Legal Narrative
“A long illness between life and death makes death a comfort both to those who die and to those who remain.”2
Abstract
The Indian legal system doesn’t acknowledge right to die in general. However, it does acknowledge a limited right to die with dignity. It means where the person chooses not to receive or stop futile life-sustaining treatment. The judicial position has been shaped by key cases, including Gian Kaur (1996), Aruna Shanbaug (2011) and the Constitution Bench case Common Cause v. Union of India (2018). In 2023, the Apex Court modified procedure and the decision in “Harish Rana v. Union of India” in 2026 further strengthened the law. The fundamental concept of the Constitution is now fairly easy to understand but difficult to implement. There is no specific law, effective registers, well-trained medical boards and sufficient palliative-care facilities, which continue to pose problems in the realization of right to die with dignity.
Keywords: Living Will, Right to Die with Dignity, Passive Euthanasia, Advance Medical Directive (AMD), End-of-Life Care, Life-Sustaining Treatment, Gian Kaur, Aruna Shanbaug, Common Cause, Harish Rana, Constitutional Safeguards, Judicial Guidelines, Legislative Framework, Implementation Challenges.
Introduction
Right to life and personal liberty is guaranteed as a fundamental right under Article 213of the Constitution of India. Through the years, the Apex Court has expanded scope of the right to life through the incorporation of such rights as right to shelter, the right to food, right to privacy and protection from the effects of climate change. Dignity is an inherent aspect of Article 21 which guarantees fundamental right to life and personal liberty and states “No person shall be deprived of his life or personal liberty except according to procedure established by law.” Article 21 is the article in the Indian Constitution which has been read as having dignity as one of its inherent components. Article 21 does not just cover life, it also covers the meaning of life.
The Supreme Court of India, in its judgment of Common Cause4allowed for passive euthanasia in cases of persons in a ‘persistent vegetative state’ and acknowledged right of an individual to refuse medical treatment when they are terminally ill by submitting a ‘living will’. Considering that advance directives or living wills may be misinterpreted, especially by individuals who may be mentally handicapped, including those raised by the Law Commission of India in its 241st Report5, Significantly, in Common Cause6(2023), the Supreme Court elucidated that the right to life does not include an ordinary right to die, it does comprehend the right to die with dignity.
“The Law Commission of India’s 241st Report, Passive Euthanasia – A Relook (2012)” refers to the cases of Gian Kaur7and Aruna Shanbaug8and highlights importance of patient autonomy, informed decision making and best interests of incompetent patients. It calls for a law by legislation on passive euthanasia to safeguard the patient and the physician. The Report also highpoints the standing of palliative care and safety measures against misuse.
“From Gian Kaur to Common Cause: Doctrinal Foundations of the Right to Die with Dignity”
Gian Kaur and the boundary of Article 21
In Gian Kaur9, a Constitution Bench reversed the judgment of P. Rathinam10 and restored criminalisation of abetment of suicide. The Court also stated that there was no general right to die as the killing of life does not go with the protection of life under Article 21 of the Constitution of India.
Meanwhile, the Court in India pointed out the difference between an abnormal termination of life and the situation of a person who is already dying or is in a vegetative state.
Aruna Shanbaug: Between life and death
In Aruna Shanbaug case11, the court was required to consider a nurse whose life for decades has been in a state of persistent vegetative state (PVS) following a pitiless sexual assault. The Court denied permission to withdraw her feeding as the hospital staff that cared for her opposed. But that was implicit. It gave the nod for passive euthanasia for very first time in India.
Common Cause (2018): The Constitutional Core
The five-judge bench led by Chief Justice Dipak Misra held the right to live with dignity also comprehends the right to die with dignity in the case of a terminal illness or irreversible vegetative state.12
It is defined by three moves. First, it decided that passive euthanasia is constitutionally acceptable, and that the welfare of the patient is more important than the State’s interest in keeping the patient alive.
Second, it recognised advance medical directives (living wills). An major of sound mind could designate and provide the name of a guardian or close relative to implement a life saving treatment, or withdraw it.
Third, it established a protection architecture, as Parliament hadn’t acted. The directive needed to be signed, voluntary, and signed by two witnesses, and then countersigned by a Judicial Magistrate of First Class (JMFC).13
The Court made it clear that these guidelines were in place until a law was passed, and as yet there is no law in place.
The 2023 Modification: Common Cause and Guidelines
It was obvious in just a few years that the 2018 procedures was too complex to be utilised. It was amended in January 2023 with significant alterations by the Supreme Court.14
These changes took out the obvious bottlenecks. They also placed the responsibility for creating boards, documenting decisions and for maintaining the level of access to directives on the shoulders of hospitals.
Implementation: The Gap Between Doctrine and Practice Administrative inertia
The efficient administrative mechanisms are vital for successful implementation of Living Wills. However, administrative delays, failure to appoint custodians, complications in forming Medical Boards, and the absence of a uniform national registry can deter their practical use.
Islands of compliance
Some states are on the move. At a public function organised by the Indian Medical Association and the State Legal Services Authority in the presence of a judge of the Bombay High Court, presiding over it from the Goa bench, Goa was reported to be the first state to set up the facility for advance medical directives. As these examples demonstrate, while the framework is workable, it’s also a picture that is very uneven. The answer to whether a ordinary citizens can make a legally binding living will still hinges on the state and city where he or she resides.
Clinical uncertainty
Uncertainty is also a reality for doctors. The practice of discharging patients “against medical advice” to avoid the legal uncertainty around withdrawal reportedly persist in some hospitals. Lack of any immunity and confusion regarding guidelines, along with fear of prosecution, are factors that push clinicians toward default over treatment. It’s not just a legal failure, it’s a policy failure. It means that sometimes patients, the doctrine was created to protect are never brought to it.15
“Harish Rana’s case:India’s first court approved passive euthanasia”
The Supreme Court’s 2026 judgment in Harish Rana16 marked a significant development in India’s law on passive euthanasia. Rana had been in a vegetative state for almost a decade and a half following brain injuries. His parents requested that assisted nutrition and hydration be terminated via a PEG tube. The Apex Court determined that artificial nutrition is medical treatment and can be withdrawn if it is in the patient’s interest. The Court also ordered palliative and end of life care, and noted the importance of dignity.17 The judgment reinforced the need for legislation, reinforcing the need for medical boards and people being cared for in the home.
Current Position
The right to die with dignity is Constitutionally guaranteed, but not uniformly implemented. The material identifies key areas of non-compliance with the Supreme Court’s guidelines of 2023, such as custodians, digital registries, medical boards and institutional training. Examples of states that have taken firm steps towards operationalization of Living Wills include Goa and Maharashtra with the online registration of Living Wills and the designation of custodians in these states18. The verdict by Kerala High Court in Martha Jacob case19 also underscores the requirement to make the system available in the rural areas with the idea of Tehsildars as custodians.
Meanwhile, Karnataka’s experience reflects that it is not easy to get the smooth procedure. Delays in the process can occur due to multiple approvals, medical-board requirements and judicial reporting. It can be a particular problem in rural areas where specialist medical facilities may be scarce. Inconsistent decisions can be caused by a lack of clarity in the guidance used to decide whether a patient is unlikely to benefit from life sustaining treatment or not.20 In addition where there is no valid Advance Medical Directive in place, there are concerns about a possible conflict of interest between the relatives/surrogates and the individual.Thus, this is a distinct dearth between constitution recognition and effective implementation.
Critical Analysis
Best interests versus autonomy
Common Cause insisted on autonomy and Advance Medical Directives, whereas Harish Rana involved non voluntary passive euthanasia without a living will. The Court thus guided by the best interests principle. However, There is concern about lack of clarity around evidential standards and the impact of family fatigue, grief or financial constraints, which require further independent safeguards.
The definitional problem
The moral distinction between labelling the withdrawal of nutrition “passive” while calling an overdose “active” is one that many ethicists would reject. Counsel for the petitioner, Harish Rana, requested the Court to refrain from using the term “passive euthanasia” and instead use the terms “withdraw or withhold life-sustaining treatment”. The vocabulary matters. It impacts the perception of withdrawal as an usual and legal clinical choice, or something akin to killing, within the eyes of doctors and families.
The case for legislation
Judicial rulings have gone a long way in interpreting the law but they can’t set up registries, provide statutory immunity for clinicians or force states to do something. There are at least five things that a statute ought to accomplish:
1. Develop a statewide or national database of advance directives.
2. Give clear immunity to those physicians who perform the process in good faith.
3. Established evidentiary requirements in non-voluntary cases, such as to prevent coercion and conflicts of interest.
4. Ensure that palliative care access is a condition for withdrawing treatment not due to lack of alternatives.
5. Make training and standing medical boards available in all districts.
Both Common Cause and Harish Rana are calling on Parliament to take action. The gap in the statute book is now the main obstacle.21
Conclusion and Suggestions
Eventually, Common Cause has provided the constitutional foundation. The effective institutions must now make it meaningful. The law has recognised the right. The system must now ensure its remedy.
The right to die with dignity is a vital right to ensure individual autonomy and dignity at the end of life, enshrined in Article 21. However, the mere fact of recognition does not guarantee effective exercise of it. The institutional framework in the context of Advance Medical Directives continues to have implementation gaps, underscoring the need for it to be strengthened.
Firstly, a standalone AMD Act should be passed by Parliament to ensure that patients, families and medical practitioners are provided clear procedures, safeguards and legal protection. Second, the Central Government should create a uniform set of Model Rules, and create a national online portal, which is linked to ABHA for registering and verifying Living Wills. Thirdly, it is necessary for Medical Boards, doctors and hospitals to be constantly trained, along with having clear Standard Operating Procedures. The awareness should also be raised by easy and simple information campaigns with regional language. It should be cost effective and freely available especially for individuals in rural areas. Last, the Supreme Court can enhance compliance monitoring with regular reports from States and Union Territories.
FOOTNOTES
1 LL.M. Student, Faculty of Law,University of Delhi.The author can be reached at piyushsinghlaw5@gmail.com
2Jean de La Bruyere (French Philosopher).
3INDIA CONST. art. 21.
4 Common Cause (A Regd. Society) v. Union of India, (2018) 5 SCC (India).
5 The Law Commission of India, “241st Report of Law Commission of India on Passive Euthanasia – A Relook (2012), https://lawcommissionofindia.nic.in/report_nineteenth/.
6 Common Cause (A Regd. Society) v. Union of India, 2023 SCC OnLine SC 99.
7 Gian Kaur v. State of Punjab MANU/SC/0335/1996.
8 Aruna Ramachandra Shanbaug v. Union of India, MANU/SC/0176/2011.
9 Supra Note 6.
10 P. Rathinam v. Union of India, MANU/SC/0433/1994.
11 Supra note 7, at 2.
12 Common Cause (A Regd. Society) v. Union of India, (2018) 5 SCC 1.
13 Manupatra Academy, https://www.manupatracademy.com/legalpost/manu-sc-0232-2018.
14 Vipan B. Kumar, Living Wills in India: A Complete Guide to End-of-Life Autonomy and Legal Framework (2026), SSRN, No. 7450298, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=7450298.
15 Sayak Mukherjee & Saptarshi Samajder, Revisiting the Right to Die with Dignity: The Impact of Common Cause v. Union of India on Euthanasia Law, 7 Indian J. L. & Legal Rsch. 3979, 3979-3995 (2025).
16 Harish Rana v. Union Of India, (2026 INSC 222).
17 Asmita Narula & Kaushiki, Between Sanctity of Life and Dignity in Death: Passive Euthanasia Under Indian Law (From P. Rathinam to Harish Rana), Neeti Niyaman (2026). https://neetiniyaman.com/passive-euthanasia in-india-right-to-die-with-dignity/.
18 Nandini Vallath et al., Procedures to Implement the Supreme Court of India Directives to Withdraw/Withhold Life-Sustaining Medical Treatment, 163 Indian J. Med. Res. 319 (2026).
19 Martha Jacob v. State of Kerala, W.P.(C) No. 41377 of 2024 (Ker. H.C. Jan.
15, 2025).
20 Sanya Darakhshan Kishwar & Sakkcham Singh Parmaar, Right to Die with Dignity: Karnataka’s Progressive Model, TSCLD (Nov. 2, 2025).
21 Subhransu Satyabrata Jena, A Dignified Exit? Building the Right to Die: India’s Euthanasia Jurisprudence from P. Rathinam to Harish Rana, 6 Int'l J. Progressive Rsch. Eng'g Mgmt. & Sci. 566 , 566-572 (2026)
