The right to life under Article 21 of the Constitution of India has been the bedrock of countless judicial interpretations, ranging from the right to livelihood to the right to privacy. Yet, one of the most profound and controversial questions under Article 21 is whether it also encompasses the right to die with dignity. This inquiry forms the crux of India’s debate on euthanasia and assisted dying.
Euthanasia — the practice of intentionally ending a life to relieve suffering — sits at the intersection of law, morality, medicine, and human rights. In India, it has sparked heated debates in the legislature, judiciary, and civil society. This article explores the legal framework, landmark judgments, ethical controversies, and the path forward in understanding euthanasia.
Understanding Euthanasia
Euthanasia is generally divided into categories:
- Active Euthanasia: A deliberate act, such as administering a lethal injection, to cause death.
- Passive Euthanasia: Withholding or withdrawing medical treatment that prolongs life, allowing natural death.
- Voluntary Euthanasia: Carried out with the consent of the patient.
- Involuntary Euthanasia: Carried out without the patient’s consent, often highly controversial and illegal.
India’s jurisprudence has mainly grappled with passive euthanasia, as active euthanasia remains unlawful and punishable under criminal law.
Statutory and Constitutional Background
- Indian Penal Code (Now Bharatiya Nyaya Sanhita, 2023): Section 306 criminalizes abetment of suicide, while Section 309 (attempt to commit suicide) remained controversial for decades before being effectively decriminalized under the Mental Healthcare Act, 2017.
- Article 21 of the Constitution: Guarantees the right to life and personal liberty. The debate has centered on whether this includes the right to die.
The Aruna Shanbaug Case (2011)
The watershed moment in India’s euthanasia debate came with Aruna Ramchandra Shanbaug v. Union of India (2011). Aruna Shanbaug, a nurse in Mumbai, had been in a permanent vegetative state for nearly four decades after a brutal assault. A plea for her mercy killing was filed before the Supreme Court.
The Court, in a landmark ruling, refused to allow active euthanasia but permitted passive euthanasia under strict safeguards. It held that:
- Passive euthanasia could be allowed in exceptional cases with High Court approval.
- A “living will” was not recognized, meaning only close relatives or doctors could approach the court.
- The principle was grounded in the right to die with dignity as part of Article 21.
This judgment was cautious, recognizing passive euthanasia while keeping the door open for legislative reform.
The Common Cause Case (2018)
The debate matured further in Common Cause v. Union of India (2018), where a Constitution Bench of the Supreme Court emphatically recognized the right to die with dignity as a fundamental right under Article 21.
The Court:
- Legalized passive euthanasia through advance medical directives (living wills).
- Allowed individuals to specify in advance whether they wished to be kept on life support in case of terminal illness or irreversible coma.
- Laid down detailed guidelines for execution of living wills, requiring attestation, medical board approvals, and judicial oversight.
This judgment was celebrated as a progressive step in aligning Indian law with global human rights principles.
Ethical and Legal Dilemmas
The debate on euthanasia is riddled with conflicting values:
- Sanctity of Life vs. Autonomy: Religious traditions often oppose euthanasia as disrespectful to life, while rights-based arguments stress autonomy and dignity.
- Slippery Slope Argument: Critics fear legalizing euthanasia may lead to abuse, especially against vulnerable groups such as the elderly or disabled.
- Medical Ethics: Doctors face a conflict between the Hippocratic Oath to preserve life and the compassionate duty to relieve suffering.
- Legislative Inaction: Despite Supreme Court rulings, Parliament has yet to enact a comprehensive euthanasia law, leaving uncertainty in medical practice.
Comparative International Perspectives
- Netherlands & Belgium: Allow active euthanasia under regulated frameworks.
- Switzerland: Permits assisted suicide, even for foreigners, sparking “suicide tourism.”
- United States: States like Oregon allow physician-assisted dying under strict safeguards.
- UK: Prohibits active euthanasia, though assisted dying continues to be debated.
Compared to these, India has adopted a cautious middle path, permitting only passive euthanasia.
Criticisms of Current Framework
- Complex Procedures: The requirement of multiple medical boards and judicial involvement makes implementation cumbersome.
- Lack of Awareness: Few citizens know about living wills or the procedure to register them.
- Unequal Access: Poor and rural patients may lack resources to pursue legal approval for passive euthanasia.
- No Active Euthanasia Debate: While passive euthanasia is recognized, there is little legislative debate on whether active euthanasia should be allowed in extreme cases.
The Way Forward
- Comprehensive Legislation: Parliament must enact a law codifying euthanasia procedures, balancing autonomy with safeguards.
- Awareness Campaigns: Citizens should be educated about living wills and end-of-life care options.
- Palliative Care Strengthening: Expanding access to quality palliative care would ensure euthanasia is not chosen merely due to lack of alternatives.
- Ethical Training for Doctors: Medical professionals need training to handle end-of-life decisions sensitively and lawfully.
- Ongoing Judicial Vigilance: Courts must continue refining guidelines to prevent misuse while respecting dignity.
Conclusion
The journey from Aruna Shanbaug (2011) to Common Cause (2018) reflects India’s evolving jurisprudence on euthanasia, moving from cautious recognition to constitutional validation of the right to die with dignity. Yet, the absence of comprehensive legislation leaves the framework incomplete and often inaccessible.
At its core, the euthanasia debate is not about choosing death, but about affirming dignity in the face of unbearable suffering. The challenge for India lies in building a humane legal system that respects individual autonomy while safeguarding vulnerable lives. In this balance rests the true meaning of justice under Article 21.