Is Euthanasia in the Absence of a Living Will Possible?

Recently, the Supreme Court clarified that the right to die with dignity applies even in the absence of a living will and laid out some considerations for passive euthanasia. 

In this Weekly, we will understand what euthanasia is and how living wills play a role in end of life care.

What is Euthanasia and What are its Types?

Euthanasia, commonly referred to as “mercy killing,” is the practice of intentionally ending or allowing the life of a person who is suffering from a terminal illness, an incurable condition, or is in a persistent vegetative state, in order to relieve prolonged suffering.

It is broadly classified into two types:

• Active euthanasia involves directly causing death through the administration of lethal substances. It is illegal in India and treated as a criminal offence akin to culpable homicide.
• Passive euthanasia involves the withdrawal or withholding of life-sustaining treatment, allowing the natural process of death to take its course.

What is the Legal Position of Euthanasia in India?

The legal position on euthanasia was clarified by the Supreme Court in Common Cause v. Union of India(2018).

The Court held that the right to life under Article 21 of the Constitution includes the right to die with dignity.

The court recognised that passive euthanasia is legally permissible, subject to strict safeguards, while active euthanasia continues to remain illegal.

This judgment recognised that prolonging life artificially in certain cases may violate human dignity.

What is a Living Will or Advance Directive?

A living will, also known as an advance directive, is a written document in which a person specifies their preferences regarding medical treatment in case they become incapable of making decisions in the future.

It enables individuals to decide whether life-support systems should be continued or withdrawn, to refuse invasive medical procedures in terminal conditions, and to ensure that medical decisions reflect their personal values.

What are the Legal Requirements for a Valid Living Will?

The Supreme Court in Common Cause v. Union of India laid down detailed guidelines to prevent misuse.

A valid living will must be executed voluntarily by a competent adult, made with a full understanding of its implications, clearly specify the circumstances for withdrawal of treatment, include explicit consent, be signed in the presence of witnesses, and be countersigned by a Judicial Magistrate.

For implementation, hospitals must constitute medical boards, and there must be multi-layered verification along with procedural safeguards.

Why are Living Wills Important?

Living wills play a crucial role in end-of-life care by preserving individual autonomy, reducing ambiguity in medical decision-making, minimising the emotional and ethical burden on families, and ensuring that decisions align with the patient’s dignity and wishes.

They bridge the gap between present consent and future incapacity.

What Issues Arise in the Absence of a Living Will?

In the absence of an advance directive, families are often forced to make difficult decisions, there may be conflict among relatives, courts frequently need to intervene, and patients may remain on life support despite having no chance of recovery.

This creates emotional, financial, and ethical strain.

What was the Significance of the Harish Rana Case?

The case of Harish Rana highlights the practical challenges of end-of-life care.

Harish remained in a persistent vegetative state for over 13 years, entirely dependent on artificial life support with no meaningful prospects of recovery.

A key issue in this case was the absence of a living will, which shifted the burden of decision-making onto the family.

Applying the principles of Common Cause v. Union of India,  the Supreme Court allowed passive euthanasia after ensuring medical board evaluations, judicial oversight, and compliance with procedural safeguards.

What did the Supreme Court Clarify Regarding End-of-Life Decisions?

The Court clarified that the right to die with dignity applies even in the absence of a living will, and that passive euthanasia can be permitted if the patient is in an irreversible condition, the prescribed safeguards are followed, and the decision is taken in the best interest of the patient.