Days after the Karnataka government issued a circular granting terminally ill patients the legal right to end their suffering, a significant debate has erupted among medical professionals and legal experts. While some support the move as a compassionate step towards patient autonomy, others contend that India lacks a comprehensive legal framework to regulate such decisions.
Notably, 85-year-old retired government school teacher HB Karibasamma stands on the verge of making history as Karnataka’s first beneficiary under the ‘right to die with dignity’ policy. Her case is the culmination of decades-long advocacy for the legalisation of passive euthanasia in India.
Though the Supreme Court legalised passive euthanasia in 2018 through the Common Cause vs Union of India ruling, Karnataka’s move formalises its implementation by establishing a structured framework for patients and medical practitioners. It is only now that Karnataka has decided to implement the right to die with dignity, with this key clarification from the state Health and Family Welfare Minister, Dinesh Gundu Rao, that the decision is not to be confused with euthanasia and “is applicable only to those who are on life support and non-responding to life-sustaining treatment.”
However, the policy has still triggered a national debate. Critics argue that while the framework provides clarity, there remain significant ethical concerns about the possibility of misuse, pressure on families, and gaps in medical decision-making. Others question whether the distinction between passive euthanasia and the withdrawal of life support is clear enough in practice. Additionally, without stringent oversight, there are fears that economic factors might influence end-of-life decisions.
For over three decades, Karibasamma has endured the debilitating effects of a slipped disc and was recently diagnosed with cancer. Over the past 24 years, she has relentlessly campaigned for the legal right to die with dignity, addressing her appeals to the Chief Minister, Prime Minister, President, and even the Supreme Court. Her unwavering determination has played a crucial role in shaping the evolving discourse on end-of-life choices in India.
Medical practitioners’ divided opinions
The medical community remains sharply divided on the issue. While some physicians see the ruling as a compassionate measure to alleviate terminal suffering, others argue that human life must be preserved through natural means.
Dr Ritu Saxena, Deputy Medical Superintendent and Chief Medical Officer at Lok Nayak Hospital (LNH), views euthanasia as a justified option in cases where advanced medicine and technology fail to provide a cure. However, she emphasises the necessity of a specialised review committee to ensure that economic hardship does not influence euthanasia
“For instance, if a stage-four cancer patient cannot afford treatment and requests euthanasia out of financial desperation, the committee should intervene to provide medical support rather than grant euthanasia,” Dr Saxena explained.
She further clarified that euthanasia should only be considered for patients suffering from irreversible conditions with no prospect of recovery. Citing Karibasamma’s case, Dr Saxena stressed that euthanasia, when properly regulated, can offer a dignified exit to terminally ill patients.
“Euthanasia should be legal across all states but must be strictly supervised by a specialised medical committee. This committee should thoroughly assess the patient’s condition and all relevant factors before granting permission,” she added.
Dr Praveen Gupta, Principal Director & Chief of Neurology at Fortis Hospital, remarked, “Euthanasia is a practice that allows for the termination of life in patients who are suffering and hopelessly ill, with no chance of recovery. I believe we should establish a system where a dedicated board determines the irreversibility of a medical condition or the lack of improvement in health, as euthanasia could potentially be misused in certain cases.”
“From a practical standpoint, a living will—where a person has already requested euthanasia in case they find themselves in such a condition in the future—could serve as a strong criterion for determining whether they are a candidate for euthanasia,” Dr Gupta added.
Contrarily, Dr Seema Balkrishna Wasnik, Head of the Emergency Department at Ram Manohar Lohia (RML) Hospital, strongly opposed the move, asserting that legislative action should precede any such policy implementation.
“This is a deeply sensitive issue that requires deliberation in Parliament. A proper legal framework should be established through a structured legislative process,” Dr Wasnik argued.
She firmly stated that life should be allowed to take its natural course. “Granting the wish for death is inappropriate in a culturally diverse nation like India. Who gets to decide whether a person should live or die?” she questioned.
Legal perspectives: A unified stand
Legal experts have also weighed in on the matter, presenting a cohesive perspective on the legal and constitutional framework surrounding euthanasia in India.
Advocate Vikas Tomar elucidated the legal position, stating, “In India, the ‘right to die with dignity’ is recognised as the right to refuse life-sustaining medical treatment, thereby permitting passive euthanasia. This principle was affirmed under Article 21 of the Constitution in the landmark Common Cause vs Union of India case (2018). However, active euthanasia, wherein a doctor directly administers lethal medication, remains strictly prohibited.”
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He further explained that the Supreme Court ruling allows terminally ill patients to execute a ‘living will,’ ensuring their right to refuse life-prolonging treatment. “The court interpreted Article 21 to encompass not only the right to life but also the right to a dignified death,” Tomar added.
Ensuring safeguards and preventing misuse
Advocate Nishant Kumar highlighted the potential risks associated with passive euthanasia, including the possibility of coercion, wrongful decisions, and financial exploitation. He emphasised the need for stringent legal oversight and regular audits to ensure transparency.
“Passive euthanasia involves withdrawing treatment rather than directly causing death. Active euthanasia, where death is induced, remains illegal under The Bharatiya Nyaya Sanhita, 2023,” the lawyer said.
“Despite its benefits, there is a risk of misuse. Families or hospitals may exploit the provision for financial gain, and vulnerable patients could be coerced. Medical assessments must be thorough, with legal oversight to prevent errors,” cautioned Kumar, who practices at the Supreme Court of India.
“This step upholds patient autonomy while implementing safeguards against abuse. However, a comprehensive national framework is essential to bring uniformity to passive euthanasia laws across states,” Kumar added.
As Karnataka pioneers this policy, its impact on terminally ill patients and the broader national discourse on euthanasia remains to be seen
