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Diksha
Graphic Era Hill University
Karnataka has become the first Indian state to implement the Supreme Court’s directive on “Right to Die with Dignity.” In a landmark move, this gives terminally ill patients the autonomy to make choices about their end-of-life care, as provided for in the Supreme Court guidelines of 2023.
BACKGROUND
The concept of the “Right to Die with Dignity” in India has evolved over the past decade. In 2011, the Supreme Court recognised passive euthanasia under specific conditions. This was again reiterated in the case of Common Cause v. Union of India in 2018, in which the court declared the practice of passive euthanasia as legal and made the provision of Advance Medical Directives (AMDs), otherwise known as living wills, available. Through AMDs, a person may make his choice regarding the course of treatment when he may be unable to speak for himself in the future.
Euthanasia is an act of deliberately ending a person’s life to relieve suffering from a painful and incurable disease or disorder.
Passive euthanasia
• In it, there is withhold or withdrawal of life-sustaining treatment (LST) for terminally ill patients undergoing prolonged medical treatment with no hope of recovery and do not have decision-making capacity.
• On the other hand, active euthanasia is the intentional act of killing a terminally ill patient on voluntary request. It is illegal in India.
In January 2023, the Supreme Court made it easier to execute AMDs by opening the right to refuse medical treatment to individuals under certain circumstances. The court stated that the right to execute an AMD is an extension of the fundamental right to bodily integrity and self-determination.
Implementation in Karnataka
On 31 January 2025, the Karnataka Health and Family Welfare Department put out an order to set up medical boards in every hospital across the state so that the message of the Supreme Court could be put across effectively. State Health Minister Dinesh Gundu Rao announced, “My Karnataka Health Department passes a historic order to implement the Supreme Court’s directive for a patient’s Right to Die with dignity.”
The health department order directs the district health officer in Karnataka to provide and deploy registered medical practitioners in every secondary medical board.
Ministry of Health and Family Welfare has released a draft “Guidelines for Withdrawal of Life Support in Terminally Ill Patients”
Key highlights of Guidelines :
• Withdrawing Life-Sustaining Treatments (LST) can be done in certain conditions such as when an individual is declared brain stem dead, etc.
• Constitution of Primary Medical Board (PMB) and Secondary Medical Board (SMB)
• Foregoing LST proposals should be made by consensus among members of PMB.
• SMB must validate the PMB decision.
• Clinical Ethics Committee to be constituted by hospitals for audit, oversight, & conflict resolution.
The order, signed by principal secretary to government, health and family welfare department, Harsh Gupta, on January 30 read: “In pursuance of the order of the Supreme Court dated Jan 24, 2023, in Miscellaneous Application in Writ Petition of 2005, the District Health Officers of all districts in the state are directed to nominate registered medical practitioners who can act as members of the Secondary Medical Board to certify Withholding/Withdrawing of life-sustaining treatment (WLST) where the patient is terminally ill with no hope of recovery or is in a persistent vegetative state and where the patient no longer benefits from the life-sustaining treatment.”
The order provides for the creation of two-tiered medical boards:
• Primary Medical Board: This board will be established at the hospital level and will review requests for the withdrawal or withholding of life-sustaining treatment based on the patient’s AMD or the family’s request.
• Secondary Medical Board: This will be at the district level and provide an added layer of scrutiny so that the decision is in the best interest of the patient.
The directive Is aimed at all government and private hospitals in Karnataka. The state also introduced a uniform format for the AMD, and people can register their wishes to be treated accordingly in future cases.
It would be a good precedent for the other states of India to emulate. The Karnataka government has given recognition to individual autonomy in making medical decisions through the implementation of the directive of the Supreme Court.
This move by the Karnataka government is a reaffirmation of the state’s commitment to progressive, humane, and equitable healthcare policies. It has placed itself at the forefront of ethical medical practices in India through the rights given to patients regarding informed decisions regarding end-of-life care.
This circular would contribute significantly to the relief of patients and their families from medical suffering; it would relieve them of protracted medical suffering while allowing respect for personal autonomy and dignity in healthcare decisions.
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