The Supreme Court judgment upholding a person’s advance directive to refuse medical treatment attempts to answer the government’s poser whether the concept of ‘Living Will’ acts against a person’s “instinctive urge to survive”.

Additional Solicitor General P.S. Narasimha, for the government, had illustrated how it is unknown whether the struggle to survive is still going on within a dying or a comatose patient, even at the point of time when doctors and relatives resolve to act upon his own advance directive.

Chief Justice Dipak Misra, who headed the five-judge Constitution Bench, addresses this argument by observing that “a patient in a terminally ill or persistent vegetative state exercising the right to refuse treatment may ardently wish to live but, at the same time, he may wish to be free from any medical surgery, drugs or treatment of any kind so as to avoid protracted physical suffering. Any such person who has come of age and is of sound mind has a right to refuse medical treatment”.

But Justice A.K. Sikri on the Bench voices skepticism by noting that while on one hand a person autonomy gives him the “right to choose his destiny”, but “there are dangers of misuse thereof as well”.

Again, the government had asked whether passive euthanasia should be allowed without a thought for how medical science may advance in future and be able to successfully treat a patient who may be in a permanent vegetative state in the present.

“Suffering is a state of mind and a perception, which varies from individual to individual and depends on various environmental and social factors. Continuous advancement in medical science has made possible good pain management in patients of cancer and other terminal illness,” the government had argued.

To this, the court held that “there is a presumption of capacity whereby an adult is presumed to have the capacity to consent to or to refuse medical treatment”.

The court held that right to refuse medical treatment is significant in an age where advanced technology in medical care has the ability to prolong life with the help of machines.