Living wills and passive euthanasia: the right to die with dignity
What Indian law allows at the end of life, how to make a living will under the 2023 rules, how medical boards decide, and what Harish Rana (2026) changed.
In short
- Active euthanasia (doing something to end life, such as a lethal injection) is a crime. Passive euthanasia (withdrawing or withholding life support from a patient with no hope of recovery) is lawful if the Supreme Court's safeguards are followed (Common Cause, 2018).
- Any adult of sound mind can write a living will (advance medical directive): sign it before two witnesses and have it attested by a notary or Gazetted Officer. No court visit is needed since the January 2023 order.
- In hospital, two medical boards (primary and secondary) must both agree, each preferably within 48 hours, and the named relative must consent; the hospital then informs the Judicial Magistrate.
- No living will? The same two-board process applies with the family deciding.
- Harish Rana (2026): tube feeding is medical treatment and can be withdrawn; the patient need not be on a ventilator; palliative care must continue to the end.
Modern medicine can keep a body alive for years on machines and feeding tubes, even when there is no hope of recovery. Families are left to make agonising choices in a hospital corridor without knowing what the law allows. Planning ahead spares the people you love that burden. This guide explains what is lawful, how to make a living will, and how decisions are taken for a patient who never made one.
What the law allows and what it does not
Active euthanasia means a positive act to end life. It is not allowed in India. A doctor or relative who does it can be prosecuted for murder or culpable homicide under the Bharatiya Nyaya Sanhita (BNS).
Passive euthanasia means withdrawing or withholding life-sustaining treatment, such as a ventilator or artificial feeding, from a patient who is terminally ill or in a permanent vegetative state with no reasonable chance of recovery, and allowing natural death. This is permitted, with safeguards.
In Aruna Shanbaug v Union of India (2011) the Supreme Court first accepted passive euthanasia in principle. In Common Cause v Union of India (2018) a five-judge bench held that the right to life with dignity under Art 21 includes the right to die with dignity, recognised advance medical directives, and laid down a procedure. That procedure proved so cumbersome that on 24 January 2023 the Court simplified it. There is still no statute; the law rests on these judgments, and the Union Health Ministry has issued draft guidelines for hospitals based on them.
Step by step: making a living will
A living will, or advance medical directive, states that if you become terminally ill or permanently unconscious with no reasonable hope of recovery, you do not want your life prolonged by medical treatment. Under the guidelines as modified in 2023:
- Write it in clear language: when it should apply (for example, terminal illness or a permanent vegetative state certified by doctors), which treatments you refuse (ventilator, dialysis, tube feeding, resuscitation), and that you made it voluntarily and understand its consequences. You must be an adult of sound mind.
- Name one or more guardians or close relatives who will give consent on your behalf when you cannot.
- Sign it before two independent witnesses, preferably not your heirs, and have it attested by a notary or a Gazetted Officer, who records that it was made voluntarily and with understanding.
- Distribute copies: to the persons you named, your family doctor, and your hospital's records; you may also keep it in your digital health record. Tell your family plainly what you have decided.
- Review it every few years. You can change or withdraw it at any time, in writing, following the same formalities.
How the decision is taken in hospital
A living will does not switch anything off by itself. When the treating doctor believes the situation described in the directive has arrived:
- Primary Medical Board. The hospital forms a board of the treating physician and at least two subject experts with at least five years' experience. It examines the patient, confirms the directive is genuine and applicable, and decides whether withdrawal is appropriate, preferably within 48 hours.
- Secondary Medical Board. If the first board agrees, the hospital forms a second board with one registered medical practitioner nominated by the district Chief Medical Officer and at least two subject experts (not on the first board). It reviews and decides, again preferably within 48 hours.
- Consent. The guardian or close relative named in the directive must agree.
- Intimation. The hospital informs the Judicial Magistrate of First Class before treatment is withdrawn.
- If a board refuses or there is a dispute, the family or the hospital can approach the High Court, which may constitute its own board.
No living will? The same two-board process applies, with the family, guardian or next friend giving consent instead of a named person.
What Harish Rana (2026) decided
Harish Rana, a student from Ghaziabad, fell from a building in 2013 at 19 and lay in a permanent vegetative state for over twelve years, fed through a tube and cared for at home by his ageing parents. The Delhi High Court refused their plea in 2024 because he was not on a ventilator. The Supreme Court constituted medical boards, both of which found no chance of recovery, and on 11 March 2026 (Harish Rana v Union of India) allowed withdrawal. The Court held that clinically assisted nutrition and hydration through a tube is medical treatment, not basic care, so it falls within the Common Cause framework; that a patient need not be ventilator-dependent to qualify; and that withdrawal must never mean abandonment. It directed AIIMS to admit him to palliative care (treatment aimed at comfort and relief from pain) with an end-of-life care plan. He died later in 2026 under that care.
Ravi, 58, watched his father spend four months on a ventilator with no prospect of waking. He decided his own family would not face that. He wrote a two-page advance directive refusing ventilation and tube feeding if two medical boards certified no reasonable hope of recovery, named his wife and then his daughter as decision-makers, signed it before two colleagues, and had it attested by a notary for a small fee. He gave copies to his wife, daughter and family physician, and asked his hospital to add it to his file.
Keep these ready
- The signed, witnessed and attested advance directive (original with you, copies with the named persons and your doctor).
- Identity proof of the person making it and of the witnesses.
- Names and contact details of the guardians or relatives named, and an alternate.
- For a patient in hospital: the medical records, the directive if any, and a written request to the hospital to constitute the Primary Medical Board.
A living will is not a "do not treat" order for every illness. It applies only when doctors certify that you are terminally ill or permanently unconscious with no reasonable hope of recovery, and only after both medical boards agree. Do not confuse it with a property will, and do not keep it secret: a directive nobody can find helps no one.
Where to go
- Attesting the directive: any notary public, or a Gazetted Officer (for example, a tehsildar or a government doctor).
- In hospital: the treating physician and medical superintendent, in writing, to constitute the Primary Medical Board; the district Chief Medical Officer nominates a member of the Secondary Board.
- Dispute or refusal: the High Court, through a lawyer; free legal aid from NALSA 15100, nalsa.gov.in.
- Palliative care: the palliative medicine department of a government medical college or large hospital; information at mohfw.gov.in.
- Older persons needing guidance: Elderline 14567. Emotional support: Tele-MANAS 14416.
Common questions
Is euthanasia legal in India?
Passive euthanasia, meaning the withdrawal or withholding of life-sustaining treatment from a patient with no reasonable hope of recovery, is lawful under the Supreme Court's guidelines in Common Cause (2018, simplified 2023). Active euthanasia and assisted suicide remain crimes. There is no statute yet; the law rests on these judgments.
How do I make a living will in India?
Write an advance medical directive stating when it applies and which treatments you refuse, name one or more relatives or guardians to consent on your behalf, sign it before two witnesses, and have it attested by a notary or a Gazetted Officer. Give copies to the named persons and your doctor. You can change or cancel it at any time in writing.
Can the family stop treatment if there is no living will?
Yes, through the same process: the hospital forms a Primary Medical Board and then a Secondary Medical Board with a doctor nominated by the Chief Medical Officer, both must find no reasonable chance of recovery, the family or guardian must consent, and the Judicial Magistrate is informed. Harish Rana (2026) was decided this way on the parents' request.
Can a feeding tube be removed, or only a ventilator?
Both. In Harish Rana v Union of India (2026) the Supreme Court held that clinically assisted nutrition and hydration through a tube is medical treatment and can be withdrawn under the Common Cause framework, and that a patient need not be on a ventilator to qualify. Palliative care to keep the patient comfortable must continue.
This article is general information for awareness, not legal advice. For your situation, consult an advocate or call free legal aid at 15100.
