The Supreme Court (March 2026) permitted the withdrawal of life-sustaining treatment for 32-year-old Harish Rana, who has been in a vegetative state since 2013 when a fall left him with a severe head injury. This is the first ever Indian court order approving passive euthanasia.
Euthanasia refers to the intentional ending of the life of a person suffering from an incurable or irreversible medical condition to relieve unbearable pain and suffering

Types

Type	Meaning	Legal Position in India
Active Euthanasia	Death is caused through a positive act, such as administering a lethal injection	Illegal: In India, this directly attracts criminal liability and may amount to culpable homicide under the Bharatiya Nyaya Sanhita. When a doctor assists the patient in performing the act, criminal liability arises for abetment to suicide.
Passive Euthanasia	Life-sustaining medical treatment is withheld or withdrawn, allowing the underlying illness to take its natural course	Permitted under judicial safeguards Withdrawing or withholding life-sustaining treatment is treated differently because it involves stopping or not initiating medical intervention and allowing the underlying illness or injury to take its course. This distinction flows from Article 21, the “right to life”, which the Supreme Court has interpreted to include the right to live with dignity. For terminally ill or persistently vegetative patients whose life is “ebbing out”, the court has held that the Constitution protects the choice not to be kept alive through invasive or futile medical intervention.

Evolution of Euthanasia Law through Supreme Court Judgments

Judgment	Development in Law
P. Rathinam v. Union of India, 1994	The Supreme Court held that the right to life under Article 21 included the right not to live. It declared Section 309 of the IPC, which criminalised attempted suicide, unconstitutional
Gian Kaur v. State of Punjab, 1996	A Constitution Bench overruled P. Rathinam. It held that the right to life does not include the right to die or commit suicide. It upheld the validity of Section 3068 IPC, which penalises the abetment of suicide, thereby distinguishing between passive euthanasia and assisted suicide.
Aruna Ramachandra Shanbaug v. Union of India, 2011	The Supreme Court permitted passive euthanasia in exceptional cases, while active euthanasia remained illegal. In the absence of legislation, withdrawal of treatment required approval of the concerned High Court.
Common Cause v. Union of India, 2018	A Constitution Bench recognised the right to die with dignity as part of Article 21. It legalised passive euthanasia and recognised Advance Medical Directives or “living wills.” This judgment not only legalised passive euthanasia but also laid down comprehensive guidelines for executing living wills, ensuring that individuals could make advance medical directives regarding their end-of-life care.
Common Cause v. Union of India, 2023	The Supreme Court simplified the 2018 procedure because its complex requirements made living wills difficult to implement. Advance directives had to be signed by two witnesses and countersigned by a judicial magistrate, and hospitals had to involve multiple authorities and medical boards. It simplified the process: Advance Directives can now be attested before a notary or gazetted officer and stored in digital health records. Hospitals constitute two medical boards — a primary board and a secondary board with an external nominee — with doctors having at least five years’ experience. The Collector’s role and mandatory magistrate visits were removed, though hospitals must inform the magistrate before implementing withdrawal of treatment.
Harish Rana v. Union of India, 2026	The Supreme Court bench passed the first judicial order specifically allowing the withdrawal of life support under the guidelines established in the Common Cause (2018) judgment. The Court ruled that Clinically Administered Nutrition and Hydration (CANH)—the feeding tubes keeping him alive—constitutes “medical treatment” rather than basic care. Therefore, it can be legally withdrawn if it serves no therapeutic purpose and only prolongs biological existence without hope of recovery. Redefining Terminology: To eliminate ambiguity, the Court held that "Euthanasia" will strictly refer to active euthanasia (which remains illegal in India), while the term "Withdrawing or Withholding of Medical Treatment" officially replaces "passive euthanasia" The "Best Interest of the Patient" Framework One of the significant portions of the judgement is the applicability of the “best interest of the patient” test. The bench emphasised that the law does not ask whether death itself is desirable. It focuses on “whether it is in the patient’s best interests that life should be prolonged by the continuance of the particular medical treatment in question.” Determining best interests, the Court said, requires a holistic assessment that goes beyond medical prognosis. Judges must weigh both medical and non-medical considerations, including whether the treatment offers any therapeutic benefit, the burdens imposed by continued intervention, and whether the patient is being kept alive in a state “devoid of awareness, autonomy, or human interaction.” Administrative & Judicial Directives for Implementation High Courts of all States shall issue appropriate directions to all Judicial Magistrates of First Class (JMFC) within their jurisdiction to receive intimation from the hospital, in accordance with the guidelines as laid down in Common Cause (supra), in the event the primary medical board and secondary medical board are unanimous in their decision to withdraw and/or withhold the medical treatment of any patient. Union of India in coordination with the respective Secretaries of Health & Family Welfare of all States/UTs, shall ensure that the CMOs of all concerned districts across the country, forthwith prepare and maintain a panel consisting of registered medical practitioners possessing qualifications in accordance with the guidelines as laid down in Common Cause, for the purpose of nomination to the secondary medical board. It shall be the duty of the Secretaries of Health and Family Welfare of each State/UT to make sure that such periodic review and updation at regular intervals is undertaken by the CMOs of all districts falling within their respective State/UT.

"Best Interest of the Patient" Framework—Harish Rana v. Union of India, 2026

Explaining that the best interest principle cannot be defined by a single, straight-jacketed test that would fit across all facts and circumstances, the Court opined that the principle of “best interest of the patient” may include, but not be limited to, the following considerations:

While deciding upon the withdrawal or withholding of medical treatment, the correct question should be whether it is in the patient’s best interests that life should be prolonged by the continuance of the particular medical treatment in question.
The determination of “best interests” requires due evaluation of all relevant circumstances and considerations, both medical and non-medical.
At the foundational level, the best interests inquiry is anchored in a strong presumption in favour of preserving life, reflecting the sanctity of life. This presumption is not absolute and may be displaced where continuation of medical treatment ceases to serve any therapeutic purpose, i.e., becomes futile, merely prolongs the suffering without the hope of recovery or causes indignity to the life of the patient.
Assessment of best interests must, therefore, necessarily encompass an evaluation of the futility of treatment, the absence of therapeutic purpose, the invasive and burdensome nature of continued medical intervention, and the indignity attendant upon artificially prolonging life in a state devoid of awareness, autonomy, or human interaction.
Decision-makers such as the patient’s next of kin/next friend/guardian, the treating physician, the members of the medical boards, or the courts (if involved), as the case may be, must look at the patient’s welfare in the widest sense, not just medical but also social and psychological.
Decision-makers must try to put themselves in the place of the individual patient and ask what his wishes and attitude to the treatment is or would be likely to be; and they must consult others who are looking after him or interested in his welfare, in particular for their view of what the patient would have wanted.
Best interests principle shall incorporate a strong element of the substituted judgment standard, requiring the decision maker to place himself, so far as possible, in the position of the patient and to consider in a patient-centric manner what that patient would have wanted if he had capacity to do so. However, substituted judgment would not operate as an autonomous or overriding standard. The ultimate inquiry remains what course of action serves the patient’s best interest.
Decision-makers, after identifying and collating necessary and ascertainable considerations, both medical or non-medical, must engage in the balance sheet exercise, which would involve weighing the potential benefits of continued treatment against its burdens, including physical suffering, invasiveness, indignity, psychological distress, wishes and welfare of the patient, the impact upon the patient’s lived experience and family life, and other like considerations.

Living Will(Advance Medical Directive)

A living will, formally known as an Advance Medical Directive, is a legal document that allows individuals to specify their preferences for medical treatment in situations where they may become incapacitated, vegetative state, or unable to communicate their decisions. This directive ensures that a person’s wishes regarding life-sustaining treatments are respected, even when they cannot express them due to medical conditions.

Simplified Procedure(Guidelines for Advance Medical Directives )

The original 2018 guidelines were complex and difficult to implement. So the Supreme Court revisited its earlier guidelines in January 2023 to simplify the process

Step	Details
Execution	The living will must be signed by the executor and two independent witnesses
Attestation	It must be attested by a notary or gazetted officer (replacing the previous requirement of a Judicial Magistrate's countersignature)
Custody	A copy is given to the family physician or next of kin and may be included in digital health records
Primary Medical Board	A three-member Board, including the treating physician, certifies the patient’s condition
Secondary Medical Board	A three-member Board appointed by the hospital, including one nominee of the Chief Medical Officer, reviews the decision
Withdrawal	Life support may be withdrawn after both Medical Boards agree and the family consents

Detailed Procedure

The table below details the step-by-step processes for implementing the Supreme Court of India’s January 24, 2023 modified guidelines in Common Cause v. Union of India, comparing the workflow when an Advance Medical Directive (AMD) Exists versus when there is No AMD

Process Stage	When an Advance Medical Directive (AMD) Exists	When NO Advance Medical Directive (AMD) Exists
Execution & Attestation	Executed voluntarily by an adult of sound and healthy mind. Must be signed in the presence of two attesting witnesses (preferably independent) and attested before a notary or Gazetted Officer (replacing the previous requirement of a Judicial Magistrate's countersignature).	Not applicable (no directive is created in advance).
Preservation & Custody	The executor must hand a copy of the AMD to their nominated guardian(s)/relatives and their family physician. A copy is kept by a designated custodian of the local Government, Municipal Corporation, Municipality, or Panchayat. The executor can also opt to incorporate it into their digital health records. The older requirement for the Judicial Magistrate of First Class (JMFC) to preserve and forward copies is deleted.	Not applicable.
Initiation & Verification	Triggered when the patient is terminally ill, on prolonged treatment with no hope of cure, and lacks decision-making capacity. The treating doctor must verify the AMD's authenticity against digital health records or with the local government custodian. The doctor informs the nominated guardian(s) about the illness and alternatives to confirm they agree that withdrawal is the best choice.	Triggered when a patient is terminally ill, on prolonged treatment for an incurable ailment, and has no hope of cure. The treating physician informs the hospital. The medical team must hold discussions with the family physician (if any) and the patient’s next of kin/next friend/guardian to explain the pros and cons, recording minutes in writing. The next of kin must provide written consent.
Primary Medical Board	Constituted by the hospital. Consists of the treating physician and at least two subject experts of the concerned specialty with at least 5 years’ experience. They must visit the patient and form a preliminary opinion on whether to certify carrying out the AMD's instructions, preferably within 48 hours of referral.	Constituted by the hospital. Comprises the treating physician and at least two subject experts of the concerned specialty with at least 5 years’ experience. Based on the written consent of the next of kin, they certify the preliminary course of action, preferably within 48 hours of referral.
Secondary Medical Board	Constituted immediately by the hospital (replacing the previous requirement where the district Collector had to set it up \| Earlier—If the medical board certified that the instructions in the AMD should be carried out, the District Collector was charged with creating a second medical board which will include the Chief Medical Officer of the district). Comprises one registered medical practitioner nominated by the Chief Medical Officer (CMO) of the District and at least two subject experts with at least 5 years’ experience who were not on the Primary Board. They must provide their opinion preferably within 48 hours.	Constituted immediately by the hospital in the same manner as the "With AMD" process. The board physically examines the patient, reviews medical records, and decides whether to concur with the Primary Medical Board, providing their decision preferably within 48 hours.
Magistrate (JMFC) Role	The hospital conveys the decision of both the Primary and Secondary Boards, along with the consent of the nominated guardian(s), to the jurisdictional Judicial Magistrate of First Class (JMFC) before giving effect to the decision to withdraw treatment. (The previous active requirement for the JMFC to physically visit the patient and authorize implementation is replaced by this conveyance).	The hospital sends an intimation of the decision to the JMFC and the patient's next of kin/next friend/guardian. The previous requirement for the JMFC to physically visit, examine the patient, discuss with the family, and actively endorse the withdrawal of treatment is completely deleted.
Legal Recourse (Disagreement or Refusal)	If the Secondary Board refuses permission, or if the Primary Board decides not to follow the directive (and a subsequent referral request to the Secondary Board fails), the nominated person, treating doctor, or hospital staff can file a writ petition in the High Court under Article 226. A Division Bench will decide. The Court can appoint an independent committee of three experts with at least 20 years’ experience.	If the Primary Board does not decide to withdraw treatment or the Secondary Board does not concur, the patient’s nominee, family member, treating doctor, or hospital staff can file a writ petition in the High Court under Article 226. A Division Bench will decide, with the same option to appoint a three-expert committee (20+ years' experience)

Issues with Implementation of Living Wills

Lack of Public Awareness: One of the primary obstacles is the lack of public awareness, as many individuals remain unfamiliar with the concept and the legal provisions governing living wills. This limited awareness has resulted in the underutilisation of living wills, preventing them from becoming a widely accepted tool for end-of-life decision-making
Cultural Sensitivities: Since family-based decision-making is deeply valued in India, discussions concerning living wills and death are often met with reluctance
Family-Centred Decision-Making: Indian society places considerable importance on collective family decisions. Consequently, an individual’s prior instructions may face resistance from family members when treatment is actually withdrawn
Administrative Inefficiencies: Bureaucratic delays hinder the effective execution and implementation of living wills
- Bureaucratic delays, failure to appoint designated custodians and difficulties in constituting Medical Boards impede the timely implementation of living wills
Slow Implementation by States: State governments and local authorities have not uniformly established the administrative machinery required by the Supreme Court’s directions. In June 2024, the Bombay High Court criticised the Maharashtra government for its slow implementation of these directives
Absence of an Accessible Registry: India lacks a uniform national registry through which hospitals can immediately locate and verify a patient’s living will during a medical emergency

Arguments in Favour of Passive Euthanasia

Protection of Human Dignity
- Compelling a person to remain on futile life support despite an irreversible condition may reduce human life to mere biological existence
Respect for Autonomy
- Individuals should have control over their bodies and medical treatment, including the right to refuse unwanted intervention
Relief from Suffering
- It protects patients from prolonged pain, indignity and burdensome medical procedures that provide no reasonable possibility of recovery
Prevention of Therapeutic Obstinacy
- Doctors should not be compelled to continue treatment that has become medically futile and merely prolongs the dying process
Emotional and Financial Burden
- Prolonged artificial treatment can impose severe emotional and financial costs on families without improving the patient’s condition
Responsible Use of Medical Resources
- Scarce intensive-care facilities should not be used indefinitely for futile treatment when they could benefit patients with a reasonable possibility of recovery

Concerns and Challenges

No comprehensive legislation
- India has no comprehensive legislation on euthanasia and end-of-life care. The legal framework rests entirely on Supreme Court judgments.
  - Legislative clarity covering advance directives, passive euthanasia, palliative sedation, physician-assisted suicide, and related end-of-life questions would provide more comprehensive, accessible, and democratically accountable guidance than judicial case-law alone.
Possibility of Abuse
- Elderly, disabled or economically dependent persons may be pressured into refusing treatment to reduce the family’s financial burden
Uncertain Medical Prognosis
- Medical predictions may be incorrect, and apparently irreversible patients may occasionally show unexpected improvement
Consent of Incapacitated Patients
- It is difficult to determine the genuine wishes of a person who has not executed a living will and cannot communicate
Conflict of Interest
- Family members may be influenced by inheritance, financial difficulties or caregiving fatigue
Slippery-Slope Danger
- Once euthanasia is permitted in exceptional cases, its scope may gradually expand to broader and more controversial situations. The Netherlands and Belgium which legalised euthanasia for competent adults have progressively expanded its scope in ways that critics argue demonstrate the slippery slope’s reality.
Unequal Healthcare Access
- A decision to discontinue treatment may result from poverty or inadequate healthcare rather than a genuinely free and informed choice
Inadequate Palliative Care
- Patients may seek death because effective pain relief, counselling, hospice care and social support are unavailable
- Palliative care alternative
  - Pain management, psychological support, spiritual care, and a dignified environment can substantially reduce the suffering that drives euthanasia requests. Rather than legalising euthanasia, the state should ensure that all citizens have access to the excellent palliative care that makes euthanasia unnecessary for most people most of the time.
Moral and Religious Objections
- Many traditions view life as sacred and argue that human beings should not deliberately interfere with the natural process of death
Conflict with the Hippocratic Tradition
- The foundational principle of medical ethics is “do no harm.” Deliberately ending a patient’s life may contradict the physician’s traditional role as a healer and weaken the relationship of trust between doctors and patients
Implementation Challenges
- Advance directive awareness
  - The vast majority of Indians are unaware of the right to make advance directives. The legal literacy, healthcare access, and institutional infrastructure required for advance directives to reach ordinary citizens is absent in most of India. A right that most people cannot exercise in practice is a right that exists primarily for the educated urban minority.
- Living Wills Remaining “Invisible”
  - India lacks a universally accessible digital registry of Advance Medical Directives. Consequently, hospitals may be unable to discover or authenticate a patient’s living will when an emergency arises
- Medical infrastructure
  - Implementing the Common Cause framework requires medical boards, hospital ethics committees, and judicial mechanisms that are available in tertiary urban hospitals but largely absent in rural and semi-urban healthcare settings where most Indians receive end-of-life care.
- Cultural barriers
  - Discussions about death and dying are culturally uncomfortable in many Indian communities. Advance directives require frank family discussion about terminal illness, dying preferences, and end-of-life wishes that many families resist having. Cultural barriers reduce advance directive uptake even among those legally
- Consent verification
  - Ensuring that advance directives reflect genuine, informed, and uncoerced choice is difficult, particularly for persons from less educated backgrounds, persons under family pressure, and persons whose understanding of their medical condition is limited

Way Forward

Enact a Comprehensive Law
- Parliament should enact a clear law governing passive euthanasia, Advance Medical Directives, medical futility and end-of-life care instead of leaving the field primarily to judicial guidelines
Establish Uniform Procedures
- Standard protocols should be framed for constituting Medical Boards, determining irreversible conditions, recording consent and resolving disagreements
Advance Directive Accessibility
- Create a Living-Will Registry
  - A secure national or state-level digital registry should enable hospitals to verify Advance Medical Directives quickly and prevent tampering or misuse
- Public awareness campaign
  - National awareness campaign on the right to make advance directives to reach all citizens regardless of education or economic status. Legal rights that most citizens are unaware of are effectively unavailable to most citizens.
- Simple language documents
  - Developing advance directive templates in simple language in all scheduled languages, making the documents accessible to persons without legal education. Advance directives written in legal language are barriers rather than tools for most citizens.
- Healthcare provider training
  - Training all healthcare providers on advance directive law. It will ensure that hospitals, clinics, and community health workers can inform patients of their rights and assist in advance directive preparation.
Strengthen Palliative Care
- Affordable palliative and hospice care must be integrated into the public health system so that euthanasia does not become a substitute for proper treatment and pain management
  - National palliative care policy
    - Developing and fully implementing a national palliative care policy, ensuring that all terminally ill patients have access to adequate pain management, psychological support, and dignified end-of-life care. Excellent palliative care reduces euthanasia demand addressing the suffering that drives euthanasia requests without the ethical and legal complexity of euthanasia itself.
  - Training
    - Integrating palliative care training into all medical and nursing curricula will ensure that healthcare providers across the country are competent in pain management and end-of-life care. The palliative care deficit is fundamentally a training deficit that medical education must address.
  - Opioid access
    - Reforming India’s opioid access policy which severely restricts morphine and other essential pain management medications to ensure that terminal patients can receive adequate pain relief.
    - Inadequate pain management is one of the most significant failures of end-of-life care in India, one that legislation and policy reform can address.
  - Community-based care
    - Developing community-based palliative care enabling terminally ill patients to die at home with support rather than in institutions.
    - Death at home surrounded by family, in familiar surroundings often better serves dignity than institutional dying even with good hospital palliative care.
Protect Vulnerable Groups
- Independent scrutiny, counselling and safeguards against coercion must protect elderly persons, persons with disabilities, women and economically dependent patients
Train Medical Professionals
- Doctors should receive training in end-of-life communication, medical ethics, determination of capacity and implementation of living wills
Recognise Conscientious Objection
- Medical professionals with genuine moral objections may be allowed to withdraw from the process, provided the patient is promptly referred to another qualified practitioner
Promote Public Awareness
- Citizens should be informed about living wills, informed consent, palliative care and the difference between passive euthanasia and suicide
Periodic Review
- The legal framework should be periodically reviewed in light of advances in medical technology, intensive care and understanding of consciousness
Reconsidering Active Euthanasia (Long-Term Policy Dialogue)
- Law Commission examination
  - The Law Commission should comprehensively examine the active euthanasia question with comparative analysis of international jurisdictions, consultation with medical professionals, ethicists, religious communities, and patient advocacy groups before any legislative consideration.
- Evidence-based policy
  - Examining the experience of jurisdictions that have legalised active euthanasia like the Netherlands and learning from their safeguard mechanisms, their implementation challenges, and their outcomes. Evidence-based policy development rather than principled position-taking.
- Public deliberation
  - Facilitating sustained public deliberation on the active euthanasia question through public consultation, parliamentary committee hearings, and civil society dialogue before any legislative change. The euthanasia question is too ethically complex and socially consequential to be resolved without genuine democratic deliberation.
- Safeguard design
  - If active euthanasia is considered in the future, it must be governed by stringent safeguards, including multiple independent medical opinions, mandatory waiting periods, psychological assessment, informed and voluntary consent, and independent judicial or statutory oversight. Such safeguards would prevent coercion and abuse while making the option available to eligible patients experiencing irreversible and unbearable suffering.

Euthanasia involves a delicate balance between the sanctity of life and the autonomy and dignity of the individual. Indian law does not recognise a general right to die, but it permits a dignified natural death through the withdrawal of futile life-sustaining treatment under strict safeguards. The judicial framework developed from Gian Kaur to Common Cause and Harish Rana must now be supported by comprehensive legislation, accessible palliative care and strong protections against coercion and abuse.

Sample Mains Question

1.What is an Advance Medical Directive? Explain its significance in protecting patient autonomy and dignity at the end of life. (150 Words, 10 Marks)

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