India's Supreme Court Permits Passive Euthanasia, Yet 'Living Wills' Remain Largely Unknown

In a crowded ward of New Delhi’s All India Institute of Medical Sciences (AIIMS), India’s premier public hospital, a mother sits quietly beside her 29-year-old son, Piyush Singh*. Diagnosed with stomach cancer a year ago, Singh has already undergone five rounds of chemotherapy. He now lies in the hospital’s palliative care unit, where the goal is no longer to cure the disease but to relieve pain and preserve his dignity.

“The world comes to AIIMS when they are not well. But where shall we go?” asks his mother. “My son has already received five doses of chemotherapy, but his condition has not improved. The doctors are not telling us anything. I don’t know what to do next.” Piyush’s family is not asking for his life to end. They simply don’t know what comes when treatment fails.

A few floors away, Aryan* has come to AIIMS from Auraiya, a small town in Uttar Pradesh state, to accompany his 40-year-old brother Amit (name changed), who has been battling mouth cancer for four years. Two surgeries, radiation and two rounds of chemotherapy later, doctors say there is little hope of him surviving. The final checkup has been done. There is nothing more left to try.

“There is no duvidha [dilemma in Hindi],” says Aryan. “The doctors have said no. So it is clear now.” He plans to take Amit to his rented flat in Gurgaon and give him whatever painkillers he has been prescribed. Beyond that, he has no plan, because no one has given him one. “I don’t know about palliative care. I don’t know how to ease his pain. I have nothing apart from the medicines I got today,” he said.

Piyush and Amit are no exceptions. They represent a reality that many Indians are coming to terms with – with little institutional help. India recorded an estimated 1.56 million new cancer cases in 2024, according to an Indian Council of Medical Research study published in the Journal of the American Medical Association. But cancer patients are not alone. Families of patients with traumatic brain injuries and degenerative neurological conditions also hit the same wall.

According to a 2025 analysis by ecancermedicalscience, an open-access medical journal, an estimated seven to 10 million people require palliative care in India, but only about 4 percent receive it. Such families find themselves with little or no awareness or preparedness for what comes next. Many have never heard of palliative care, or that the law gives them the right to document their treatment preferences before a crisis arrives.

The problem is also rooted in how many Indians confront death – a phenomenon that is one of the least-discussed subjects within families or societies. In many households, conversations about dying are considered inauspicious. In such a worldview, to think of interventions in how or when someone dies carries a moral weight that goes beyond medicine or law. Families often avoid discussing medical wishes until a loved one is critically ill, leaving relatives to make deeply personal decisions during moments of grief and uncertainty.

In 2018, India’s Supreme Court recognised that the “right to die with dignity” was part of the fundamental right to life, enshrined in Article 21 of the Indian Constitution. The court also allowed such patients to record their wishes about life-sustaining treatment if they lose the capacity to decide in an advanced stage of their ailment. The top court’s ruling was in response to a petition filed by Common Cause, an NGO, which called for legal procedures allowing terminally ill individuals to execute Advance Medical Directives, commonly known as “living wills”, to refuse life-prolonging medical treatment.

“It [judgement] broadens the scope of Article 21. It now affirms, kind of completely, that the right to life includes the right to die with dignity. That is the bottom line for us,” Vipul Mudgal, director of Common Cause, the organisation behind the 2005 petition, told Al Jazeera.

Yet, for most Indians, that right largely existed on paper – until six years later. In 2024, a family in Ghaziabad, an industrial district on the outskirts of New Delhi, filed a petition in the Delhi High Court and later in the Supreme Court, asking for a decision on the fate of a 32-year-old patient who was in a vegetative state for nearly 13 years. Harish Rana’s case was a first in India where passive euthanasia, or withdrawal of life support, was permitted by the top court. On March 11, the Supreme Court directed the withdrawal of his life support at AIIMS, New Delhi. He passed away two weeks later.

“A family reaches such a decision when it sees no scope for improvement. Harish Rana could not speak, we were his voice,” Rana’s father Ashok told Al Jazeera. “He was not in that state for 13 days or 13 months, but for 13 years.” All those years, said Ashok, he watched his son breathe but not recover, with only one question on his mind: “I am around 63 years old, and my wife is 58 years old. If something happens to either of us, who would take care of him?” That is when they decided to approach the court.

A 2019 survey across seven cities, including New Delhi, Mumbai and Kolkata, by Healthcare at Home (HCAH), a health advocacy group, found that 73 percent of urban Indians were unaware of their right to a living will. Even among people aware of their right, only 6 percent had actually drafted such a will. “The Harish Rana case was made more complex because there was no living will,” said Manish Jain, the lawyer who represented the family in court. “Living will clinics are absent across India.”

Concerned over a likely misuse of living wills, the Supreme Court initially made its guidelines complex, requiring magistrate countersignatures and medical boards with 20 years of experience. In 2023, a five-judge top court bench simplified the process, removing the magistrate requirement, reducing the minimum experience to five years, and allowing multiple nominees.

“Decisions are being made every day, sometimes by the family members, sometimes by the doctors, sometimes because of paucity of money,” said Mudgal. However, living wills and the right to die exist entirely through judicial interpretation, as there is still no parliamentary law governing the matter.

“There are many patients like this who don’t have legal awareness of passive euthanasia. Not only patients, but their doctors also do not have full awareness about palliative care,” Dr Saipriya Tewari, principal consultant and unit head of pain management and palliative care at Max Super Speciality Hospital in New Delhi, told Al Jazeera.