Karnataka Approves ‘Right To Die With Dignity’ Order: What Is it, Understanding Its Ethical Concerns, Patient Rights, And More

Right To Die With Dignity Order: Supreme Court Rulings and Karnataka’s Move

Karnataka’s decision is rooted in a series of landmark Supreme Court rulings. The Common Cause vs. Union of India case in 2018 was a turning point, as it recognised the legality of passive euthanasia and living wills. Passive euthanasia, in this context, refers to the withdrawal or withholding of life-sustaining treatment to allow a terminally ill patient to die naturally, in accordance with their wishes. The 2023 Supreme Court judgement further streamlined the process, reducing bureaucratic hurdles and clarifying the conditions under which life-sustaining treatment can be stopped.

The 2023 guidelines introduced key changes, including:

• Withdrawal of Life-Sustaining Treatment (WLST): Requests for WLST must be reviewed by primary and secondary medical boards.
• Living Wills: Patients can now express their end-of-life wishes through advance medical directives, ensuring their preferences are honoured.
• Approval Process: Decisions require approval from the treating doctor, two medical boards (each with three doctors), and a designated practitioner from the District Health Office.
• Judicial Oversight: The process must be validated by a Judicial Magistrate of the First Class (JMFC) to ensure transparency and fairness.
• Advanced Medical Directive (AMD): Patients can appoint a trusted individual to make healthcare decisions if they become unable to do so.

Timeline of Key Supreme Court Rulings on Euthanasia

• 2011: Aruna Shanbaug v. Union of India recognised that life-sustaining treatment could legally be withheld or withdrawn even from persons without decision-making capacity.
• 2018: Common Cause v. Union of India recognised the right to die with dignity as a fundamental right under Article 21 of the Indian Constitution, and legalised the use of advance medical directives or 'living wills.'
• 2023: Common Cause v. Union of India simplified the process for making living wills and withholding/withdrawing life-sustaining treatment by removing bureaucratic hurdles, making it more accessible and straightforward.

Legal Expert Insights: Balancing Autonomy and Safeguards

Meghna Mishra, a senior legal expert at Karanjawala & Co, explains that the ‘Right to Die with Dignity’ is an extension of Article 21 of the Indian Constitution, which guarantees the Right to Life. “This ensures that terminally ill patients can exercise their autonomy, making end-of-life decisions that align with their wishes,” she says. However, she emphasises that strict criteria must be met: the patient must suffer from an incurable, terminal illness or be in a permanent vegetative state. Conscious patients must provide informed consent, while unconscious patients rely on living wills or family consent.

Mishra also highlights the ethical and legal safeguards in place to prevent misuse. “The system is designed to ensure that the decision remains voluntary for the patient. Any sign of coercion or undue influence can lead to criminal action, protecting vulnerable individuals from abuse.”

Ethical Concerns and Safeguards: Preventing Misuse

One of the biggest concerns surrounding the ‘Right to Die with Dignity’ is the potential for misuse, such as coercion by family members or financial pressures. Karnataka’s framework addresses these concerns with robust safeguards:

• Medical Boards: A panel of senior doctors must certify that the patient’s condition is irreversible.
• Judicial Oversight: In cases of dispute, the High Court can intervene to ensure fairness.
• Written Consent: Family members must provide written consent, and any evidence of coercion can result in legal consequences.
• Transparency: The entire process is documented to ensure accountability and transparency.

The Role of Medical Professionals: Ethical Dilemmas

For doctors, the ‘Right to Die with Dignity’ presents both opportunities and challenges. While the law protects medical professionals who act in good faith, it also respects their right to conscientious objection. Doctors who are uncomfortable with the idea of euthanasia can opt out, but hospitals must ensure that another qualified professional is available to carry out the procedure. This ensures that patients’ rights are upheld without forcing medical practitioners to compromise their ethical beliefs.

Some experts have called for mandatory ethics training to help doctors navigate these complex decisions. Such training could provide clarity and support, ensuring that medical professionals feel confident in their roles while upholding the principles of compassionate care.

Celebrities and influencers have also come forward in support of Karnataka’s progressive decision to approve the ‘Right to Die with Dignity.’ Bollywood actress Kajol, known for her powerful performances and strong social stance, has publicly voiced her support for the state’s move. Kajol drew a direct parallel to her 2022 film Salaam Venky, which tells a story of a young man’s legal battle for the right to die with dignity.

Karnataka’s Impact on Other States

Karnataka’s decision could set a powerful precedent for other states in India. While the Supreme Court has provided a legal framework, the lack of a uniform national law has led to inconsistencies in how end-of-life decisions are handled. Karnataka’s proactive approach could inspire other states to adopt similar measures, paving the way for a more standardised and compassionate approach to end-of-life care across the country.

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