Authored By: Kanishka Paltani
National Law University, Delhi
INTRODUCTION
The debate around euthanasia is ever-pervading and has gained significant traction in recent years. The central dilemma is that can one liberate oneself from mortal existence if it becomes too painful, or is life granted to us by the State to be used in its service. Does that make an unnatural end to it a violation of that duty? This issue has several strata that must be decoded layer by layer — the medical approach, the role of religion, and the general moral opinion of the particular society in relation to euthanasia.
Several countries are regarded as the euthanasia capitals of the world because choosing death medically is significantly easier there. While death may be preferable as liberation from a terminal illness, it cannot be an escape or an easy way out of disappointment from life. India has maintained strict rules on this, but the recent case of passive euthanasia involving Harish Rana has catalysed what was already a burning debate. [1]
This paper seeks to examine euthanasia through several rarely asked questions. When does prolonging life become prolonging suffering and who has the authority to draw that line? Does the right to dignity under Article 21 of the Indian Constitution extend to the manner of one’s death, or does it stop at the threshold of living? Is the line between passive and active euthanasia a meaningful legal distinction or a moral convenience? And perhaps most critically, does India’s current legal framework, post Common Cause v. Union of India (2018), actually protect the dying, or does it simply protect the system from having to confront them?[2]
EUTHANASIA AS MURDER
The question of whether euthanasia constitutes murder rests on one’s interpretation of intent, harm, and bodily autonomy in both law and moral reasoning. Drawing from utilitarian philosophers like Jeremy Bentham, the goal of ethics and law is to maximise happiness and minimise pain.[3] From this standpoint, if a patient is suffering unbearable physical and emotional pain owing to a terminal illness and chooses death, that choice is an act of mercy and a liberation from suffering rather than an act of violence against life. In terms of medical ethics, practitioners take the Hippocratic oath, which demands that they do no harm and uphold the dignity and autonomy of the patient.[4] However, what constitutes harm has several interpretations. Prolonging a person’s suffering against their will is, in itself, a form of harm.
THE HUMAN RIGHTS DIMENSION
Questions relating to abstract concepts like life and death naturally fall in the grey areas of the spectrum and cannot be assessed objectively. However, in such situations, we must weigh the framework that best protects individual rights while minimising institutional harm. While international human rights law offers a framework for evaluating euthanasia, several inconsistencies are also evident in the approach.
Article 2 which is the Right to life under the European Convention on Human Rights, protects individuals’ right to life and the right to personal autonomy however it doesn’t grant the right to die even if its voluntary. [5] The irony is that the law protects the right to autonomy but prevents them from making decisions that affect it directly.
In Pretty v United Kingdom, a woman with terminal motor neurone disease sought legal permission for her husband to assist her in ending her life, as she was physically unable to do so herself.[6] She argued that Article 2 of the European Convention on Human Rights protects individual autonomy, including the choice to die, just as it allows refusal of life-sustaining treatment. However, the European Court of Human Rights held that Article 2 guarantees the right to life but does not include a right to die, and therefore her husband could not lawfully assist her suicide. This example suggests that the court may recognise an individual’s pain and help prevent coercion but it does not prioritise personal autonomy. The irony is that under the same Convention, a person may legally refuse life-sustaining treatment as established in Re B (Adult: Refusal of Medical Treatment) and effectively choose death through inaction, but may not actively request it. The law permits death by omission but not by choice.[7]
THE CASE FOR EUTHNASIA AS A LIBERATION FROM SUFFERING
The legal case for euthanasia as mercy is best understood through the principle of informed consent, which is a cornerstone of medical jurisprudence globally. Informed consent requires that a patient, possessed of full mental capacity and adequate information about their condition and prognosis, voluntarily authorises or refuses a medical intervention. Beauchamp and Childress identify autonomy and non-maleficence as the two foundational principles of biomedical ethics and it is precisely these two principles that come into direct conflict when a terminal patient chooses death.[8] In Airedale NHS Trust v Bland, the House of Lords held that withdrawing life-sustaining treatment from a patient in a persistent vegetative state was lawful, provided it was in the patient’s best interest.[9] The judgment established that the sanctity of life, while a fundamental value, is not absolute and must be weighed against the patient’s dignity and autonomy.
This principle was further developed in Washington v Glucksberg, where the United States Supreme Court, while not recognising a constitutional right to assisted suicide, acknowledged that individual states could legislate on the matter.[10] The court reflected the position that the right to die is a legitimate subject of legal regulation rather than an inherently criminal one.
From the standpoint of medical ethics, the principle of patient autonomy, codified in instruments like the Declaration of Lisbon on the Rights of the Patient (1981, amended 2015) holds that a competent patient’s informed decision must be respected.[11] Overriding a consistent, informed wish to die is not simply a medical decision. It is a legal imposition on bodily autonomy that courts in several jurisdictions have begun to recognise as unjustifiable.
THE INDIAN LEGAL FRAMEWORK
India’s engagement with euthanasia has been cautious and incremental. Section 309 of the Indian Penal Code historically criminalised attempted suicide.[12] Section 306 penalised abetment of suicide, reflecting a legislative framework that treated the termination of life, under any circumstances, as a criminal act.[13] The Law Commission of India, in its 196th Report, recommended the decriminalisation of attempted suicide and also opened the conversation around passive euthanasia, noting that the existing framework failed to account for cases of terminal illness and permanent vegetative states.[14]
The decisive shift came with Common Cause v Union of India (2018), where a five-judge constitutional bench unanimously held that the right to life under Article 21 of the Constitution includes the right to die with dignity.[15] [16] The Court validated advance directives and laid down a detailed procedural framework for their execution including requirements of witnesses, countersignature by a Judicial Magistrate, and review by medical boards. While the judgment was landmark, the procedure it prescribed has been widely criticised as excessively complex. In Common Cause (II) (2023), the Supreme Court itself revisited the guidelines and simplified them, reducing the number of witnesses required and removing the mandatory role of the Judicial Magistrate in the execution of advance directives.[17]
The Harish Rana case brought these procedural inadequacies into sharp public focus. Rana, left in a permanent vegetative state following an accident, became the subject of a prolonged petition by his family to withdraw life support.[18] Despite the legal framework established in Common Cause, the family faced significant institutional and procedural obstacles, revealing the gap between judicial recognition of the right and its practical enforcement. The case raises a pointed legal question – if the exercise of a constitutional right requires years of litigation, does it function as a right at all, or does it become a privilege distributed by access to courts?
PASSIVE VS ACTIVE EUTHANASIA: A REAL DISTINCTION OR A MORAL CONVENIENCE?
The legal distinction between passive and active euthanasia is well-established but increasingly contested on doctrinal grounds. In Airedale NHS Trust v Bland, Lord Goff drew the distinction between acts and omissions, holding that withdrawing treatment was an omission and therefore lawful, whereas administering a lethal substance would constitute an unlawful act.[19] This act-omission distinction has been the foundation of passive euthanasia jurisprudence across common law jurisdictions.
However, this distinction has faced significant academic and judicial criticism. In Rodriguez v British Columbia, the Supreme Court of Canada noted, in dissent, that the act-omission distinction produces arbitrary outcomes.[20] A patient on a ventilator may legally have it withdrawn, but a patient who cannot refuse treatment by any physical means is left without equivalent legal remedy. The dissent foreshadowed what eventually became law in Canada through Carter v Canada, where the Supreme Court struck down the blanket prohibition on assisted dying as a violation of the Canadian Charter of Rights and Freedoms, holding that a competent adult with a grievous and irremediable medical condition has the right to seek medical assistance in dying.[21] [22]
India has not yet moved in this direction. Active euthanasia remains illegal under the IPC, and Common Cause explicitly limited its holding to passive euthanasia. Whether the act-omission distinction can survive sustained constitutional scrutiny under Article 21, particularly as the right to dignity has been expansively interpreted in cases like KS Puttaswamy v Union of India (2017) remains an open and important legal question.[23]
THE ROLE OF RELIGION AND SOCIAL MORALITY
The legal framework around euthanasia does not operate in a vacuum. Constitutional courts in India have consistently held that personal law and social morality cannot override fundamental rights, the Shayara Bano v Union of India being the clearest recent example.[24] Applied to euthanasia, this means that religious or cultural objections to the right to die, while relevant to the legislative debate, cannot constitutionally justify denying a competent individual the exercise of their Article 21 rights.
The Law Commission’s 241st Report on Passive Euthanasia acknowledged this tension, noting that any legislation on the subject must balance constitutional rights against the social and religious context in which medical decisions are made in India, particularly in a country where family-based decision-making is the norm and individual advance planning around death remains uncommon.[25] The Report recommended a legislative framework that accommodates both individual autonomy and institutional safeguards, a recommendation that Parliament has yet to act upon.
CONCLUSION
The legal evolution of euthanasia in India reflects a judiciary willing to advance where the legislature has not. Common Cause established the constitutional foundation. Common Cause (II) acknowledged the procedural failures of that foundation. Cases like Harish Rana demonstrate that even corrected procedures are insufficient without institutional will and public awareness.
The passive-active distinction, borrowed from common law and left largely unexamined in the Indian context, requires legislative attention. The trajectory in comparative jurisdictions, from Bland to Carter suggests that the distinction is not as doctrinally stable as Indian law currently assumes. With the Puttaswamy judgment having firmly established privacy and dignity as core constitutional values, the legal argument for a more comprehensive framework, one that addresses active euthanasia with robust safeguards rather than a blanket prohibition is stronger than it has ever been.
The question before Indian law is no longer whether the right to die with dignity exists. The Court has answered that. The question is whether the law is willing to make that right real, accessible, functional, and protective of those who need it most.
BIBLIOGRAPHY
PRIMARY SOURCES
Cases
Airedale NHS Trust v Bland [1993] AC 789
Carter v Canada (Attorney General) [2015] 1 SCR 331
Common Cause v Union of India (2018) 5 SCC 1
Common Cause v Union of India (II) (2023) 4 SCC 1
Harish Rana v Union of India [2026] INSC 222
KS Puttaswamy v Union of India (2017) 10 SCC 1
Pretty v United Kingdom (2002) 35 EHRR 1
Re B (Adult: Refusal of Medical Treatment) [2002] EWHC 429 (Fam)
Rodriguez v British Columbia (Attorney General) [1993] 3 SCR 519
Shayara Bano v Union of India (2017) 9 SCC 1
Washington v Glucksberg 521 US 702 (1997)
Legislation
Canadian Charter of Rights and Freedoms 1982, s 7
Constitution of India 1950, art 21
Indian Penal Code 1860, s 306
Indian Penal Code 1860, s 309
International Instruments
Convention for the Protection of Human Rights and Fundamental Freedoms (European Convention on Human Rights, as amended) art 2
World Medical Association, Declaration of Lisbon on the Rights of the Patient (adopted 1981, amended 2015)
SECONDARY SOURCES
Books
Beauchamp T and Childress J, Principles of Biomedical Ethics (8th edn, Oxford University Press 2019)
Bentham J, An Introduction to the Principles of Morals and Legislation (first published 1789, Clarendon Press 1907)
Edelstein L, The Hippocratic Oath: Text, Translation and Interpretation (Johns Hopkins Press 1943)
Official Reports
Law Commission of India, 196th Report on Medical Treatment to Terminally Ill Patients (2006)
Law Commission of India, 241st Report on Passive Euthanasia (2012)
[1] Harish Rana v Union of India [2026] INSC 222
[2] Common Cause v Union of India (2018) 5 SCC 1
[3] Jeremy Bentham, An Introduction to the Principles of Morals and Legislation (first published 1789, Clarendon Press 1907) ch 1
[4] Ludwig Edelstein, The Hippocratic Oath: Text, Translation and Interpretation (Johns Hopkins Press 1943)
[5] Convention for the Protection of Human Rights and Fundamental Freedoms (European Convention on Human Rights, as amended) art 2
[6] Pretty v United Kingdom (2002) 35 EHRR 1
[7] Re B (Adult: Refusal of Medical Treatment) [2002] EWHC 429 (Fam)
[8] Tom Beauchamp and James Childress, Principles of Biomedical Ethics (8th edn, Oxford University Press 2019)
[9] Airedale NHS Trust v Bland [1993] AC 789
[10] Washington v Glucksberg 521 US 702 (1997)
[11] World Medical Association, Declaration of Lisbon on the Rights of the Patient (adopted 1981, amended 2015)
[12] Indian Penal Code 1860, s 309
[13] Indian Penal Code 1860, s 306
[14] Law Commission of India, 196th Report on Medical Treatment to Terminally Ill Patients (2006)
[15] Common Cause v Union of India (n 2)
[16] Constitution of India 1950, art 21
[17] Common Cause v Union of India (II) (2023) 4 SCC 1
[18] Harish Rana v Union of India [2026] INSC 222 (n 1)
[19] Airedale NHS Trust v Bland (n 9)
[20] Rodriguez v British Columbia (Attorney General) [1993] 3 SCR 519
[21] Carter v Canada (Attorney General) [2015] 1 SCR 331
[22] Canadian Charter of Rights and Freedoms 1982, s 7
[23] KS Puttaswamy v Union of India (2017) 10 SCC 1
[24] Shayara Bano v Union of India (2017) 9 SCC 1
[25] Law Commission of India, 241st Report on Passive Euthanasia (2012)
