Is the Right to Die with Dignity in the Absence of a Living Will Possible?

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 the right to die with dignity is and how living wills play a role in end-of-life care.

What is the right to die with dignity?

The Right to Die with Dignity is a fundamental right in India provided under Article 21 of the Indian Constitution. 

• A person who has the capacity to take decisions about their healthcare has the right to refuse life-sustaining treatment;
• An adult person has the right to make an advance medical directive (AMD). In this document, they can express their wishes about their future medical treatment for situations when they may not have the capacity to make decisions about their health care;
• Life-sustaining treatment can be legally withheld or withdrawn from persons without the capacity to make decisions about their healthcare, either in accordance with their advance medical directive or even if they have not made one.

It is important to note that a person refusing life-sustaining treatment still has the right to access palliative and other forms of end-of-life care.

The right to die with dignity is often understood as ‘euthanasia’, active or passive. However, this understanding is incorrect. In March 2026, the Supreme Court of India clarified that the appropriate terminology is ‘withholding or withdrawal of medical treatment’. 

What is the Legal Position of the right to die with dignity in India?

• The legal position on the right to die with dignity was set 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 withholding or withdrawal of life-sustaining treatment is legally permissible, and set a procedure for the process to function in the country. The procedure is for persons with a terminal illness, a person in a persistent vegetative state, or like conditions at a time when further treatment is futile. The decision to withhold/withdraw only starts when an individual loses decision-making capacity. An individual with decision-making capacity has the right to refuse any treatment, including life-sustaining treatment, even if it results in their death.
• Once the process starts, the verification happens through two medical boards (primary and secondary), consisting of 3 doctors’ each with at least 5 years of experience. The secondary medical board must have a doctor appointed by the Chief Medical Officer. 
• Euthanasia or the intentional killing of a person remains illegal. 
• The Court has recognised that prolonging life artificially in certain cases may violate human dignity.

What is a Living Will or Advance Directive?

An advance medical direction, colloquially referred to as a  living will, 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. The document also gives an individual the right to nominate someone on their behalf to make decisions when the individual loses decision-making capacity. The nominee in this case does not need to be limited to a family member, and can include a friend, partner, chosen family or anyone else. 

A living will enables individuals to decide whether life-support systems should be continued or withdrawn, to refuse invasive medical procedures in specific 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 who is at least 18 years of age., It should clearly specify the wishes for future treatment, and nominate a person to make decisions should they lose decision-making capacity. A living will must be signed by the individual in the presence of two independent witnesses (not the nominee) and a gazetted officer or notary. 

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 decision-makers, 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 various decision-makers, courts might need to intervene, and patients may remain on invasive treatment despite having no chance of recovery.

This creates emotional, financial, and ethical strain.

What was the Significance of the Harish Rana Case?

The Harish Rana case clarified the inclusion of clinically assisted nutrition and hydration as part of withholding or withdrawal of life-sustaining treatment. Harish Rana was in a persistent vegetative state for over 13 years, entirely dependent on artificial life support with no meaningful prospects of recovery.

As his condition was so before the right to die with dignity was recognised, he did not have a living will, and in its absence the burden of decision-making shifted to his family. 

Applying the principles of Common Cause v. Union of India,  the Supreme Court allowed the withdrawal of clinically assisted nutrition and hydration which Harish was receiving via a PEG Tube,after ensuring medical board evaluations, and compliance with procedural safeguards.

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

The Hon’ble Court clarified that the right to die with dignity applies even in the absence of a living will, and the need for using correct terminology. It also set forth a best interest principle discussing how decisions for withholding and withdrawal can take place.

To learn more, please look up: https://vidhilegalpolicy.in/eolctoolkit/