On the implications of euthanasia in India

The recent judgment by the Supreme Court in the Harish Rana v. Union of India (2026) case has raised questions regarding the ethical, legal, and social implications (ELSI) of passive euthanasia. Euthanasia is related to the right to die with dignity, which was recognised by the Supreme Court in Common Cause v. Union of India (2018). The court held that the right to die with dignity is inseparable from the right to receive quality palliative care. Hence, in the Harish Rana case, the court, for the first time, allowed the withdrawal of the applicant’s Clinically Assisted Nutrition and Hydration (CANH).

The court had held in the Common Cause case that the right to die with dignity is an integral part of the right to life under Article 21 of the Constitution. Allowing passive euthanasia and recognising the Advance Medical Directives (living wills) for terminally ill patients to refuse life-prolonging treatment was laid down in Aruna Shanbaug v. Union of India (2011). Following this, in Common Cause v. Union of India (2023), the court streamlined the process of passive euthanasia, making its implementation easier.

In the new guidelines, the court changed the requirement for two medical boards, a hospital board and a district-level board, refining it to make the process smoother, and mandatory immediate judicial oversight in every case was removed. While addressing advance directives (living wills), the court emphasised patient autonomy, allowing individuals to refuse life-sustaining treatment and die naturally with dignity.

Considering the above, a few questions arise regarding euthanasia and its relevance in India. First, whether granting passive euthanasia is ethical. It is logically perceived that birth and death are natural processes; hence, nature should decide when a person dies and how the body responds to illness. In this context, any interference with the rules of nature may be considered unethical.

However, it is also a fact that life is the period between birth and death, and it is spent in a society where dignity is of utmost importance. Life, therefore, can be viewed as more sociological than biological. Both the birth and the death should be dignified. In this context, the right to die with dignity assumes greater significance.

Ethical aspects of euthanasia

The ethical principles enshrined in this act of granting passive euthanasia further clarify this issue. The primary and probably the most significant aspect is the principle of autonomy, which grants the patient — or, in cases of terminal illness, their next of kin — the right to make decisions. Second is the principle of beneficence, which is related to the patient’s benefit, which the doctors treating the patient should consider. Third is the principle of non-maleficence, which suggests that the decision to allow passive euthanasia should not cause harm. Finally, the principle of justice must be protected to ensure that no injustice is done to the patient.

Apart from these principles, we may look at the decision from the viewpoint of the Theory of Double Effect proposed by St. Thomas Aquinas. According to this theory, every action creates two effects, and the one that is less harmful or beneficial should be considered ethical. In the case of passive euthanasia, the action — withdrawal of life support, or CANH in the Harish Rana case — leads to two effects. First, the death of the patient, and second, relief from suffering. If the decision is taken without malice, the act can be considered ethical as the patient was relieved of his pain.

Social implications

The right to die with dignity or passive euthanasia in India reflects a progressive but cautious approach, mainly due to a transition in societal values. This transition is from rigid moral traditions to a more compassionate, rights-based approach. While it promotes dignity, autonomy, and relief from suffering, it also raises concerns about misuse, ethical conflicts, and social inequality. There has also been a transition from the social attitude of protecting life at any cost to the quality of life being more important than its length.

Another major implication is economic in nature, as long-term life-support treatment without any hope of recovery would put the family under severe economic stress, especially in the middle- and lower-income groups. In this context, the right to die with dignity appears to be justified.

Further, social implications may include its possible misuse and especially vulnerable people like the elderly, disabled and poor may face coercion. This may create a situation where the decision may be driven by financial constraints, social neglect, and family pressure. Hence, critics may point out that it would amount to disguised abandonment.

The court has taken utmost care while delivering the judgment and stated that “passive euthanasia is an obsolete and incorrect term, and should not be used either in common usage or legal writing and discussions”. It unnecessarily confuses the legal position on the issue, as the debate cannot be neatly divided into ‘acts’ and ‘omissions’. Further, the court also held that the patient is not abandoned by withdrawing or withholding medical treatment. Palliative and end-of-life care must continue for these patients.

(C.B.P. Srivastava is President, Centre for Applied Research in Governance, Delhi)

Published – March 30, 2026 10:14 pm IST