Common Cause lies in its recognition that dignity is not confined to sustaining biological existence but extends to preserving an individual’s autonomy at the end of life. By recognising advance directives and permitting withdrawal of life – sustaining treatment, the court aligned Indian constitutional jurisprudence with modern principles of bodily integrity and informed consent. However, by requiring multiple procedural safeguards, the court acknowledged that unrestricted autonomy could expose terminally ill patients to coercion, familial pressure and medical abuse. The judgement therefore reflects a proportional constitutional approach in which personal liberty is harmonised with the state’s legitimate interest in protecting life.

(B) Judicial Oversight Formed On Passive Euthanasia After Considering The Plight Of Harish Rana

Referring to the recent verdict in Harish Rana v. Union of India, (2026) SCC OnLine SC 358, decided on 11-03-2026, the division bench has been foremostly laid out in the erudite words of Henry Ward Beecher, “God asks no man whether he will accept life. That is not the choice. You must take it. The only choice is how.” With this statement, the facts of the permanent vegetative state of the petitioner party was judged on a humane and ethical note rather than a substantive fact. The primary question of law here resided in whether to consider the intervention of clinically assisted nutrition and hydration (CANH) as a medical treatment for it to be considered constitutional and not criminally opposed to the ethical treatment of a helpless person.

It was noted by the Hon’ble Justice J.B. Pardiwala that the patient’s morose state to become better despite the continuous CANH support was extremely unlikely. It is just in his case to stop or withdraw the treatment altogether for making his sufferings easy and to let him pass with dignity. He remarkably highlighted the difficulties surrounding the brain-dead patient’s caretakers and his peers for the devaluing of his living existence, as much as for the patient himself who was unresponsive to the outer world. It was on the behalf of the suffering party, it was the family’s reasoning for their persistent efforts to keep him alive at the cost of the degradation of his health on his death bed that remained futile after 13 years of financial, emotional and physical struggles. Further, the omission of doing such acts would allow respite to both.

After quoting Subharistha, “Between the funeral fire and the mental worry, it is the mental worry which is more devastating. While the funeral fire burns only the dead body, the mental worry burns the living one,” The judiciary awarded the decree, considering the plight, to give the sufferer the right to die with dignity, withholding medical support which served no therapeutic purpose, making it a landmark for passive euthanasia or mercy killing. The judiciary further decriminalized the family and medical practitioners liability under Section 306 and 309 of the IPC in the cares of passive euthanasia unless specified by the Parliament in the hereafter cases.

(C) Legislative Comparison Between Indian Euthanasia Laws And International Policy Standards

While considering the legality of Euthanasia, the global policies surrounding the subject initially came to the limelight with the legalization of physician-assisted suicide in the “Termination of Life on Request and Assisted Suicide (Review Procedures) 2001” bill passed in the nation of Netherlands which took effect from April 1, 2002. It was here, at first, that a country formally affirmed the validity of voluntary end of life (vide the Articles 293 and 294 of the Dutch Criminal Code). This was soon followed by Belgium with the enactment of the ‘Belgian Act on Euthanasia on May 28, 2002’ legalizing voluntary Euthanasia for the terminally ill (as recently amended in 2026 expanding the access to minors in some special cases which is substantially controversial).

From the legal framework decisions as held in the ruling in Airedale NHS Trusts v. Bland [1993] UKHL 17, the appeal against the discontinuation of treatment of a PVS minor patient, was dismissed followed by declaring the rule of sanctity of life fundamental but not absolute wherein, the Lords allowed the discontinuation of the treatment, supporting the end of life process for the PVS minor. This has been a profoundly landmark judgement for the United Kingdom followed by Pretty v. United Kingdom.

The Supreme Court in Carter v. Canada (2015) allowed the assisted dying of a critically serious medical patient. Subsequently, the physician assisted suicide is now permitted under the Article 115 of the Swiss Penal Code, inspired from the Dutch Model. At the western front is also the first Latin American nation of Colombia legalizing the model of Euthanasia as early as Judgment C-239 in 1994. Whereas, the country of the United States of America has, also, now legalized euthanasia in a few states namely, Washington, Oregon and California, comprehensively, encouraging countries such as Spain (2021) and France to consider it.

While the Supreme Court of India has by and large, firmly stanced against active forms of Euthanasia, it’s still on a debating journey towards formally declaring the legality of passive euthanasia in the light of events. Putting aside the Hippocratic Oath, the sensitivity of the issue doesn’t just involve the duty and assistance of a physician to enhance the quality of the life of the patient but it is to consider the uncertainty around the betterment of a terminally ill, PVS patient who’s living existence not only is financially but emotionally exhausting for those involved. Justice Sikri formally remarked that the validity on the right to life and right to die regarding Article 21 doesn’t require the strict interpretation, while reflecting on the judgment in CESE Limited and Others v. Subhash Chandra Bose and Others (1992) which reinforced the intake by holding physical and mental well-being within its limits. 

The current stance of India with its long-standing debate for legally recognizing euthanasia to considerably implementing it in severe cases, from the P. Rathinam (1994) to Harish Rana (2026) and the Law Commission Reports, has progressed to a legally permissibility of mercy killing for its ethical discourse. While the judiciary may not actively observe the prospects of active euthanasia for its dubious ethical discourse, it has come to reward the deterrence of a life statement to those involved by allowing withholding medical assistance for such cases. 

VI. CONCLUSION

The judicial and social debate surrounding the legality of euthanasia has left this discussion engraved in almost every legislation of the nations worldwide, for its ethical and constitutional discourse. Yet the most profound milestone to consider is, the gradual shift from the absolute regulation of the ‘right to die’, to the recognition of the elements of dignity, bodily autonomy and sanctity based in the established ‘right to life’ under the Article 21 of the Indian Constitution, which states the aforementioned as a basic fundamental right to all of the citizens.

This paper has considerably mapped the interdisciplinary issue from its legally recognized inception in the P. Rathinam v. Union of India (1994), to the now featured, Harish Rana v. Union of India (2026), covering several judgments highlighting the question of medical ethics, the constitutionality and, religious sanctity and societal opinions surrounding the end-of-life choices. The Indian judiciary, provided with due diligence, has over time adjusted the previous rulings according to the ever evolving ethical standards and judicial interpretations on mercy killing and letting to die with dignity dicta. This has achieved, both, regular dissent and assent with the absence of a comprehensive legislation regarding the medical standards involving withholding assistance, access to palliative care for terminally ill and the risks of exploitation in active euthanasia, which the judiciary has, to an extent, been able to decide fairly upon. This critical juncture has pushed the laws to be reconsidered, revised and evaluated for the affirmation of dignity, economic hardships, and social dependency involved in such special cases. 

It is to conclude that the Indian jurisdictions have time and again considered this matter with a progressive judicial intent ensuring that the right to die with dignity should not be interpreted strictly within the limits of legislative rigidity, however, the challenges lie ahead despite the doctrinal soundness of the interpretations thus far.

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