Topical Context: A UK Bill Rekindles a Global Debate
In June 2025, the United Kingdom’s House
of Commons passed the Terminally Ill Adults (End of Life) Bill, reigniting a
global conversation about euthanasia. The proposed law permits
physician-assisted dying for mentally competent adults expected to live fewer
than six months, subject to medical certification and oversight by a national
panel. While the Bill is still awaiting House of Lords approval, it marks a
bold legal and moral step that many Western countries have gradually embraced.
India, however, stands at a different
crossroads. While we have recognised passive euthanasia through a series of
Supreme Court judgments—Aruna Shanbaug (2011), Common Cause
(2018), and its procedural revision in 2023—we have consciously drawn a line
against active euthanasia. Cultural values, institutional capacity, and
socio-economic conditions make it unlikely that India can or should mirror the
UK’s path. But that does not mean we should remain static.
India’s Legal Recognition, But Practical
Inaccessibility
Passive euthanasia in India permits the
withdrawal of life-sustaining treatment when it merely prolongs suffering. It
is not an act of killing but an allowance for death to take its natural course.
Yet, despite legal recognition, procedural requirements—advance directives,
dual medical board clearance, and occasional judicial oversight—make
implementation painfully slow.
For patients in terminal stages or their
families, these delays amount to cruelty. The law, though sound in principle,
is often hollow in practice. Reports from tertiary hospitals suggest that in
most cases, families are forced to make decisions informally and outside the
legal framework, thus placing doctors in a difficult legal position. The
absence of an efficient implementation system erodes the very dignity the law
was intended to preserve.
Why India Must Chart Its Own Course
The UK model, while progressive, rests on
strong institutional supports like the NHS, universal access to general
practitioners, and a reliable regulatory framework. India’s healthcare system
is fragmented, uneven, and under-resourced. Moreover, India’s societal
context—marked by deep family involvement, religious sensitivities, and varying
literacy levels—makes end-of-life choices far more complex.
Introducing active euthanasia here, even
with safeguards, may inadvertently pressurize the elderly, disabled, or
financially dependent to opt for death. In a country where medical care is
expensive and palliative care underdeveloped, this could produce ethical
dilemmas of coercion.
There are also jurisprudential concerns.
While Article 21 of the Constitution guarantees the right to life and has been
interpreted to include the right to die with dignity, this cannot be stretched
to mean a right to be killed. The Supreme Court has been cautious in
maintaining the distinction between omission and commission, between allowing
death and causing death. The Indian approach reflects a careful ethical
conservatism suited to the realities of the country.
Still, Reform Is Urgent—And Possible
Rather than expanding into active
euthanasia, India should focus on refining its passive euthanasia protocol. A
humane, efficient system can be built by leveraging digital tools and
streamlining procedures. There is already growing consensus among medical
professionals and legal scholars that the present system is too cumbersome.
Advance directives should be registered on
a national digital portal, linked with Aadhaar for biometric verification. This
system must allow patients to create, update, or revoke their directives
easily. A treating physician should validate the patient’s mental capacity and
intent online.
Hospital ethics committees, consisting of
senior doctors, a palliative care specialist, and a neutral third party, should
be empowered to authorise withdrawal of life support within 48 hours.
Exceptional cases can be flagged for further scrutiny.
Rethinking Oversight Beyond the Ombudsman
Model
Although a state-level ombudsman was
initially proposed for oversight, India’s experience with ombudsman schemes in
banking and insurance has been mixed. Delays, limited enforcement powers, and
public unfamiliarity have marred their effectiveness. Instead, a more
transparent, decentralized review mechanism—perhaps built into hospital
networks and monitored through digital dashboards—may be more suitable.
Independent medical auditors or health commissioners with statutory backing
could be alternatives worth exploring.
Mandatory safeguards—such as a seven-day
cooling-off period, psychological counselling, and palliative care
review—should remain part of the process to prevent misuse and ensure decisions
are fully informed. These safeguards also align with international best
practices and help address fears of abuse, especially among vulnerable
populations.
The Way Forward: Constitutional Dignity
and Compassion
India’s constitutional promise of dignity
in life must extend to dignity in dying. Reforming passive euthanasia does not
require us to imitate the UK’s active euthanasia model, but it does compel us
to make the current framework workable.
Digitally driven procedures, local
hospital-based ethics review, and effective—but not burdensome—oversight can
make end-of-life decisions more accessible and humane. This path is consistent
with Indian values, safeguards against abuse, and empowers patients without
risking exploitation.
In addition, medical education must
integrate training on end-of-life care, including ethical and legal components.
Public awareness campaigns are essential to normalise discussions on advance
care planning. Without public trust and awareness, even the best laws will fail
to serve their purpose.
Conclusion: A Right That Must Be Realised
India need not follow the UK into active
euthanasia, but neither can it afford to leave passive euthanasia locked in red
tape. As terminally ill patients wait in pain, the law’s delay becomes their
torment. Reform is not just a legal adjustment; it is a moral necessity.
Through technological innovation,
simplified procedures, and a robust but context-sensitive ethical framework,
India can honour its constitutional promise. The right to die with dignity must
be more than a judicial declaration. It must be a practical reality.
Author: K. Kannan, former judge, Punjab
& Haryana High Court; Author, Medicine and Law, (2025) 2nd edn, Thomson
Reuters.
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