The Debate on Euthanasia – Explained Pointwise

The Supreme Court of India has recently permitted the withdrawal of life-sustaining treatment for a 32-year old Harish Rana, who has been in a vegetative state since 2013. This is the first ever Indian court order approving passive euthanasia.

Table of Content

What is Euthanasia? What is the Status of Euthanasia in India? What is the Judicial View regarding Euthanasia? What are the arguments in favour of Euthanasia? What are the arguments against Euthanasia?

What is Euthanasia?

• Euthanasia, often referred to as “mercy killing,” is the practice of intentionally ending a person’s life to relieve pain and suffering, typically in the case of a terminal illness or an incurable, distressing condition.
• The term is derived from the Greek words eu (good) and thanatos (death), literally meaning a “good death.”
• Based on the method used – euthanasia can be of 2 types:
  

  Active Euthanasia	Passive Euthanasia
  This involves taking a direct action to cause the patient’s death. A doctor or another person does something specific, such as administering a lethal injection of drugs.	This involves allowing a person to die by withholding or withdrawing life-sustaining treatments. Examples include: Turning off a ventilator (life support). Not performing life-saving surgery. Stopping or not starting feeding tubes or hydration. Withholding medications that are necessary to prolong life.
  Active Euthanasia is Illegal: Administering a substance to cause death remains a criminal offense in India.	Passive Euthanasia is Legal: The Supreme Court of India legalized passive euthanasia under “exceptional circumstances,” recognizing the “Right to Die with Dignity” as part of the Right to Life under Article 21 of the Constitution.

Understanding Key Terms: Physician Assisted Suicide (PAS): PAS, sometimes called as aid-in-dying, is a semi-passive method of euthanasia in which a medical practitioner prescribes or introduces the appropriate amount of lethal dose to end life at the patient’s request. Permanent Vegetative State (PVS): It is a state in which a patient is unable to sustain himself or herself and requires the assistance of one or more life support systems or even other people to perform basic human functions. Terminal disease: It refers to a medically confirmed incurable and irreversible sickness or condition that will, within reasonable medical judgement, result in death. Advanced medical directive: It is also known as a ‘living will,’ and it is a direction issued by a person who wishes to avoid receiving extraordinary medical care if he or she is diagnosed with a fatal illness. To be legal, such a direction must be voluntary, competent, and given in advance.

 

What is the Status of Euthanasia in India?

• Active Euthanasia (Illegal): Taking a direct action to end a life remains a criminal offense under the Bharatiya Nyaya Sanhita (BNS), 2023, and can be classified as culpable homicide or murder.
  Passive Euthanasia (Legal): The withdrawal or withholding of life-sustaining treatment for terminally ill patients or those in a Persistent Vegetative State (PVS) is legal. This is recognized as a fundamental right under Article 21 (Right to Die with Dignity).
  
• Procedural Framework:
  1. Primary Medical Board: A board of at least three doctors at the treating hospital must certify that the patient has no hope of recovery.
  2. Secondary Medical Board: A second board, including an external expert nominee, must concur with the primary board’s findings.
  3. Judicial Oversight: The hospital must intimate a Judicial Magistrate (First Class) of the decision.
  4. Living Wills: Individuals can now pre-register an Advance Medical Directive (Living Will) via a notary or gazetted officer, which is stored in digital health records (ABHA). This document instructs doctors on when to stop treatment if the person becomes incompetent.

 

What is the Judicial View regarding Euthanasia?

P. Rathinam v. Union of India (1994)	The Supreme Court ruled that Section 309 (Attempt to Suicide) of the Indian Penal Code, 1860 is violative of Article 21 of the Indian Constitution. The Court stated that Section 309 of the Penal Code should be repealed in order to make our penal rules more humane.
Gian Kaur v. The State of Punjab (1996)	Article 21, which deals with the ‘right to life,’ was deemed to exclude the ‘right to die.’ The constitutionality of Sections 306 (Abetment to Suicide) and 309 of the 1860 Code was confirmed.
Aruna Ramchandra Shanbaug v. Union of India (2011)	It was recognized that the patient (Aruna Shanbaug) was no longer a living person and her life was devoid of any human element. The Supreme Court directed a team of three doctors to submit a report to them after assessing the mental and physical conditions of the patient. Accordingly, passive euthanasia was permitted for the first time in the history of India. The Supreme Court also laid down the guidelines for the grant of permission for passive euthanasia.
Common Cause v. Union of India (2018)	The Supreme Court ruled that under Article 21 of the Indian Constitution, an individual has the right to die with dignity as part of his or her right to life and personal liberty. An adult of competent mental capacity is entitled to make an informed decision and has a right to refuse medical treatment including withdrawal from life-saving devices. As a result of this judgement, life-support systems for the terminally ill or those in incurable comas can be removed. The Court also recognised the importance of writing a living will (Advanced Medical Directive) and allowed people to opt out of artificial life support.
Chandrakant Narayanrao Tandale v. State of Maharashtra (2020)	Active euthanasia is a form of euthanasia that is illegal. The Court expressed sympathy towards the petitioner in this case but his petition of active euthanasia was not allowed.
Harish Rana Case (2026)	The Supreme Court bench passed the first judicial order specifically allowing the withdrawal of life support under the guidelines established in the Common Cause (2018) judgment. The Court ruled that Clinically Administered Nutrition and Hydration (CANH)—the feeding tubes keeping him alive—constitutes “medical treatment” rather than basic care. Therefore, it can be legally withdrawn if it serves no therapeutic purpose and only prolongs biological existence without hope of recovery.

 

What are the arguments in favour of Euthanasia?

1. Right to Self-Determination (Autonomy):
   • Individuals should have the fundamental right to decide what happens to their own bodies.
   • A person facing terminal illness or unbearable suffering should be free to choose the manner and timing of their death.
   • Denying this choice is seen as a violation of personal liberty and human dignity.
   • Just as people have the right to refuse medical treatment, they should have the right to end their life on their own terms.
2. Relief from Unbearable Suffering:
   • For patients suffering from terminal illnesses with no hope of recovery, life can become an unrelenting experience of pain, indignity, and distress.
   • Euthanasia offers a compassionate way to end suffering that cannot be adequately controlled even with palliative care.
   • Prolonging life artificially in such cases may only extend agony rather than provide meaningful existence.
3. Human Dignity:
   • Every person deserves to die with dignity, rather than in a state of complete dependence, pain, or loss of bodily functions.
   • Euthanasia allows individuals to end their lives while they still retain a sense of self and personal identity.
   • A dignified death is considered by many as the final expression of a life lived with self-respect.
4. Compassion and Mercy:
   • Allowing a loved one or patient to suffer needlessly when a painless death is possible is seen by many as cruel and uncompassionate.
   • Euthanasia, from the Greek meaning “good death,” is fundamentally rooted in the idea of showing mercy.
   • Doctors and caregivers who support euthanasia argue that true compassion sometimes means helping end suffering, not merely prolonging biological life.
5. Reducing the Burden on Families:
   • Terminal illness can place enormous emotional, physical, and financial strain on families and caregivers.
   • Prolonged end-of-life care can lead to “catastrophic healthcare spending,” often pushing families into deep poverty for treatment that offers no hope of a cure.
   • Euthanasia can spare families the prolonged anguish of anticipatory grief and caregiving exhaustion.
6. Overburdened Healthcare Systems:
   • In countries with strained public healthcare resources like India, keeping terminally ill patients on life support indefinitely consumes enormous resources that could benefit others.
   • Voluntary euthanasia could, in some cases, free up resources for patients who genuinely want and can benefit from continued care.
7. Precedent from Countries Where It Works:
   • The Netherlands, Belgium, Canada, Switzerland, and several other countries have legalized forms of euthanasia or assisted dying with strict regulatory frameworks.
   • Evidence from these countries suggests that with proper safeguards — multiple doctor approvals, psychological evaluation, waiting periods — abuse can be minimized.
   • These systems demonstrate that euthanasia can be administered responsibly within a well-designed legal and medical framework.

 

What are the arguments against Euthanasia?

1. Sanctity of Life:
   • Most religious and many secular traditions hold that human life is sacred and inherently valuable, regardless of its quality or condition.
   • Life is considered a gift — from God in religious traditions, or as an intrinsic good in secular philosophy — that should not be deliberately ended.
   • Deliberately taking a human life, even with consent, is seen as a fundamental violation of the sanctity of human existence.
2. The Slippery Slope Danger:
   • One of the most powerful arguments against euthanasia is the fear of a slippery slope — that once legalized for extreme cases, it will gradually expand to cover broader and more questionable situations.
   • Evidence from Belgium and the Netherlands shows that euthanasia has progressively extended to psychiatric patients, elderly people tired of life, and even children — far beyond the original terminal illness framework.
   • What begins as a safeguarded exception can, over time, become routine practice, eroding the moral boundaries protecting vulnerable lives.
   • Once society accepts intentional killing as a solution to suffering, the threshold for what constitutes “unbearable suffering” may keep lowering.
3. Risk of Abuse and Coercion:
   • Vulnerable patients — the elderly, disabled, mentally ill, or economically disadvantaged — may feel subtle or overt pressure to choose death.
   • Family members burdened by caregiving responsibilities, or motivated by inheritance, could consciously or unconsciously influence a patient’s decision.
   • In healthcare systems under financial strain, patients may feel they are a burden and choose euthanasia not out of genuine desire but out of guilt.
   • Truly voluntary, fully informed, and completely free consent is extremely difficult to verify, making the system inherently susceptible to exploitation.
4. Medical Ethics and the Hippocratic Tradition:
   • The foundational principle of medical ethics is “do no harm” — and deliberately ending a patient’s life directly contradicts this principle.
   • The Hippocratic Oath, followed for centuries, explicitly prohibits physicians from administering lethal substances.
   • Allowing doctors to kill patients fundamentally alters the nature of the doctor-patient relationship, potentially eroding trust.
   • Patients, especially vulnerable ones, may fear seeking medical care if they believe doctors have the power and willingness to end their lives.
5. Palliative Care as a Better Alternative:
   • Opponents argue that the solution to suffering is not death, but better palliative and hospice care.
   • Modern pain management, psychological support, and holistic end-of-life care can effectively address most forms of physical and emotional suffering.
   • Many calls for euthanasia arise not from irreversible suffering but from inadequate access to quality palliative care.
   • Instead of investing in euthanasia frameworks, societies should invest in expanding and improving end-of-life care for all patients.
6. Devaluation of Disabled and Elderly Lives:
   • Permitting euthanasia sends a harmful societal message — that some lives are not worth living, particularly those of the disabled, chronically ill, or elderly.
   • This can reinforce existing prejudices and stigmas against people with disabilities or degenerative conditions.
   • Disabled rights advocates strongly oppose euthanasia, arguing that the desire to die among disabled people often stems from social isolation, inadequate support, and discrimination — not the disability itself.
   • A just society should respond to suffering by improving support systems, not by facilitating death.
7. Religious and Moral Objections:
   • Major world religions — Christianity, Islam, Hinduism, Judaism, and Buddhism — broadly oppose euthanasia on moral and theological grounds.
   • Suffering, in many religious traditions, is viewed as having spiritual meaning and value — as an opportunity for growth, redemption, or karmic resolution.
   • Taking one’s life or assisting in doing so is considered a sin or moral transgression in most faith traditions.
   • In pluralistic societies, laws must take into account the deeply held moral convictions of large sections of the population.
8. Legal and Safeguard Failures:
   • No matter how carefully crafted, legal safeguards around euthanasia are difficult to enforce in practice.
   • Determining whether consent is truly voluntary, whether suffering is truly unbearable, and whether all alternatives have been exhausted involves inherently subjective judgments.
   • Regulatory oversight of euthanasia cases in countries where it is legal has repeatedly been found to be inconsistent and inadequate.
   • The irreversible nature of euthanasia means that any failure in the system results in the unjustifiable taking of a human life.
9. Societal and Cultural Shift:
   • Widespread acceptance of euthanasia risks normalizing death as a solution to difficulty, suffering, or social burden.
   • It could gradually shift cultural attitudes toward life — particularly vulnerable life — in dangerous directions.
   • A society that embraces euthanasia may become less motivated to invest in care, research, and support systems for its most vulnerable members.
   • Opponents argue that true civilizational progress lies in how well we care for the suffering, not in how efficiently we end their lives.

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