Evolution of Euthanasia Jurisprudence in India

Syllabus: GS2/Polity & Governance; Issue Related To Health

Context

• In India, euthanasia and the right to die with dignity has evolved through judicial interpretation of Article 21 of the Constitution, which guarantees the Right to Life and Personal Liberty.
• Recently, the Supreme Court’s decision to allow withdrawal of life support under established legal guidelines highlights the continuing development of India’s jurisprudence on end-of-life care and dignity in death.

Background: Harish Rana Case

• In 2013, 20-year-old Harish Rana suffered severe injuries that left him in a Persistent Vegetative State (PVS), meaning he had no awareness of his surroundings and required continuous medical assistance to survive.
• For 13 years, his parents and doctors provided constant care, yet no medical improvement occurred.
• The parents approached the Supreme Court of India seeking permission to withdraw life support so that nature could take its course.
• It compelled the Court to evaluate the request within the framework of constitutional rights, medical ethics, and existing guidelines on passive euthanasia.

Evolution of Euthanasia Jurisprudence in India

• Gian Kaur v. State of Punjab (1996): It laid the foundation for the dignity debate. Key ruling:
  • The Supreme Court recognised the ‘right to live with dignity’ under Article 21. However, it rejected the idea that Article 21 includes a right to die.
  • The Court held that suicide or assisted suicide could not be constitutionally protected.
• Aruna Shanbaug Case (2011): Aruna Shanbaug had been in a Persistent Vegetative State for decades after a brutal assault. A petition was filed seeking withdrawal of life support. Key outcomes:
  • The Court rejected the specific plea but recognised passive euthanasia in limited circumstances.
  • It laid down guidelines for withdrawal of life support.
  • It required approval from High Courts and medical boards to prevent misuse.
  • The Court relied on international legal developments to support this cautious recognition of passive euthanasia.
• Law Commission Reports (2006 and 2012): It concluded that withholding or withdrawing life support from terminally ill patients should not attract criminal liability if done in the patient’s best interest.
  • These reports significantly influenced later judicial decisions and ethical discussions.
• Common Cause v. Union of India (2018): The 2018 Constitution Bench decision marked a watershed moment in Indian constitutional law. Key findings:
  • The right to die with dignity is part of Article 21.
  • Patients have the right to refuse medical treatment.
  • Individuals can create Advance Medical Directives (Living Wills).
  • Passive euthanasia is permissible under strict safeguards.
  • The judgment linked dignity with privacy, autonomy, and self-determination, drawing from earlier jurisprudence such as the Puttaswamy Privacy Judgment (2017).
• Clarifications in 2023: The Supreme Court later simplified the procedural requirements in 2023, making living wills and withdrawal procedures more practical.
  • These rulings collectively form what are now known as the Common Cause Guidelines.

Supreme Court’s Analysis in the Harish Rana Case

• The Supreme Court held that Clinically Assisted Nutrition and Hydration (CANH) qualifies as medical treatment, meaning it can legally be withdrawn under the Common Cause guidelines. The Court observed that:
  • CANH requires specialised medical supervision.
  • It involves continuous evaluation and emergency medical management.
• Withdrawal of Treatment in the Patient’s Best Interest: The Court emphasised that treatment must provide therapeutic benefit.
  • If medical intervention merely prolongs biological existence without recovery, continuation may not serve the patient’s interests.
  • After considering the views of medical boards and the family, the Court concluded that withdrawal of life support was consistent with the patient’s best interest.

Key Concerns & Issues in the Right to Die with Dignity

• Sanctity of Life vs. Right to Dignity: Permitting euthanasia may undermine the sanctity of life principle.
  • Forcing a person to remain alive in irreversible suffering violates dignity and autonomy under Article 21.
• Moral Role of Doctors: Medical ethics traditionally emphasise saving life (Hippocratic Oath).
  • Withdrawal of treatment raises dilemmas about whether doctors are ending life or allowing natural death.
• Cultural and Religious Sensitivities: Many religions in India oppose euthanasia, viewing life as sacred and not subject to human control.
  • Ethical acceptance varies across communities.
• Ambiguity in Legal Framework: Despite repeated judicial observations, India still lacks comprehensive legislation on euthanasia and end-of-life care.
• Complex Procedures: The Common Cause guidelines require primary medical board, secondary medical board, documentation and consent.
  • Many hospitals lack the infrastructure to implement these procedures efficiently.
• Distinction Between Passive and Active Euthanasia: Passive euthanasia (withdrawal of life support) is permitted under safeguards.
  • Active euthanasia (deliberate administration of substances to cause death) remains illegal.
• Lack of Awareness: Many patients and families are unaware of Living Wills or Advance Medical Directives.
  • Hospitals often lack clear protocols.
• Medical Infrastructure Limitations: Smaller hospitals may not have multi-specialist medical boards required under the guidelines.
• Economic Factors: End-of-life care can be extremely expensive. Families may seek euthanasia due to financial distress rather than patient welfare.
• Property and Inheritance Disputes: Possibility of misuse in cases involving inheritance conflicts or family disputes.
• Healthcare Inequality: In India, many patients lack access to palliative care or quality life-support treatment.
  • Euthanasia debates risk overshadowing the need for better end-of-life care systems.
• Lack of Palliative Care Infrastructure: India has limited hospice and palliative care facilities, especially in rural areas.

Related Measure: Safeguards Against Misuse

• To prevent misuse of euthanasia provisions, the Supreme Court established multiple safeguards:
  • Primary Medical Board evaluation;
  • Secondary independent Medical Board review;
  • Consent and participation of family members;
  • Documentation of medical condition;
  • Compliance with Common Cause guidelines;
• These measures aim to balance individual dignity with protection against coercion or abuse.

Way Forward

• The Supreme Court has repeatedly expressed the ‘pious hope’ that Parliament will enact legislation on euthanasia and end-of-life decisions. A law could:
  • Provide clear procedural safeguards;
  • Protect doctors from liability;
  • Ensure patient autonomy and dignity; and 
  • Prevent misuse.
• India requires a clear statutory framework governing euthanasia and living wills to avoid ambiguity and protect both patients and medical practitioners. Key steps include:
  • Parliamentary legislation on end-of-life medical decisions;
  • Awareness about advance directives;
  • Ethical guidelines for hospitals and doctors.

Conclusion

• The Harish Rana case represents another step in the evolution of India’s constitutional understanding of dignity in death. 
• Judicial interpretation has gradually recognised that dignity must extend to the final stages of human existence, while Article 21 initially focused on protecting life.
• Through such cases, the judiciary continues to shape constitutional morality, ensuring that the law addresses complex ethical realities while safeguarding human dignity.

Source: TH