Last week The Supreme Court of India (SC) passed an order allowing PASSIVE EUTHANASIA in the case of Harish Rana from Ghaziabad, who has been in a comatose condition for more than 12 years. Passive euthanasia in India refers to the withdrawal or withholding of life-sustaining medical treatment from a patient who is terminally ill or in a permanent vegetative state, allowing the person to die naturally. Unlike active euthanasia (which involves deliberately causing death), passive euthanasia focuses on stopping extraordinary medical interventions that prolong life without meaningful recovery.
The SC has played a major role in shaping the legal framework for passive euthanasia.
Legal Background
1 Aruuna Shanbaug Case– The issue of euthanasia first received national attention in the Aruna Shanbaug case, involving a nurse who remained in a vegetative state or over four decades after a brutal assault. The SC allowed passive euthanasia under strict conditions and stated that withdrawal of life support could be permitted with approval from the High Court.
However, the process was complicated and lengthy.
2 Common Cause judgment (2018)- In March 2018, the SC recognised the Right to Die with Dignity as part of Article (Right of Life) of the Indian Constitution. The court legalised passive euthanasia and introduced the concept of a Living Will or Advance Directive, allowing individuals to state their medical preferences in advance.
Standard Operating Procedure (SOP) for Passive Euthanasia
The SC established detailed guidelines for hospitals, doctors, patients, and families. These guidelines ensure that the decision is ethical, transparent and free from coercion.
Earlier on 23 Jan 2023, I had written a blog on passive euthanasia
https://dailyhappenings.in/passive-euthanasia
1 Advanced Directive (Living Will)- A living Will is a written document made by a person while they are mentally sound, specifying that life-sustaining treatment should not be continued if they become terminally ill or permanently unconscious. According to the SC- the person must be an adult with full mental capacity; the directive must be written clearly, it must specify the circumstances in which life support can be withdrawn, and it should name a guardian or health-care proxy who can make decisions on the patient’s behalf.
The document should be signed by the person making it, attested by two independent witnesses, and authenticated by a notary or a gazette officer.
2 Activation of the Living Will– When a patient becomes terminally ill or enters a vegetative state:
- The treating physician reviews the living will
- The hospital verifies the authenticity of the document
- A medical board is formed to examine the patient’s condition
3 Formation of Medical Board- The SC mandated two levels of medical review to prevent misuse.
Board Primary Medical – The hospital must form a medical board consisting of the treating physician, at least two specialists (doctors with a minimum experience of more than 5 years). The board examines the patient gives their recommendation on whether the patient can be medically cured or not.
Secondary Medical Board– A second independent board must also examine the patient. This board must Be constituted by the hospital or district collector authority, and must include different specialists not involved in the first board. They independently verify the decision.
3 Consent of Family/Surrogate– Even if a living will exists-
- The family or nominated representative must be informed.
- Their views should be considered.
If no living will exists
- The family or next of kin can request withdrawal of life support.
- The medical boards still must approve the request.
4 Certification and Documentation- Once both medical board agrees: their decisions must be documented in writing; the hospital must maintain a complete record, and the decision is communicated to the patient’s family.
After completing all these formalities, the life-sustaining treatment, such as ventilators, artificial nutrition, or resuscitation support, can be withdrawn, but the doctors must continue palliative care to ensure the patient does not suffer.
In 2023, the SC simplified the SOP
- Authentication of a living will can be done by a notary or a gazetted officer, instead of a judicial magistrate.
- Hospitals can form the secondary medical board internally.
- Documentation requirements were streamlined.
Ethical Principles Behind the SOP– The SC guidelines are based on key ethical principles:
Patient Autonomy– Every individual has the right to decide how their medical treatment should proceed.
Dignity in Death- Prolonging life artificially without hope or recovery can violate human dignity.
Safeguards Against Misuse– Multiple medical boards and documentation prevent pressure, coercion, or financial motives.
The SC’s SOP for passive euthanasia represents a significant step toward recognising the right to die with dignity. By allowing living wills and establishing a structured medical review process, the court has created a balance between patient autonomy and safeguards against misuse.
Anil Malik
Mumbai,, India
16th March 2026