Introduction and definitions:
Sir Francis Bacon , an English Philosopher and Statesman coined the term Euthanasia in the 17th century. He used this term to describe the physician's responsibility to alleviate suffering and guarantee a peaceful death for patients. The word 'euthanasia' is derived from the Greek word 'eu' meaning good or well and 'thanatos' meaning death, which literally means ' good death' or ' easy death'.

Ancient philosophers like Plato and Seneca discussed the idea of a good death and has been debated since ancient times in various cultures. The meaning of euthanasia has evolved over time and initially it referred to a natural, painless death. While today it refers to an intentional act of ending a life to relieve suffering, either through active or passive means. Active euthanasia means directly causing the patent's death, example administering a lethal injection.

Passive euthanasia means withholding or withdrawing life-sustaining treatment, example removing a ventilator. PAS means physician assisted suicide where a doctor provides the means but the patient takes them independently. Active Euthanasia and PAS are considered illegal in India whereas passive euthanasia is considered legal since the Supreme Court ruling in 2018.

Legalizations and Study Report

• The road to legalization started with the Gian Kaur v. State of Punjab (1996), where the Supreme Court stated 'the right to die is not a fundamental right,' rejecting the petitioner's argument, ruling that the right to life does not include the right to die. It held that suicide and euthanasia are not constitutionally protected, making any form of assisted dying illegal.
  
• In the year (2011) in Aruna Shanbaug v. Union of India, India saw the very first legal recognition of passive euthanasia. Aruna, a nurse in Mumbai, had been in a persistent vegetative state (PVS) for almost 37 years after an unfortunate incident of a brutal assault. The petition filed to allow passive euthanasia (withdrawal of life support). Here the Supreme Court allowed passive euthanasia under strict conditions with High Court approval. 'Right to die with dignity' was recognized under Article 21. Although active euthanasia was still considered illegal.
  
• Common Cause v. Union of India (2018), legalized passive euthanasia and living wills after a Public Interest Litigation (PIL) was filed for terminally ill patients. The Supreme Court fully legalized passive euthanasia for terminally ill patients as well as allowed individuals to make advance directives for their end-of-life treatment preferences. This ruling eliminated the need for case-by-case High Court approval, making passive euthanasia more accessible and establishing legal recognition of living wills, which ultimately empowered patients to make future medical decisions. However, the approval process still requires multiple medical boards, judicial oversight, and family consent, leading to delays. Doctors and families still hesitate to withdraw life support due to fear of legal consequences, as there are no clear protections for doctors who follow a patient's living will. The Supreme Court set strict conditions for advance directives, making them difficult to draft and enforce.
  
• Active Euthanasia is legal in some countries like the Netherlands, Belgium, Canada, and some parts of the US. If passive euthanasia is legalized, allowing the patient to die with dignity, why must a suffering patient wait for natural death? Active euthanasia provides a more humane option than withdrawing life support. The immense pain the terminally ill patient endures despite palliative care makes active euthanasia a peaceful alternative. Prolonging life through artificial means is emotionally and financially draining for families, and keeping a patient who would rather choose active euthanasia but is on life support increases hospital costs without improving quality of life. Misuse of active euthanasia is a problem, but it can be regulated with the help of strict laws like in Canada, the Netherlands, and Belgium.
  
• As stated in Assisted Dying and Voluntary Euthanasia: Exploring Healthcare Professionals' Perceptions in a Tertiary Care Setting in South India, a research was conducted in May-June 2024 with the objective to explore the perceptions of doctors and nurses about performing assisted dying and voluntary euthanasia. The research explores arguments for and against euthanasia, highlighting the need for a balanced approach: first simplifying passive euthanasia, second improving access to palliative care, and then considering active euthanasia along with strict laws. It also examines the ethical and cultural perspectives of legalizing euthanasia.
  

Ethical and Cultural Perspectives:

Pro Euthanasia Ethics

• Right to die with dignity is an individual right — the right to make decisions about one's own body and life, which includes the right to die. If a person is suffering from a terminal illness, they should have the option to choose a dignified death instead of years of suffering.
• Reduces burden on families and the healthcare system.
• Active euthanasia also holds ethical consistency with passive euthanasia, as its outcome is similar, though critics argue that the methods differ.
  

Anti-Euthanasia Ethics

• The Declaration of Geneva, a version of the Hippocratic Oath prescribed by the Medical Council of India (MCI), emphasizes respect for human life, professional independence, and patient-centered care. Therefore, a doctor's duty is to preserve life, not end it.
• The risk of misuse or coercion exists toward vulnerable patients, who may be pressured by hospitals or families to choose death.
• Legalizing active euthanasia could lead to abuse beyond terminally ill patients, including people with mental illnesses and elderly people who feel like a burden.

Therefore, a step toward betterment would be to invest in improving palliative care.

Religious Views
India is a diverse country which has people from multiple religions, and most believe only god has the right to take life, however some religions have subtle differences. So lets understand it. In Hinduism it is mostly opposed because they believe in karma and the cycle of birth and rebirth, therefore ending a life unnaturally would disrupt the cycle as well as Manusmriti and Bhagavad Gita emphasize that suffering is a natural part of life and should be endured rather than escaped.

However in certain sects like Jainism, voluntary fasting to death is practiced which show that some forms of end of life choices did exist in the Indian tradition since the start. Therefore we can conclude euthanasia and its forms are mostly opposed but have some exceptions.

In Islam , life is viewed as a precious gift by Allah and only he has the authority to end it. In their holy book Quaran , it is mentioned that one should not take their own life. It is mentioned in Surah 4:29, therefore even passive euthanasia that is legal in India is controversial in Islamic teachings. In Christianity , suffering is supposed to have spiritual values and life must be preserved as long as possible.

Their holy book Bible states in Exodus 20:13 ' Thou shalt not kill ', which can be interpreted as opposing Euthanasia. Catholic teachings also emphasize palliative care over euthanasia. In Buddhism there is a division of opinion as they teach compassion and non-violence but also emphasizes karma and taking life can have spiritual consequences.

Comparative Analysis:

Let us compare the laws and acceptance of Passive and Active Euthanasia and PAS of India with other countries.

• India vs Liberal Countries (Netherlands, Belgium, Canada)
  India only allows passive euthanasia and strictly controls it through court and medical oversight. The above liberal countries allow Active Euthanasia and Physician-Assisted Suicide with clear, detailed laws and protections. These countries prioritize patient autonomy over traditional or religious objections.
  
• India vs Countries allowing only PAS (Switzerland, United States)
  India prohibits PAS, which is the patient taking prescribed lethal medication. However, Switzerland and the United States allow PAS but not direct active euthanasia (doctor-administered death). They allow patients to control the manner and timing of death.
  
• India vs Conservative Countries (United Kingdom)
  India has legalized Passive Euthanasia, although the process is lengthy and complicated. In the UK, Active Euthanasia and PAS are both illegal, but withdrawing life support is legal and accepted under informed consent. Therefore, both the UK and India share a more traditional and cautious approach by respecting life preservation and ethical concerns.

India is therefore moderately progressive if compared with certain countries but more conservative if compared with the Netherlands, Belgium, and Canada. The legalization of Passive Euthanasia can be seen as a major shift forward after the 2018 judgment.

Challenges, Loopholes, and Recommendations for Reforms:

While the 2018 Supreme Court ruling allowing passive euthanasia was a major step forward, there are still practical problems with how euthanasia is handled in India today. A closer look shows that the system is very slow, confusing, and not very accessible for ordinary people, and that some important legal safeguards are still missing.

Challenges

• Bureaucratic delays: One of the biggest issues is how complicated the whole process is. Right now, passive euthanasia requires approvals from multiple medical boards and sometimes even the courts. This can lead to serious delays, which can be extremely painful for patients and families who are already in distress.
• Lack of awareness: Even though passive euthanasia and living wills are legally recognized, most people and even many doctors aren't really aware of how the process works. Many hospitals don't have clear guidelines, making it even harder for families to know what to do.
• Doctors' fear of legal trouble: Doctors often hesitate to withdraw life support, even when it's legally allowed, because they're scared of being accused of murder or negligence later on. There's not enough legal protection for healthcare workers who act in good faith according to a patient's wishes.
• Complicated process for Living Wills: Although living wills are legally valid, the rules for making one are really strict, requiring multiple witnesses, notarization, and even approval from a Judicial Magistrate. Because of all this, very few people actually manage to register a living will.
• Risk of misuse: There's always a danger that vulnerable people like the elderly or the disabled might be pushed into agreeing to euthanasia by family members who are thinking about money or inheritance. Without very tight controls, the system could be abused.
  

Loopholes in the Current Law

• There is no clear, uniform national policy on euthanasia procedures, so different hospitals and states handle cases differently.
• Doctors don't have strong legal immunity, which discourages them from honoring living wills.
• If there is a dispute between family members about withdrawing life support, there is no fast and simple system to resolve it quickly.
• Patients with chronic, unbearable but non-terminal conditions aren't clearly covered under the current rules, leaving a lot of grey areas.

Recommendations for Improvement
Instead of relying only on Supreme Court guidelines, Parliament should pass a proper law on euthanasia. This would give clear rules, protect patients and doctors, and ensure consistency across the country.

The procedure for making a living will should be made much easier. Ideally, it should be possible to register a living will online through a government portal without having to go through complicated court processes.

Doctors who act in good faith based on a patient's living will (or following the law on euthanasia) should have strong legal protection. This would encourage more doctors to help without fear.

There should be special medical boards and High Court benches that deal only with euthanasia cases and they should have to give decisions quickly, ideally within a few weeks. This would prevent unnecessary suffering caused by legal delays.

Alongside changes to euthanasia laws, India needs to invest much more in hospice care and pain management services. Good palliative care can often reduce the need for euthanasia altogether by making the patient's final days more comfortable.

The government should also launch public awareness campaigns explaining how euthanasia laws work, how to make a living will, and what patients' rights are at the end of life.

Conclusion
Euthanasia remains one of the most sensitive and deeply emotional topics in India today. While the Supreme Court's decision in 2018 was a big step forward, allowing passive euthanasia and recognizing the right to die with dignity, the path ahead is still filled with challenges. The reality is that the process remains too slow, complicated, and scary for most families and doctors.

If we truly want to respect the dignity of those who are suffering, we need to do more than just legalize we need to make the system kinder, simpler, and more accessible. Passing a clear law, protecting doctors, speeding up approvals, and spreading awareness can help ensure that no one has to fight unnecessary battles at the end of their life.

At the same time, India must remember its roots, balancing compassion with caution, and making sure vulnerable people are protected from harm. Improving palliative care and hospice services will also make a huge difference, offering patients comfort whether or not they choose euthanasia.

Dignity in death is just as important as dignity in life. It's time India moves forward with both courage and care, giving people not just the right to live well, but also the right to leave peacefully when their suffering becomes too much to bear.

References:

• https://pmc.ncbi.nlm.nih.gov/articles/PMC10006483/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3440914/
• https://journals.lww.com/pmrr/fulltext/2024/01030/assisted_dying_and_voluntary_euthanasia__exploring.3.aspx

Written By: Leena Akhariya