In January 2023, the Supreme Court of India issued a
landmark decision in the Common Cause v. Union of India case, revising its 2018 guidelines to make passive euthanasia and living wills more accessible. This ruling upholds the right to die with dignity as part of Article 21’s right to life, focusing on passive euthanasia where life support is withdrawn for terminally ill patients.
*Reasons for 2023 Modifications*
These steps proved overly bureaucratic, leading to no successful cases by 2022, prompting simplification like notary attestation and digital integration.
*Key Changes in 2023 Ruling*
These guidelines permitted terminally ill patients or those in permanent vegetative states (PVS) to refuse
life-sustaining treatment, recognizing the right to die with dignity under Article 21.
*Execution of Living Wills*
In 2018, advance directives required signing before two witnesses and countersignature by a Judicial Magistrate First Class. The 2023 ruling replaced this with simpler attestation by a notary or gazetted officer, plus two witnesses, removing the magistrate step entirely.
*Storage and Registration*
Previously, living wills were kept with the local magistrate, registered governmentally, and copied to family and health centers. Now, they integrate directly into national digital health records via a designated portal by the National
Medical Commission or state bodies, for quicker access.
*Medical Board Composition*
The 2018 primary board included the treating physician, a senior hospital doctor, and one from another hospital.
Updated rules specify the primary board as the treating physician plus two experts (5+ years experience) from the same hospital, deciding in 48 hours.
*Secondary Review Process*
Under 2018 rules, the district Collector formed and oversaw a secondary board, then sent files to the magistrate. The 2023 version empowers the primary
hospital’s secondary board (including a district-nominated doctor) to review independently in 48 hours; the Collector is informed afterward, without forming the board.
*Oversight and Appeals*
Magistrate confirmation is no longer needed
pre-execution; they are notified post-board approval. Families can approach the High Court directly for cases without living wills or to challenge denials.
*Background on Euthanasia in India*
Passive euthanasia gained recognition in 2011 via the Aruna Shanbaug case, allowing withdrawal of life support under strict conditions. The 2018 Common Cause judgment formalized living wills—advance directives refusing treatment in irreversible conditions—but the process was overly complex.
In 2011, the Supreme Court for the first time recognised the legality of passive euthanasia in the case of Aruna Ramchandra Shanbaug v Union of India.
After being sexually assaulted by a ward attendant of Mumbai’s KEM Hospital in 1973 and suffering a brain
injury in the process, nurse Aruna Shanbaug was left in a
‘persistent vegetative state’ for decades, with no possibility of recovery. Journalist and author Pinki Virani, who wrote a book on Shanbaug, filed a petition at the Supreme Court in 2009 seeking an end to the life-supporting treatment the hospital was providing to Shanbaug, arguing that she should be allowed to die peacefully.
The court, while ruling out passive euthanasia in this case, held that Shanbaug was still alive as she did not require life support. However, the court recognised the legality of passive euthanasia, though it clarified that this could only be done with the approval of a High Court. By 2023, no cases had succeeded due to bureaucratic hurdles, prompting the court to intervene.
