Reforming Passive Euthanasia in India

Syllabus: GS2/Polity and Governance; GS4/Ethics

Context

• Despite the legal validity of passive euthanasia, its implementation remains mired in procedural complexity, institutional gaps, and ethical ambiguity.

About Euthanasia in India

• Euthanasia — often termed ‘mercy killing’ — refers to the intentional ending of a person’s life to relieve suffering, usually from terminal illness or irreversible conditions.
• Passive Euthanasia: Involves withholding or withdrawing life-sustaining treatment (e.g., ventilators, feeding tubes) when recovery is medically impossible. It is legal under specific safeguards.
• Active Euthanasia: Involves administering a lethal substance to end life. It remains illegal under Section 103, 105 of Bharatiya Nyaya Sanhita (BNS), and physician-assisted suicide is punishable under Section 108 of the BNS.

India’s Legal Milestones

• Aruna Shanbaug Case (2011): It permitted passive euthanasia under strict guidelines, distinguishing it from active euthanasia and emphasized that withdrawing life support in cases of irreversible coma was not equivalent to killing.
• Common Cause v. Union of India (2018): The Supreme Court recognized the ‘Right to Die with Dignity’ as a fundamental right under Article 21 of the Constitution.
  • It legalized living wills, allowing individuals to express their medical preferences in advance should they fall into an irreversible vegetative state.

Medical and Institutional Perspectives

• The Indian Council of Medical Research (ICMR) issued ethical guidelines emphasizing the role of palliative care and patient autonomy.
  • It underscored that while medical technology can prolong life, it cannot guarantee dignity.
  • It advocated for institutional ethics committees to ensure compassionate end-of-life care decisions.

Government Guidelines

• Constitution of Primary and Secondary Medical Boards with experienced physicians;
• Verification of advance directives, ideally linked to Aadhaar for biometric validation;
• Ethical oversight by hospital committees;
• A 48-hour window for decision-making to avoid prolonged suffering.

Ethical and Cultural Dimensions

• Hinduism emphasizes ahimsa (non-violence) but also accepts prayopavesa—a form of fasting unto death under spiritual discipline.
• Jainism permits Sallekhana, a voluntary death through fasting, under specific religious conditions.
• Islam and Christianity generally oppose euthanasia, seeing life as sacred and only terminable by divine will.
• Family-centric Decision-making: In many cases, families play a central role in end-of-life choices, complicating the implementation of individual autonomy.
• Healthcare Disparities: Limited access to palliative care and uneven medical infrastructure make ethical euthanasia difficult to administer uniformly.

Comparative Perspective

• Countries like the Netherlands, Belgium, and Canada permit euthanasia under regulated conditions, balancing individual autonomy and medical ethics.
• UK Model: In June 2025, the UK’s House of Commons passed the Terminally Ill Adults (End of Life) Bill, permitting physician-assisted dying for mentally competent adults expected to live fewer than six months, with stringent medical certification and oversight.
• It reflects a growing global trend toward granting individuals greater autonomy over end-of-life decisions.

Why the UK Model Doesn’t Fit India?

• The UK’s approach depends on robust institutional support — a strong National Health Service, universal access to general practitioners, and trustworthy regulatory mechanisms.
  • In contrast, India’s healthcare system is fragmented and under-resourced.
• Social realities further complicate matters: deep family involvement, religious sensitivities, and economic dependency could turn active euthanasia into an instrument of subtle coercion.
• The elderly, disabled, or financially burdened might feel pressured to choose death to relieve their families.

Refining the Passive Euthanasia Framework

• Digital Advance Directives: Create a national digital portal linked to Aadhaar for registering, updating, or revoking advance directives.
  • Physicians should verify mental competence and intent through the same platform.
• Hospital-Based Ethics Committees: Establish committees comprising senior doctors, a palliative care specialist, and an independent member.
  • Authorise withdrawal of life support within 48 hours, with exceptional cases referred for higher review.
• Decentralised Oversight: Replace ineffective ombudsman systems with transparent hospital networks monitored via digital dashboards.
  • Empower independent medical auditors or health commissioners with statutory authority.
• Safeguards Against Misuse: Retain a seven-day cooling-off period, mandatory counselling, and palliative care review to ensure fully informed and voluntary decisions.
• Building a Culture of Dignified Dying: Public trust and awareness are essential, to make euthanasia laws meaningful. The way forward includes:
  • Integrating end-of-life care ethics into medical education.
  • Launching public campaigns to normalise advance care planning.
  • Ensuring accessible palliative care across the country.

Conclusion

• India’s constitutional promise of dignity needs to encompass both living and dying and it can uphold its moral and legal integrity while easing the suffering of those at life’s end, by reforming passive euthanasia through digitally driven, transparent, and compassionate mechanisms.

Source: TH