Patient can make living will to die with dignity, says SC

The Supreme Court on Friday ruled that a terminally-ill patient or a person in the persistent vegetative state can execute an "advance medical directive" or a "living will" to refuse medical treatment.

The court held that the right to live with dignity included smoothening of the process of dying in case of a terminally ill patient or a person in the persistent vegetative state with no hope of recovery.

A five-judge Constitution bench presided over by Chief Justice Dipak Misra unanimously declared passive euthanasia can be undertaken with advance medical directive as part of one's fundamental right to live with dignity. "Accelerating the process of death for reducing the period of suffering constitutes a right to live with dignity," the court held.

In a landmark judgement, the top court laid down comprehensive principles relating to the procedure for execution of advance directive or "living will" and spelt out guidelines and safeguards to give effect to passive euthanasia. It can be executed only by a person with a sound mind, containing absolute, clear and unambiguous terms and also specify the person who can execute it. The document should be signed along with a witness before a judicial magistrate. A decision for acting on such an advance directive can be taken by the medical board.

"Right to life and liberty as envisaged under Article 21 of the Constitution is meaningless unless it encompasses within its sphere individual dignity. With the passage of time, this court has expanded the spectrum of Article 21 to include within it the right to live with dignity as the component of the right to life and liberty," the judgement authored by the CJI on behalf of him and Justice A M Khanwilkar said.

The court said its directions and guidelines would remain in force till Parliament brings a legislation on the subject. The 538-page judgement was delivered on a PIL by NGO Common Cause seeking recognition of "living will" made by terminally ill patients for passive euthanasia.

Justices A K Sikri, D Y Chandrachud and Ashok Bhushan also wrote their own separate and concurring judgements.

Allowing advance directives relating to the withdrawal or withholding of life-sustaining
treatment with adequate safeguards may lead society towards an informed, intelligent and just solution to the problem, Justice Sikri said.

In his judgement, Justice Chandrachud said dignity in the process of dying is as much a part of the right to life under Article 21, as life and death are inseparable. "The Constitution protects the legitimate expectation of every person to lead a life of dignity until death occurs," he said.

Justice Bhushan declared that an adult human being having the mental capacity to make an informed decision has the right to refuse medical treatment including withdrawal from life-saving devices. A person can execute an advance medical directive in accordance with safeguards.