The Maharashtra government has made a groundbreaking decision to grant terminally ill patients the right to die with dignity, marking a historic and compassionate step forward in healthcare policy. This initiative allows patients suffering from incurable and painful conditions to make end-of-life decisions within 48 hours, empowering them with the autonomy to choose a peaceful and dignified departure. The decision aligns with the Supreme Court’s guidelines on passive euthanasia and the concept of a living will, emphasising that the right to life inherently includes the right to die with dignity. Passive euthanasia, which involves the withdrawal of medical treatment with the deliberate intention to hasten the death of a terminally ill patient, has been a subject of legal and ethical debate for years.
The Supreme Court’s 2018 judgement formally recognised living wills as a valid mechanism for individuals to document their medical preferences in advance for situations where they may be unable to express informed consent. This ruling, delivered in response to a petition by the NGO ‘Common Cause,’ underscored the importance of personal autonomy, stating that no individual should be forced to endure prolonged suffering against their wishes. The court acknowledged that keeping a patient alive through artificial means without their consent amounts to an assault on their body and dignity. This judgement, which followed earlier recognition of passive euthanasia in the 2011 Aruna Shanbaug case, laid down strict guidelines to ensure that the process is conducted ethically and transparently.
Despite the progressive stance, the policy is not without its complexities. Concerns have been raised about uninformed consent and the potential implications of rapid advancements in medical technology. The government has implemented stringent safeguards, requiring comprehensive training for medical professionals to guide patients and families through this deeply personal decision-making process. In addition, the Centre’s earlier opposition to living wills, citing ethical dilemmas and global practices, further underscores the need for careful deliberation in implementing these policies.
This decision represents a significant step toward addressing the broader issues surrounding end-of-life care in India. By allowing patients to exercise their right to refuse life support, Maharashtra has set a powerful example for other states, promoting dignity, respect, and compassion in the face of terminal illness. This initiative opens the door to further discussions on patient-centred care, balancing medical ethics with human rights, and ensuring that the most vulnerable individuals receive the support and respect they deserve in their final moments.
The right to die with dignity is rooted in the belief that individuals should have the autonomy to end their suffering through voluntary euthanasia or assisted suicide, particularly in cases of terminal illness or unbearable pain. This concept, however, raises significant ethical and legal debates about who holds the authority to make such profound decisions. Cultural and religious perspectives further complicate this discourse, ranging from the acceptance of non-violent suicide practices like Prayopavesa in Hinduism and Santhara in Jainism, to the outright condemnation of suicide in faiths such as Catholicism, Islam, and Judaism.
India’s legal framework on euthanasia distinguishes between active and passive euthanasia. Active euthanasia, involving the administration of lethal substances to end a life, remains illegal. In contrast, passive euthanasia—defined as the withholding or withdrawal of life-sustaining treatment—has been legal in specific circumstances since pivotal Supreme Court rulings, including the Aruna Shanbaug case (2011), the Common Cause judgement (2018), and subsequent modifications in 2023. Patients seeking passive euthanasia must provide consent through a living will and be either terminally ill or in a vegetative state. In January 2023, the Supreme Court further simplified the procedural requirements for creating advanced medical directives, making the process more accessible and efficient.
The legal journey toward recognising passive euthanasia began with the tragic case of Aruna Shanbaug, a nurse who suffered a brutal attack in 1973 that left her in a vegetative state for 42 years. Activist Pinki Virani filed a petition on Shanbaug’s behalf in 2009, arguing that her continued existence violated her right to live with dignity. However, the Supreme Court rejected the plea to withdraw life support, citing the opposition of the hospital staff who cared for her. Despite this, the court legalised passive euthanasia as a concept, allowing the withdrawal of medical treatment or sustenance in certain circumstances. Shanbaug passed away in 2015 due to pneumonia, but her case became a cornerstone in India’s euthanasia discourse.
In 2014, the Supreme Court revisited the issue during a Public Interest Litigation (PIL) filed by the NGO Common Cause. Observing inconsistencies in the Aruna Shanbaug judgement, the court referred the matter to a Constitution Bench to address the social, legal, medical, and constitutional dimensions of euthanasia. In 2018, this five-judge bench delivered a landmark judgement, recognising the validity of living wills or advance medical directives. This allowed consenting individuals to specify in advance their wish to be passively euthanised if they were to suffer from a terminal illness or enter a vegetative state. The court reiterated its rejection of active euthanasia and clarified that its ruling would serve as the law of the land until Parliament enacted specific legislation.
Before the institutionalisation of passive euthanasia, patients and their families often resorted to measures such as Leaving Against Medical Advice (LAMA) to discontinue life-sustaining treatment, shifting responsibility from physicians to patients. The 2018 ruling provided a legal and ethical framework, ensuring that such decisions were made with informed consent and safeguards. By modifying the Common Cause guidelines in 2023, the Supreme Court addressed procedural complexities, streamlining the process for drafting valid advance medical directives.
India’s evolving stance on euthanasia reflects a delicate balance between upholding individual autonomy and addressing ethical, legal, and societal concerns. While active euthanasia remains prohibited, the recognition of passive euthanasia and living wills has marked a significant step toward respecting the dignity of terminally ill patients. However, the absence of comprehensive legislation continues to highlight the need for Parliament to enact a robust legal framework that aligns with these judicial advancements.
