Passive euthanasia refers to the withdrawal or withholding of life-sustaining medical treatment from a patient who is terminally ill or in a permanent vegetative state (PVS), allowing death to occur naturally. Unlike active euthanasia, where deliberate action is taken to cause death, passive euthanasia involves stopping medical interventions that artificially prolong life. In India, the concept is closely linked with the constitutional guarantee of the Right to Life and Personal Liberty under Article 21.

The Indian judiciary gradually evolved its interpretation of the right to life to include the right to live with dignity. In Gian Kaur vs State of Punjab (1996), the Supreme Court clarified that Article 21 protects the right to live with dignity but does not include the right to die. However, the Court also observed that the process of dying with dignity may be part of the right to life in certain circumstances. This laid the foundation for later judgments dealing with euthanasia and end-of-life care.

A significant shift occurred in Aruna Shanbaug vs Union of India (2011), where the Supreme Court formally recognised passive euthanasia under strict safeguards. The Court permitted the withdrawal of life support in exceptional cases involving terminally ill patients, subject to approval by medical boards and judicial oversight. Later, the Common Cause vs Union of India (2018) judgment expanded this principle by recognising the right to refuse medical treatment and introducing the concept of a “living will”. Thus, Indian jurisprudence now recognises passive euthanasia as a constitutional expression of dignity, autonomy, and self-determination under Article 21.

The recognition of the right to die with dignity represents a significant development in Indian constitutional law because it expands the interpretation of Article 21 beyond mere survival to include the quality and dignity of human life. The Supreme Court has repeatedly emphasised that the right to life does not simply mean animal existence but encompasses the right to live with autonomy, privacy, and dignity. Extending this reasoning to the final stage of life acknowledges that individuals should have some control over how their life ends, particularly when medical treatment no longer offers any meaningful recovery.

The landmark Common Cause vs Union of India (2018) judgment firmly established this principle. The Constitution Bench held that the right to refuse medical treatment is an intrinsic part of personal liberty. This recognition was closely linked to the broader constitutional values of autonomy, privacy, and bodily integrity, which had already been reinforced by the Supreme Court in cases such as the Puttaswamy judgment (2017) on the right to privacy. By allowing individuals to create advance directives or living wills, the Court ensured that people can express their wishes regarding end-of-life medical care.

From a broader perspective, this development reflects the evolution of constitutional morality in India. It recognises the emotional, ethical, and medical complexities faced by families and doctors when a patient remains in a persistent vegetative state for years. By balancing individual autonomy with safeguards against misuse, the judiciary has attempted to ensure compassion, dignity, and ethical decision-making in end-of-life care.

The Common Cause vs Union of India (2018) judgment represents a watershed moment in India’s legal approach to end-of-life care. In this case, a Constitution Bench of the Supreme Court recognised that the right to refuse medical treatment forms part of the fundamental right to life and personal liberty under Article 21. The Court also acknowledged that forcing life-prolonging medical treatment upon a terminally ill patient may violate their dignity and autonomy.

To operationalise this principle, the Court introduced a structured framework for withdrawing or withholding life-sustaining treatment. A central feature of this framework was the recognition of “living wills” or advance directives, which allow individuals to state their preferences regarding medical treatment in situations where they may no longer be capable of expressing their consent. This empowers patients to retain control over their medical decisions even in cases of severe illness or unconsciousness.

The Court also established multiple safeguards to prevent misuse. These include:

• Verification of the patient's condition by primary and secondary medical boards.
• Consultation with family members or next of kin.
• Strict documentation and procedural oversight.

The case of Harish Rana provides an important contemporary example of how the Supreme Court applies the legal framework governing passive euthanasia in India. After suffering a severe fall in 2013, Mr. Rana entered a persistent vegetative state (PVS) and remained dependent on life-support systems for over 13 years. With no signs of recovery and continuous medical dependence, his parents approached the Supreme Court seeking permission to withdraw life support so that nature could take its course.

The Court examined two key legal questions under the Common Cause guidelines. First, it had to determine whether Clinically Assisted Nutrition and Hydration (CANH) constituted “medical treatment.” The Court concluded that CANH involves complex medical supervision, periodic evaluation, and specialised expertise. Therefore, it qualifies as medical treatment and falls within the scope of the Common Cause framework governing withdrawal of treatment.

The second question concerned whether withdrawing treatment would serve the “best interests” of the patient. The Court held that doctors have a duty to continue treatment only as long as it provides therapeutic benefit. When recovery is medically impossible and treatment merely prolongs biological existence, continuing intervention may not serve the patient’s dignity. After considering the opinions of medical boards and the wishes of the family, the Court permitted withdrawal of life support. This case demonstrates how constitutional principles of dignity and autonomy are applied in real-life situations involving ethical and emotional complexity.

The debate on euthanasia raises complex ethical, legal, and medical questions in India. On one hand, supporters argue that allowing passive euthanasia respects the dignity and autonomy of patients who are suffering from terminal illnesses or irreversible medical conditions. When medical science can no longer offer meaningful recovery, prolonging life through artificial means may only extend suffering for both the patient and their family. In such cases, allowing natural death can be viewed as a compassionate and humane approach.

However, euthanasia also raises serious ethical concerns. Critics argue that legalising withdrawal of life support could create the risk of misuse or coercion, particularly in societies where vulnerable individuals such as the elderly, disabled, or economically disadvantaged may face pressure from family members. There is also concern that decisions about ending life may conflict with cultural, religious, and moral values that emphasise the sanctity of life.

To address these concerns, the Supreme Court has introduced strict procedural safeguards through the Common Cause guidelines. These include medical board verification, documentation, and family consultation. While these measures reduce the risk of misuse, the absence of a comprehensive legislative framework remains a challenge. Many experts argue that Parliament should enact a clear law on euthanasia to provide greater legal certainty and protect the interests of patients, doctors, and families.

The Supreme Court has repeatedly emphasised the need for legislative intervention in euthanasia-related matters because the current legal framework is largely based on judicial guidelines rather than a comprehensive statute. Although the Court has played a proactive role in recognising passive euthanasia and the right to die with dignity, it has acknowledged that complex medical and ethical issues are best addressed through detailed legislation enacted by Parliament.

One reason for this is the institutional limitation of courts. Judicial decisions generally arise in response to specific cases and may not fully address all practical situations faced by doctors and hospitals. For example, issues such as documentation procedures, liability protections for medical professionals, and clear definitions of terminal illness require detailed statutory guidelines. Legislation can provide a uniform framework applicable across the healthcare system.

Another reason is the need to ensure legal clarity and accountability. Without a clear law, doctors may fear criminal liability when withdrawing life support, even if acting in the patient’s best interests. A well-designed legal framework could define procedures, establish safeguards, and clarify responsibilities of medical practitioners and family members. Therefore, while judicial decisions have advanced constitutional principles of dignity and autonomy, comprehensive legislation is necessary to institutionalise these principles and ensure ethical end-of-life care across the country.