In June, the U.K.’s House of Commons passed the Terminally Ill Adults (End of Life) Bill, reigniting a global conversation about euthanasia. The proposed law permits physician-assisted dying for mentally competent adults expected to live fewer than six months, subject to medical certification and oversight by a national panel. While it is awaiting approval from the House of Lords, the Bill marks a bold legal and moral step that many western countries have embraced.
While India has recognised passive euthanasia through a series of Supreme Court judgments, it has consciously drawn a line against active euthanasia. Cultural values, institutional capacity, and socio-economic conditions make it unlikely that India will mirror the U.K.’s path. But that does not mean it should remain static.
Practical inaccessibility
Passive euthanasia permits the withdrawal of life-sustaining treatment when it merely prolongs suffering. It is not an act of killing but an allowance for death to take its natural course. Yet, despite legal recognition, procedural requirements, such as advance directives, dual medical board clearance, and occasional judicial oversight, make implementation painfully slow.
For patients in terminal stages or their families, these delays amount to cruelty. The law, though sound in principle, is often hollow in practice. Reports from tertiary hospitals suggest that in most cases, families are forced to make decisions informally and outside the legal framework, thus placing doctors in a difficult legal position. The absence of an efficient implementation system erodes the very dignity the law was intended to preserve.
The U.K. model, while progressive, rests on strong institutional supports such as the National Health Service, universal access to general practitioners, and a reliable regulatory framework. India’s healthcare system is fragmented, uneven, and under-resourced. Moreover, its societal context — marked by deep family involvement, religious sensitivities, and varying literacy levels — makes end-of-life choices more complex. Introducing active euthanasia, even with safeguards, may inadvertently pressurise the elderly, disabled, or financially dependent to opt for death. As medical care is expensive and palliative care underdeveloped, this could produce ethical dilemmas of coercion.
There are also jurisprudential concerns. While Article 21 of the Constitution guarantees the right to life and has been interpreted to include the right to die with dignity, this cannot be stretched to mean a right to be killed. The Supreme Court has been cautious in maintaining the distinction between omission and commission, between allowing death and causing death. The Indian approach reflects a careful ethical conservatism suited to the realities of the country.
Charting its own course
Rather than expanding into active euthanasia, India should focus on refining its passive euthanasia protocol. A humane, efficient system can be built by leveraging digital tools and streamlining procedures. There is already growing consensus among medical professionals and legal scholars that the present system is too cumbersome.
Advance directives should be registered on a national digital portal, linked with Aadhaar for biometric verification. This system should allow patients to create, update, or revoke their directives easily. A treating physician should validate the patient’s mental capacity and intent online.
Hospital ethics committees, consisting of senior doctors, a palliative care specialist, and a neutral third party, should be empowered to authorise withdrawal of life support within 48 hours. Exceptional cases can be flagged for further scrutiny.
Although a State-level ombudsman was initially proposed for oversight, India’s experience with ombudsman schemes in banking and insurance has been mixed. Delays, limited enforcement powers, and public unfamiliarity have marred their effectiveness. Instead, a more transparent, decentralised review mechanism — perhaps built into hospital networks and monitored through digital dashboards — may be more suitable. Independent medical auditors or health commissioners with statutory backing could be alternatives worth exploring.
Mandatory safeguards, such as a seven-day cooling-off period, psychological counselling, and palliative care review, should remain part of the process to prevent misuse and ensure decisions are fully informed. These align with international best practices and help address fears of abuse, especially among vulnerable populations.
The way forward
India’s constitutional promise of dignity in life must extend to dignity in dying. Reforming passive euthanasia does not require India to imitate the U.K.’s active euthanasia model, but it does compel it to make the current framework workable. Digitally driven procedures, local hospital-based ethics review, and effective (but not burdensome) oversight can make end-of-life decisions more accessible and humane. This path is consistent with Indian values, safeguards against abuse, and empowers patients without risking exploitation. In addition, medical education must integrate training on end-of-life care, including ethical and legal components. Public awareness campaigns are essential to normalise discussions on advance care planning. Without public trust and awareness, even the best laws will fail to serve their purpose.
Published – October 07, 2025 01:05 am IST