Passive Euthanasia

Passive euthanasia refers to the act of allowing a patient to die by withdrawing or withholding life-sustaining treatment — such as mechanical ventilation, artificial feeding (Clinically Assisted Nutrition and Hydration, or CANH), or resuscitation — rather than actively administering a lethal agent. In India, passive euthanasia was first judicially recognised in Aruna Shanbaug v. Union of India (2011) and was comprehensively legalised by a five-judge constitutional bench of the Supreme Court in Common Cause v. Union of India (2018). The 2018 judgment grounded the right to passive euthanasia in Article 21 of the Constitution — the right to life — holding that the right to life encompasses the right to die with dignity, free from artificial prolongation of suffering. The 2018 ruling also created the legal framework for Advance Directives (Living Wills), allowing competent adults to specify, in advance, their refusal of life-sustaining treatment in case of future incapacitation. The procedural safeguards prescribed — attestation by a Judicial Magistrate, review by two separate medical boards, and judicial approval — were widely criticised as unworkable in practice. In 2026, the Harish Rana case before the Supreme Court is seeking a significant simplification of this procedure: elimination of the mandatory Magistrate requirement, reduction to a single medical board, and creation of a national digital registry for advance directives. Indian law draws a clear legal line: passive euthanasia (permitted with safeguards) is distinct from active euthanasia (administering a lethal substance — illegal in India) and physician-assisted suicide (where the patient self-administers a prescribed lethal drug — not covered by Indian law). The ethical debate around passive euthanasia involves tensions between patient autonomy and dignity on one side, and concerns about medical ethics, family pressure, and economic motivations on the other.

• 1 Legal basis: Common Cause v. Union of India (2018) — 5-judge constitutional bench; held right to die with dignity is part of Article 21
• 2 Aruna Shanbaug v. UoI (2011): First judicial recognition; allowed withdrawal of artificial feeding for PVS (Persistent Vegetative State) patients with High Court approval
• 3 CANH (Clinically Assisted Nutrition and Hydration): The most contested form — withholding tube feeding from PVS patients; courts treat it as a medical intervention, not basic care
• 4 2018 procedure (criticised as unworkable): Written advance directive → 2 witnesses → Judicial Magistrate attestation → primary medical board → secondary medical board → Judicial Magistrate permission to execute
• 5 2026 Harish Rana case: SC bench considering simplified procedure — notary/gazetted officer attestation, single medical board, national digital registry; aims to make the right practically exercisable
• 6 Active euthanasia (lethal injection etc.) remains ILLEGAL in India; physician-assisted suicide is not addressed by Indian law
• 7 Voluntary vs non-voluntary: Voluntary = patient has valid advance directive; Non-voluntary = incapacitated patient with no directive — family + medical board + court decide
• 8 Gian Kaur v. State of Punjab (1996): Right to life does NOT include right to die; Common Cause (2018) distinguished this — dying with dignity ≠ hastening death
• 9 Mental Healthcare Act 2017, Section 115: Suicide attempt is presumed to be under severe stress — decriminalised under Section 309 IPC
• 10 International comparison: Netherlands, Belgium (active euthanasia legal, 2002); Canada — MAID (Medical Assistance in Dying, 2016); UK — passive euthanasia permitted via court orders; India — only passive euthanasia permitted

A 72-year-old patient in Bengaluru suffers a massive stroke and has been in a Persistent Vegetative State for 14 months with no signs of neurological recovery. The patient had executed a valid advance directive three years prior stating he did not wish to be kept alive by artificial means if his condition was declared irreversible. His family produces the directive before the hospital ethics committee; a medical board certifies the irreversibility of his condition. Under the Common Cause (2018) framework — and potentially the simplified Harish Rana procedure — the feeding tube and ventilator can be withdrawn, allowing him to die naturally. This is passive euthanasia in practice.