Right to Die with Dignity: Karnataka’s Progressive Model

Authored by Sanya Darakhshan Kishwar, Assistant Professor of Regulation at Jindal World Regulation College, O.P. Jindal World College, Sonipat, India & Sakkcham Singh Parmaar, a Third-year legislation scholar at Jindal World Regulation College, O.P. Jindal World College, Sonipat, India

The Supreme Courtroom, within the landmark case of Aruna Ramchandra Shanbaug v. Union of India (2011), held that within the case of a everlasting vegetative state, passive euthanasia may solely be carried out after a suggestion by a state-approved and Excessive Courtroom-sanctioned medical board for withdrawal of life-sustaining therapy. Nonetheless, it is very important be aware that at this stage, the court docket didn’t recognise the authorized chance of people administering a “dwelling will,” underneath which one can state a want to not obtain life-sustaining therapy in an end-stage terminal situation. Seven years later, in Widespread Trigger v. Union of India (2018) proper to die with dignity was recognised as a element of the broader proper to life. Importantly, the Supreme Courtroom allowed “dwelling wills” or “Advance Medical Directives (AMD).” The case notes a paradigm shift within the Indian jurisprudence by way of end-of-life selections, giving folks extra company over their deaths. Widespread Trigger went a step additional in recognising the authorized place of passive euthanasia, which had solely been prompt as a chance by Aruna Shanbaug. Whereas Aruna Shanbaug allowed passive euthanasia underneath restricted circumstances topic to the advice by a state-approved and Excessive Courtroom-sanctioned medical board, Widespread Trigger entrusted people with the ability to refuse life-support therapy upfront, thereby securing higher autonomy and a extra lucid statutory setting for end-of-life decision-making.

In 2024, Karnataka carried out the Supreme Courtroom’s directive on the fitting to die with dignity, enabling terminally sick sufferers to withdraw life help by way of a regulated course of involving medical boards and judicial oversight. Whereas passive euthanasia is legally recognised in India, interpretational ambiguities persist, elevating important questions in regards to the implementation of the Widespread Trigger directive. On this mild, the authors intend to debate the potential difficulties in deciphering the scope and the ensuing implementation of the Widespread Trigger directive on the fitting to die with dignity.

An necessary growth in Widespread Trigger was the judgment’s laying down of tips for passive euthanasia and Advance Medical Directives, however these had been thought of cumbersome. Thus, on January 24, 2023, the Supreme Courtroom, in Miscellaneous Utility No. 1699 of 2019 in Writ Petition (Civil) No. 215 of 2005, simplified the rules for passive euthanasia and the execution of Advance Medical Directives to make the method simpler and fewer burdensome for the sufferers and their households. On January 30, 2025, Karnataka issued a round imposing the Supreme Courtroom’s 2023 directive on Advance Medical Directives and withdrawal of life-sustaining therapy for sufferers who’re “not anticipated to learn from life-sustaining therapies.” The method requires consent from subsequent of kin, approval by the treating physician, and authorisation from medical boards, with data submitted to a Judicial Justice of the Peace. Karnataka, the second state after Kerala, marks a progressive shift towards respecting autonomy and dignity in end-of-life care.

In a research of 81 nations, consultants rated the High quality of Loss of life and Dying in 2021. India ranked 59th, which isn’t a very spectacular determine. One other research highlights a considerable want to enhance palliative care in India. The Lancet Fee (2022) experiences that lower than 2 per cent of Indians have palliative care entry, leaving many terminally sick sufferers with out help. This lack might make euthanasia appear the one possibility. Subsequently, first, a coverage should tackle such healthcare inequalities, and thereafter, Karnataka may enact its personal legislation to make sure readability and moral follow. For assuaging misuse of the Widespread Trigger directive,  Karnataka ought to expedite funding within the growth of palliative care providers to offer sufficient ache aid and luxury care to sufferers, making euthanasia much less of an alternate within the absence of such care. Public schooling about end-of-life choices, affected person rights, and the significance of advance directives is important for knowledgeable decision-making. Moreover, the authors recommend psychological evaluations needs to be mandated for all instances present process euthanasia. On this regard, India may look as much as Oregon’s Loss of life With Dignity Act (DWDA). Below DWDA, although psychological evaluations are usually not routinely mandated for all instances, they’re required when both the attending or consulting doctor believes the affected person’s judgment could also be impaired by a psychiatric or psychological dysfunction, comparable to melancholy. In such instances, the affected person have to be referred to a state-licensed psychiatrist or psychologist for counselling. No life-ending medicine may be prescribed till the psychological well being skilled determines that the affected person isn’t affected by a dysfunction inflicting impaired judgment.

Karnataka has made a beautiful try at operationalising autonomy by way of its round, however on nearer scrutiny of the procedural setup, the round finds many hurdles. The process for acquiring needed approvals from a treating physician, a board of medical medical doctors, and at last reporting to a Judicial Justice of the Peace is advanced and difficult, significantly for people who are sometimes in a state of profound misery.  Moreover, this methodology could also be exceedingly burdensome in rural areas, the place entry to proficient medical boards composed of specialized physicians and authorized authorities may very well be considerably restricted for sufferers concerned on this process. One other challenge is the widespread backlog in administration. The duty to convene the medical board and submit paperwork to the judiciary solely for reporting functions introduces bureaucratic delays right into a time-sensitive course of. For the terminally sick affected person, enduring excessive ache and having already misplaced most of their practical capability, the gradual means of approval leads to further ready time that compounds their struggling; thus, the fitting to die with dignity turns into a theoretical relatively than a sensible actuality. When a really intimate medical determination, already delicate in nature, finally ends up being a really lengthy administrative quasi-judicial one, one may name it “judicialisation of loss of life.”

Moreover, the round doesn’t present any particulars on the standards towards which the board would base its determination. For instance, the way to decide {that a} affected person is “not anticipated to learn from life-sustaining therapies” Completely different members of the medical group might have totally different views concerning this prognosis, and this might result in inconsistency within the course of… The round mentions that “if there isn’t any legitimate AMD, the surrogate would be the subsequent of kin (household) or the following good friend or guardian (if any) of the affected person.” This turns into one other important space of publicity. Given the sturdy realities of familial pressures on this society vis-a-vis inheritance and caregiving burdens, that is going to be a provision vulnerable to abuse by family with dangerous ulterior motives within the identify of quickening loss of life to the affected person.

Whereas the current recognition of passive euthanasia and the authorized provision for dwelling wills in Karnataka represents a major stride towards making certain particular person autonomy in end-of-life selections, its profitable implementation requires greater than clear laws. It requires a multifaceted strategy that integrates strong healthcare infrastructure, strong moral safeguards, and complete public schooling. By addressing home challenges and drawing classes from worldwide expertise, Karnataka can construct an moral, compassionate, and sustainable framework for end-of-life care.