The Supreme Court emphasized the need for comprehensive legislation governing passive euthanasia in India, observing that the continued absence of a statutory framework has compelled the judiciary to repeatedly step in and frame guidelines. The Court made these observations while dealing with a case concerning withdrawal and withholding of life-sustaining treatment for a 32-year-old man who had remained in a persistent vegetative state for thirteen years. The Bench of Justice J.B. Pardiwala and Justice K.V. Viswanathan highlighted the legislative vacuum surrounding end-of-life care decisions and urged the Union Government to consider enacting a law on the subject.
The Court noted that the absence of legislation on passive euthanasia has required judicial intervention from time to time as a matter of constitutional necessity. According to the Bench, the judiciary has had to develop guidelines to address complex issues related to withdrawal or withholding of life-sustaining treatment. However, the Court clarified that such guidelines were never intended to serve as a permanent substitute for legislative action.
While considering the matter, the Court traced the legal and institutional history of passive euthanasia in India. It observed that the issue had been examined by the 196th Report of the Law Commission of India in 2006. The Law Commission had concluded that withdrawing life support or medical treatment for terminally ill patients would not amount to criminal liability for attempting suicide, provided that such decisions are taken in the best interests of the patient. The report had also identified Parliament’s competence to legislate on the issue and had attached a draft bill for consideration by the Union Government.
Despite the recommendations made in the report, the Court noted that no legislative action was taken. The Bench further referred to the role played by litigation initiated by the organisation Common Cause, which had approached the Supreme Court seeking recognition of the right to die with dignity as a fundamental right under Article 21 of the Constitution. That petition had also requested reconsideration of the earlier decision in the case of Gian Kaur v. State of Punjab.
The Court then discussed the first major case in which the issue of euthanasia was examined by the Supreme Court, namely the Aruna Shanbaug case decided in 2011. In that case, the Court declined the request for active euthanasia for Shanbaug, who had remained in a persistent vegetative state after suffering a brutal assault in a hospital. However, the Court had recognised the concept of passive euthanasia and laid down certain guidelines governing withdrawal of life-sustaining treatment as an interim measure in the absence of legislation.
Subsequently, the Law Commission again addressed the issue in its 241st Report in 2012. The report reiterated the earlier recommendations and proposed a revised legislative framework. It also suggested certain modifications to the procedures relating to the constitution of medical boards that would be responsible for evaluating requests to withdraw medical treatment. The report appended a revised draft bill intended to guide the government in formulating legislation on end-of-life care.
The Court further referred to discussions that had taken place in Parliament on the subject. In response to questions raised in the Rajya Sabha about whether the government intended to enact a law on passive euthanasia following the guidelines laid down by the Supreme Court in the Aruna Shanbaug judgment, the Minister of Health and Family Welfare had stated that the guidelines issued by the Court already had the effect of law and that there was no proposal at that time to introduce legislation.
The Court also noted that in 2016 the Ministry of Health and Family Welfare had published a draft bill titled the Medical Treatment of Terminally-Ill Patients (Protection of Patients and Medical Practitioners) Bill. The ministry had invited public comments on the proposed legislation. However, after the consultation process, no further action was taken to enact the bill into law.
The Bench then referred to the landmark constitutional judgment delivered in 2018 in the Common Cause case. In that decision, the Supreme Court recognised the right to die with dignity as a fundamental right under Article 21 of the Constitution. The Court laid down detailed guidelines governing withdrawal and withholding of life-sustaining treatment in cases where patients are unable to express their wishes. The judgment also recognised the validity of living wills and advance directives relating to medical treatment.
While delivering the 2018 decision, the Constitution Bench had expressed hope that the legislature would enact a comprehensive law addressing the issue of passive euthanasia and end-of-life care. Justice A.K. Sikri, who was part of the Bench in that case, had expressed what the Court described as a “pious hope” that Parliament would step in and frame appropriate legislation to provide clarity and uniformity in dealing with such sensitive matters.
The present judgment observed that even after eight years since the Common Cause decision, the legislative framework envisaged by the Court has not yet been enacted. The Bench stated that the prolonged absence of legislation has made it necessary for the Court to repeatedly intervene and address issues relating to passive euthanasia through judicial directions. According to the Court, this situation arises not out of institutional preference but because of the need to fill a legal vacuum.
The Court emphasized that although the guidelines laid down in the Common Cause judgment have functioned as important interim safeguards protecting the right to live and die with dignity, they were never intended to operate as a permanent substitute for legislation. The Bench stated that comprehensive statutory provisions would provide greater clarity, coherence and certainty in addressing complex and emotionally sensitive questions surrounding end-of-life decisions.
In its observations, the Court urged the Union Government to consider enacting a comprehensive law on passive euthanasia in line with the principles articulated by the Constitution Bench in the Common Cause decision. The Court indicated that legislation would help establish a clear framework governing withdrawal of medical treatment and end-of-life care, thereby ensuring consistency and transparency in decision-making processes.
The Bench further remarked that issues relating to end-of-life care involve complex medical, legal and ethical considerations. Because such decisions affect patients, families and medical practitioners, the Court stated that a legislative framework would help address practical concerns and provide guidance to all stakeholders involved in such cases.
The observations were made in the course of proceedings in a case titled Harish Rana v. Union of India. In that matter, the Court allowed withdrawal and withholding of life-sustaining treatment for the patient who had been in a persistent vegetative state for more than a decade. While deciding the case, the Bench reiterated the need for statutory regulation of passive euthanasia in India.
By urging the Union Government to enact legislation, the Supreme Court highlighted that judicial guidelines alone cannot adequately address the complex and sensitive issues associated with passive euthanasia and end-of-life medical decisions. The Court concluded that a comprehensive law would bring clarity and certainty to the legal framework governing these matters while ensuring protection of the constitutional right to live and die with dignity.
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