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2023 INSC 85Supreme Court of India

Common Cause v. Union of India

The Right to Die with Dignity: Living Will Made Accessible

24 January 2023Justice K.M. Joseph, Justice Ajay Rastogi, Justice Aniruddha Bose, Justice Hrishikesh Roy, Justice C.T. Ravikumar
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TL;DR

The Supreme Court simplified the procedure for executing a Living Will (Advance Medical Directive) for passive euthanasia. The 2023 order removed the requirement of Magistrate attestation, reduced the experience criteria for doctors, and made the process more accessible. Now, a Living Will can be signed before two witnesses and attested by a Notary or Gazetted Officer.

The Bottom Line

You can now create a Living Will to refuse life-prolonging treatment if terminally ill. The process has been simplified—no Magistrate required, just two witnesses and a Notary/Gazetted Officer attestation.

Case Timeline

The journey from FIR to Supreme Court verdict

filing
1 Jan 2005

PIL Filed

Common Cause files PIL seeking recognition of right to die with dignity

judgment
9 Mar 2018

Constitution Bench Judgment

Five-Judge Bench recognizes passive euthanasia and right to die with dignity as fundamental right

filing
1 Jul 2019

ISCCM Application

Indian Society for Critical Care Medicine files application to modify cumbersome guidelines

judgment
24 Jan 2023

Modified Guidelines

Supreme Court simplifies Living Will procedure, removes Magistrate requirement

The Story

In 2005, an NGO called Common Cause approached the Supreme Court praying for a declaration that the 'fundamental right to live with dignity' under Article 21 of the Constitution includes the 'right to die with dignity' and seeking directions for adopting suitable procedures for executing 'Living Wills' (Advance Medical Directives).

In the landmark 2018 judgment, a five-Judge Constitution Bench recognized passive euthanasia and the right to die with dignity as a fundamental right under Article 21. The Court laid down elaborate guidelines for executing Living Wills, which included attestation by a Judicial Magistrate First Class (JMFC), approval from multiple medical and legal authorities, and doctors with 20 years of experience on medical boards.

However, in July 2019, the Indian Society for Critical Care Medicine (ISCCM) filed a miscellaneous application describing the 2018 guidelines as "cumbersome" and practically inaccessible for most people. They highlighted that the stringent procedural requirements were defeating the very purpose of the right that was recognized.

The applicant sought modification of the guidelines to make them more practical and accessible, arguing that the requirement of judicial attestation and highly experienced doctors was creating unnecessary barriers for terminally ill patients and their families.

Legal Issues

Click each question to reveal the Supreme Court's answer

1Question

Whether the 2018 guidelines for executing a Living Will need modification to make them more accessible?

Tap to reveal answer
1SC Answer

YES. The Court found that the 2018 guidelines were "cumbersome" and practically inaccessible. The requirement of Magistrate attestation and doctors with 20 years experience created unnecessary barriers. The Court modified the guidelines to make them more practical and accessible.

This addresses the practical implementation of the right to die with dignity recognized in 2018.

2Question

What should be the simplified procedure for executing a Living Will?

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2SC Answer

A Living Will can now be signed in the presence of two independent witnesses and attested by a Notary or Gazetted Officer. The requirement of Magistrate involvement has been removed.

This makes the procedure accessible to ordinary citizens without requiring judicial involvement.

3Question

What should be the composition and experience requirement for Medical Boards?

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3SC Answer

The experience criteria for doctors on Medical Boards was reduced from 20 years to 5 years. The number of members on both Primary and Secondary Medical Boards was reduced to three. The Chief District Medical Officer requirement was removed.

This ensures that qualified medical professionals can assess cases without impractical experience thresholds.

Arguments

The battle of arguments before the Supreme Court

Petitioner

Vihaan Kumar

1

2018 guidelines are impractical

The requirement of Magistrate attestation and 20-year experienced doctors makes it nearly impossible for ordinary citizens to execute a Living Will.

M.A. No. 1699 of 2019
2

Defeating the purpose of the right

The stringent procedural requirements are defeating the very purpose of recognizing the right to die with dignity.

3

Need for accessible healthcare decisions

End-of-life decisions are time-sensitive and require simpler, accessible procedures that can be implemented in medical emergencies.

Respondent

State of Haryana

1

Safeguards are necessary

The strict guidelines were put in place to prevent misuse and protect vulnerable patients from decisions made against their interests.

2

Judicial oversight prevents abuse

Magistrate involvement ensures that the Living Will is genuine and not made under coercion or undue influence.

Court's Analysis

How the Court reasoned its decision

The Supreme Court recognized that while the 2018 judgment was path-breaking in recognizing the right to die with dignity, the procedural guidelines had become barriers to accessing this right. The Court adopted a pragmatic approach, balancing the need for safeguards against misuse with the need for accessibility.

The right to die with dignity is a fundamental right under Article 21. However, this right cannot be illusory due to impractical procedural requirements.

Emphasizes that fundamental rights must be practically accessible.

A Living Will can now be signed in the presence of two independent witnesses and attested by a Notary or Gazetted Officer. Magistrate involvement is no longer required.

Key procedural modification making Living Wills accessible.

The experience criteria of doctors on Medical Boards is reduced from 20 years to 5 years.

Makes it easier to constitute Medical Boards to assess cases.

Both Medical Boards should give their opinion preferably within 48 hours.

Ensures timely decisions in end-of-life situations.

Allowed

The Verdict

Relief Granted

The modified guidelines make the procedure for executing a Living Will accessible to ordinary citizens, enabling them to exercise their fundamental right to die with dignity.

Directions Issued

  • Living Will can be signed in presence of two independent witnesses
  • Attestation by Notary or Gazetted Officer (Magistrate no longer required)
  • Experience criteria for doctors reduced from 20 years to 5 years
  • Medical Board size reduced to three members each
  • Preferable time limit of 48 hours for Medical Boards to give opinion
  • Chief District Medical Officer requirement removed; can nominate someone

Key Legal Principles Established

1

The right to die with dignity is a fundamental right under Article 21.

2

An individual's right to execute advance medical directives is an assertion of the right to bodily integrity and self-determination.

3

Passive euthanasia (withdrawal of life-supporting treatment) is legally permissible under proper safeguards.

4

Active euthanasia (administering lethal substances) remains illegal in India.

5

Procedural requirements for exercising fundamental rights must be practical and accessible.

6

A Living Will allows a person to give advance instructions for withdrawal of life-support when they are in a terminal condition and unable to communicate.

Key Takeaways

What different people should know from this case

  • You have a fundamental right to die with dignity under Article 21.
  • You can create a Living Will (Advance Medical Directive) specifying your wishes about life-prolonging treatment.
  • The Living Will requires two witnesses and attestation by a Notary or Gazetted Officer—no Magistrate needed.
  • Your Living Will will be implemented when you are terminally ill and unable to communicate your wishes.
  • Passive euthanasia means withdrawal of life support, not active administration of lethal substances.
  • Your family and doctors must respect your Living Will when you cannot communicate.

Frequently Asked Questions

A Living Will is a document where you specify in advance what kind of medical treatment you want or don't want if you become terminally ill and are unable to communicate your wishes. It typically includes instructions about withdrawal of life-support systems.
Passive euthanasia involves withdrawal of medical treatment or life support, allowing the patient to die naturally. Active euthanasia involves actively administering lethal substances to end life. Only passive euthanasia is legal in India.
You need to: (1) Write your Living Will specifying your wishes about end-of-life treatment, (2) Sign it in presence of two independent witnesses, (3) Get it attested by a Notary or Gazetted Officer. The document should be kept safely and shared with family members and your doctor.
Yes, a Living Will can be revoked or modified at any time by the person who made it, as long as they are of sound mind and able to communicate.
When you are terminally ill and unable to communicate, the hospital constitutes a Primary Medical Board (3 doctors with 5+ years experience) and then a Secondary Medical Board (appointed by the District Medical Officer) to verify the Living Will and your medical condition before implementing it.
No. Passive euthanasia is the withdrawal of futile life-prolonging treatment for terminally ill patients who have no chance of recovery. It is not suicide and is now legally recognized as part of the right to die with dignity.

DISCLAIMER: This case summary is for educational and informational purposes only. It does not constitute legal advice. For advice on your specific situation, please consult a qualified advocate. JurisOptima is not responsible for any actions taken based on this information.

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