Withdrawing life-supporting care: The procedure and the hurdles

Source: The post “Withdrawing life-supporting care: The procedure and the hurdles” has been created, based on “Withdrawing life-supporting care: The procedure and the hurdles” published in “Indian Express” on  12th March 2026.

UPSC Syllabus: GS Paper-3– Science and technology

Context: Euthanasia refers to the practice of intentionally ending or allowing the end of a person’s life in order to relieve suffering caused by a terminal or incurable illness. In India, active euthanasia is illegal, but passive euthanasia has been permitted by the Supreme Court under strict safeguards, recognising the right to die with dignity as part of Article 21 of the Constitution. Important judicial developments include the judgments in Aruna Shanbaug Case and Common Cause vs Union of India, which laid down guidelines for passive euthanasia and living wills.

Types of Euthanasia

I. Active Euthanasia

1. Active euthanasia refers to the deliberate act of ending a patient’s life through measures such as administering a lethal injection or drug.
2. This form of euthanasia is illegal in India because it involves directly causing the death of a patient.
3. However, active euthanasia is legal in some countries such as the United States, Canada, Australia, and parts of Europe under specific regulations.

II. Passive Euthanasia

1. Passive euthanasia refers to allowing a patient to die naturally by withholding or withdrawing life-sustaining medical treatment.
2. It involves stopping treatments that artificially prolong life when there is no reasonable hope of recovery.
3. Such treatments may include ventilator support, cardiopulmonary resuscitation, dialysis, chemotherapy, radiotherapy, or artificial nutrition.

Procedure for Passive Euthanasia in India

1. Assessment by the Treating Physician

1. The process begins when the treating physician assesses whether the patient has any realistic possibility of recovery or meaningful quality of life.
2. The physician evaluates the medical condition and determines whether continuing treatment would only prolong suffering.

2. Review by the Primary Medical Board

1. A Primary Medical Board is constituted in the hospital to examine the case.
2. The board consists of the treating physician and two subject experts with at least five years of experience.
3. The board reviews the patient’s condition and discusses the prognosis with the patient’s family members.
4. After consultation, the board and the family attempt to reach a shared decision regarding the withdrawal or continuation of treatment.

3. Review by the Secondary Medical Board

1. If the decision is made to withdraw life-sustaining treatment, the case is referred to a Secondary Medical Board.
2. This board consists of a doctor nominated by the district Chief Medical Officer and two subject experts with at least five years of experience.
3. The secondary board is required to review the case and make a decision within 48 hours.

4. Informing the Magistrate

1. After approval by the secondary medical board, the hospital must inform the jurisdictional magistrate before withdrawing life-supporting treatment.
2. The magistrate’s approval is not mandatory, but the information must be formally communicated.

Role of Living Will

1. A living will is a legal document through which a person can express their wishes regarding medical treatment in advance.
2. It becomes applicable when the person loses the capacity to make decisions due to illness or incapacity.
3. Through a living will, individuals can specify whether they want life-supporting treatments to be continued or withdrawn.
4. The document also allows a patient to nominate a trusted person who can take medical decisions on their behalf.

Key Hurdles in Implementation

1. Lack of Medical Expertise: Many hospitals, especially in smaller towns, do not have enough experienced specialists to form the required medical boards.
2. Delay in Formation of Secondary Boards: The process requires a list of nominated doctors from the district Chief Medical Officer, but many states have not yet prepared such lists.
3. Administrative and Procedural Complexity: The requirement of multiple boards and formal procedures often makes the process slow and difficult to implement in practice.
4. Fear of Legal Consequences: Many private hospitals hesitate to withdraw life-supporting treatment because they fear litigation and legal complications.
5. Emotional and Ethical Concerns: Families often experience emotional distress and guilt while taking decisions related to withdrawing life-sustaining treatment.

Way Forward

1. The government should enact a clear law on euthanasia to replace reliance on judicial guidelines.
2. States should prepare lists of qualified doctors for secondary medical boards to ensure timely decisions.
3. Hospitals should strengthen palliative care and ethics committees to guide end-of-life decisions.
4. Awareness about living wills should be increased to respect patient autonomy.
5. Legal protection for doctors acting in good faith should be ensured to reduce fear of litigation.

Conclusion: Passive euthanasia in India attempts to balance patient autonomy, medical ethics, and legal safeguards. Although the Supreme Court has provided a framework to ensure the right to die with dignity, effective implementation requires better awareness, institutional preparedness, and simplification of procedures.

Question: Explain the concept of euthanasia and discuss the procedure and challenges in implementing passive euthanasia in India.

Source: Indian Express