Individuals have a right to die with dignity, India’s Supreme Court upheld on Friday in a landmark verdict that permits the removal of life-support systems for the terminally ill or those in incurable comas.

Passive euthanasia, as it is called, will apply only to a terminally ill person with no hope of recovery, a panel of five judges said. Active euthanasia, by administering a lethal injection, continues to be illegal in India.

In active euthanasia, a specific overt act is performed to end the patient’s life whereas in passive euthanasia, something is not done that would be necessary to preserve a patient’s life, the panel noted.

“It is due to this difference that most of the countries across the world have legalized passive euthanasia either by legislation or by judicial interpretation with certain conditions and safeguards.”

Even though passive euthanasia has been legal since 2011 in India, the government is yet to pass the law. Meantime, a non-government organization approached the top court with a plea to also legalize the right to a living will.

“At that time the Supreme Court said they will look at this whole passive euthanasia thing again, which they have, and they have upheld their own judgement,” said activist and author Pinki Virani.

Virani’s plea to the top court in 2009 for passive euthanasia of Indian nurse Aruna Shanbaug, who had survived in a coma for more than 40 years after she was sexually assaulted, caught the nation’s attention.

Two years later, the court passed a law permitting passive euthanasia. The issue is not considered politically contentious in India.

Dignity in death

When the sanctity of life was destroyed, said a panel of five judges headed by Chief Justice Dipak Misra, “Should we not allow them to cross the door and meet death with dignity? For some, even their death could be a moment of celebration.”

The court also permitted individuals to decide against artificial life support, should the need arise, by creating a “living will.”

The decision makes it legal for the terminally ill to decide against using life support systems to continue living, and frees the doctors and families of those who slip into incurable comas to halt such measures, in the patients’ best interest.

“This is an important, historic decision, which clears the air,” said Supreme Court lawyer Prashant Bhushan.

“Everybody will breathe a sigh of relief, because people were earlier apprehensive that if they withdrew life support, they could be prosecuted for culpable homicide,” he added.

Bhushan had filed a petition to the Supreme Court on behalf of a registered society, Common Cause, seeking recognition of the right to establish a living will.

“The court has held that an individual has a full right to decide that he should not take any kind of medical treatment or that he should not be kept alive by artificial life support systems,” Bhushan added.

The 538-page judgment places management of terminally ill patients at the center stage.

“It has been highlighted that determination of the seemly criteria will keep the element of misuse by the family members or the treating physician or, for that matter, any interested person at bay and also remove the confusion,” the panel notes.

Dr. Naresh Trehan, head of Medanta Heart Institute near New Delhi said the living will “opens itself to abuse. That’s where the sanctity of the process will be important.”

A competent committee would comprise doctors, lawyers, social activists and the local administration of the hospital, Trehan said.