The Law Blog

_{Asmit Kumar Singh is a 4th year student of BA LL.B at National Law University Odisha. He can be reached at 22ba024@nluo.ac.in.}

On 30^th of January, 2025, Karnataka officially issued its permission through a circular for permitting ill patients beyond the irrecoverable stage, and have the option for passive euthanasia. This move officially followed the guidelines of the Supreme Court in 2023. It became the first state to issue and provide its direction, and it has been reaffirmed as a fundamental right under Article 21 of the Constitution of India. It reflects as a transformative step, while it’s still debatable in other parts of the state of India upon its legitimization. The medical term that defines intervention to assist death is known as medical euthanasia. This procedure is quite debatable and illustrates different viewpoints from the moral standpoints, and legitimacy to allow for uniformity. This process is quite complex due to vague guidelines and criteria for such medical assistance to death. The person’s right to die has also been associated with euthanasia. In this blog, the analysis of the Indian jurisprudence compared with the Netherlands on how to legitimise the purpose of such treatment.

Persisting Challenges and Issues in Euthanasia Implementation

The breakthrough development surrounding the term “assisted suicide”, which created a groundbreaking norm against the morality of the society, alongside maintaining the current balance by addressing the right to die under Article 21 of the COI, which protects the personal autonomy choices of the person. The legalization of such challenges is perceived differently in different states, which makes it difficult due to the moral and religious beliefs of individuals in contrast to persons who are beyond recovery, pleading for death to be relieved from their sufferings. The major issues it faced is improper legislation of laws and procedure, existing acts with amendment failed to highlight the current legal scenario in demands to such passive euthanasia, recognition of right to deal under article 21 of the constitution of India, as it embody such rights of the individual and their autonomy, and there is a risk of enforcement due to vague guidelines on whom to applicable or not as it required specific requirement of law to be applicable. The main ingredient is whether there is a valid consent, depending on the circumstances in which it has been made, through orally or by directives. The analysis of another country to understand and their legal takeaways need to be implemented in the existing policies and legal framework to address them.

Key Decision Concerning This Issue

In the aforesaid judgment of Aruna Ramchandran Shanbaug v. Union of India on 7^th of March, 2011 legalized the passive euthanasia in India under strict judicial and medical guidelines. The court laid down the requirement for guidelines to be approved by the high courts, based upon medical boards, recommendations of secondary medical boards, and a three-level field expert committee. This transformative judgment led to development, established procedure, and strictly disallowed illegal active euthanasia and issued its order to have a proper framework to legalise passive euthanasia. The word “passive euthanasia” signifies intervention upon the treatment of an ill person supported with medical equipment by withholding or withdrawing life-sustaining medical treatment to allow the person to die.

The expansion of the legality of the right to die enshrined under Article 21 of the Constitution of India as part of the guarantee to the right to life was started and laid the foundation for the new concepts under the judgment of Common Cause v. Union of India, 2018. It recognized how the living wills or advance medical directives (ADs) allow patients suffering from terminal illness or in vegetative states to consent in advance for passive euthanasia. From above, the judgments lack implementation at the state level.

Ambit of Consent and Legal Responsibilities of Doctors in Euthanasia

The laws aren’t fixed and are non-uniform across various states of India. However, the passive euthanasia treatment requires consent to use it. The term consent is vague and its lack proper definition defined under the mental Health Care Act under section 2 (j), which states that, “informed consent” means consent given for a specific intervention, without any force, undue influence, fraud, threat, mistake or misrepresentation, and obtained after disclosing to a person adequate information including risks and benefits of, and alternatives to, the specific intervention in a language and manner understood by the person;” it didn’t included the possibility of other interpretation of ill patients, patients in vegetative states, etc. The lack of collecting data and its morality based upon religion, customs which has been followed since time immemorial. The lack of interpretation and case study led to stagnant growth as opposed to other developed nations such as Switzerland, the Netherlands, Colombia, etc. The developed nation had taken the initiative for its research and its legal complexities in addressing it.

The existing customs followed by every physician or doctor under the Code of Medical Ethics Regulation, 2002, and are obligated to respect these rules while providing services to ill and sick persons. The main issue in addressing such involvements of doctors or physicians involved in such treatments as it is viewed as committing a crime, and against their oath. In contrast to the doctors’ code of conduct vs the right to life, the ethics code of doctors be responsible and obligated towards the patients and treat them with empathy. However, it became quite debatable violation of the doctor’s code related to assisted suicide. The Supreme Court has ruled in Common Cause v. Union of India that, without clear instigation or encouragement, a conviction under Section 108 BNS cannot be sustained. This means that unless a doctor actively encourages or aids a patient in committing suicide, they may not be held liable under this section. However, the legal framework remains strict, and any direct involvement in active euthanasia could lead to criminal charges. As a result, the involvement of doctors is complex in addressing it, and without any clear justification to they can’t be involved in it under this section.

Comparison with the Legal Framework and Euthanasia Regulations in the Netherlands

In comparison with other developed jurisdictions like the Netherlands. Comparing it with the Netherlands, as it is the first country to legalize assisted suicide and permit a physician to provide assisted dying to a patient whose suffering the physician assessed as unbearable. In 2002, the first Dutch euthanasia act came, and this Act was developed in the context of searching for the proper balance between unbearable suffering for the patient, and the government’s duty to protect the lives of individual citizens. The Netherlands has developed in this aspect and extended whether healthy people or senior citizens are given the option to end their lives. They are exercising their right to die as they have fulfilled their completed life. The Netherlands remains focused on the question of whether the Dutch government should allow legal support for self-determination, that is, increased patient autonomy within the Euthanasia Act and its practice.

In the case of Albert Heringa, Albert Heringa, son of Mary Heringa, he requested her to consult her GP (General Physician) to end her life due to a diagnosis of heart failure, chronic kidney disease, osteoporosis, and macular degeneration. The GP resisted it, and she requested her son to end her life. The son decided the end her mother’s life by doses of poison. Albert Heringa was convicted in 2010 of violating the prohibition of assisted suicide. As a result, the son was prosecuted and the court, looking at the intention of the accused, reduced the term of sentence to 3 years. This analysis underlies how the Albert Heringa case (with its plea for more self-determination and patient autonomy) in the Netherlands challenges both the validity and sustainability of the Dutch Euthanasia Act.

In the Netherlands, physician-assisted death is only allowed under the condition of due care. This particular article is a margin of appreciation which is used by the Dutch government “to prevent misuse of assistance with suicide and to protect incapacitated and vulnerable persons.”

Critical Analysis of both the jurisprudence of the Netherlands and India

The major takeaways are to have legislation on this specialization of such to be handled delicately to address the legal issues concerning about violation of the right to life. The developed jurisdiction, like the Netherlands, solely focuses on private consumption and protects it. As a result, the laws are framed to express the rights of the individuals in the country. The euthanasia act, which was passed to cohabitate and maintain the relationship between the patient-physician relationship, and any acts outside of it will be heavily influenced in administering such treatments to such people who have completely lived their life or suffering from any irrecoverable disease. The Albert Hiranga judgment showcased the judiciary’s role in maintaining patients’ autonomy on their right to life and respects the choices of the individuals. These statutory due care criteria enable a due care assessment of unbearable suffering by physicians in response to a well-considered request from the patient. Furthermore, with their ruling in the Albert Hiranga case, the Supreme Court states that these statutory due care criteria are not a violation of the right to self-determination as stipulated by art. 8 of the ECHR. As such, the physician–patient relationship is predominantly present in the due care criteria to enable a well-functioning and safe euthanasia practice. Therefore, physicians’ assessment of unbearable suffering cannot be omitted following the “completed life” or “tired of living” request for physician-assisted death.

However, it lacked one aspect regarding religious views presently in India, with various concerns in implementing it. The Indian legal framework under the Mental Health Care Act needs to address the trends of the world to address it, and bring amendments to maintain the right to autonomy of the people to express their rights without any legal intervention of BNS. The religious part of it needs to be implemented as the doctors and the physicians are considered as the Gods. To balance such views, the parliament should frame such laws to legalize passive euthanasia, and legal awareness should be raised about their rights. In response to the legal issues that persisted has been clarified in the judgment of Common Cause v. Union of India clarified the legal guidelines related to the withdrawal of life-sustaining treatment (LST). In addition to this, a circular was issued related to passive euthanasia by the Ministry of Home and Family Welfare. This guideline was aimed at providing a structured framework for healthcare providers regarding end-of-life care. However, these are yet to be implemented, and fewer states have implemented it, while Karnataka became the first to consider it by judicial intervention.

Conclusion

The legalization and effective implementation of passive euthanasia in India shows crucial steps towards maintaining the rights of patient autonomy and the right to die with dignity under Article 21 of the Constitution. When the Karnataka official order circulated in January 2025, it marked with progress of translating Supreme Court guidelines into actionable state policy, addressing the needs of terminally ill patients beyond recovery. However, the present legal framework in India is fragmented and ambiguous across various states, with issues relating to unclear definitions of consent, ethical dilemmas faced by medical professionals, and socio-cultural and religious opposition. On the other hand, the Netherlands would be instructive in having a full-fledged legal regime balancing patient autonomy, physician duties, and protection against misuse, concerning the landmark decisions like Albert Heringa. Legal clarity combined with public awareness and strong safeguards shall provide a compassionate, respectful, and ethically acceptable framework towards end-of-life care in India, in turn ensuring that all patients eligible for dying with dignity do enjoy this right.