Open Access Research Article
WITHHOLDING AND WITHDRAWAL OF LIFE-SUSTAINING TREATMENT IN INDIA: RECONCILING PATIENT AUTONOMY, BEST INTERESTS AND THE RIGHT TO DIE WITH DIGNITY
Abstract
ABSTRACT
Advances
in medical technology have transformed the legal and ethical meaning of death
and dying Mechanical ventilation, dialysis, clinically assisted nutrition and
hydration (CANH), vasopressors and other life-sustaining interventions can
preserve physiological functions for prolonged periods even when the underlying
medical condition is irreversible The resulting legal question is therefore not
merely whether biological life can be prolonged, but whether a particular
medical intervention should continue when it no longer provides a realistic
therapeutic benefit or is inconsistent with the patient's wishes, welfare or
dignity Indian constitutional jurisprudence has gradually developed a framework
for addressing this question P Rathinam v Union of India initially adopted an
expansive interpretation of Article 21 by recognising a right to die, but this
approach was rejected by the Constitution Bench in Gian Kaur v State of Punjab.
At the same time, Gian Kaur recognised the constitutional significance of dignity
at the end of natural life Aruna Ramachandra Shanbaug v Union of India
subsequently considered withdrawal of life-sustaining treatment from a patient
in a persistent vegetative state In Common Cause (A Regd Society) v Union of
India, the Constitution Bench recognised the right to die with dignity as part
of Article 21 and upheld the validity of Advance Medical Directives (AMDs). The
procedural framework was subsequently modified in 2023 to make its
implementation more workable.
The
Supreme Court's decision in Harish Rana v Union of India, represents an
important contemporary development The Court considered clinically assisted
nutrition and hydration administered through a medically implanted device as
medical treatment capable of being withdrawn within the applicable legal
framework The Court also clarified that the best-interests inquiry concerns
whether prolonging life through the particular treatment remains in the
patient's best interests, rather than whether death itself is beneficial The
judgment emphasised medical and non-medical considerations, prior wishes and
values, the balance-sheet approach, medical-board assessment and continuity of
palliative care This article argues that Indian law should increasingly adopt
the more precise terminology of withholding and withdrawal of life-sustaining
treatment rather than treating all such decisions under the broad expression
"passive euthanasia" It proposes a four-stage patient-centred
framework based on: (i) present decision-making capacity and wishes; (ii) valid
and applicable Advance Medical Directives; (iii) structured best-interests
assessment informed by prior wishes and values; and (iv) independent review
where disagreement, coercion or substantial uncertainty exists
A
comparative examination of the United Kingdom, United States, Netherlands,
Canada and Switzerland demonstrates that there is no single international model
for end-of-life decision-making These jurisdictions differ significantly in
their treatment of refusal of treatment, advance directives, physician-assisted
dying, euthanasia, best interests and judicial oversight The comparative lesson
for India is therefore not to copy any particular foreign model, but to
identify institutional safeguards capable of protecting autonomy while
preventing coercion and abandonment The article concludes that India requires
comprehensive legislation governing Advance Medical Directives, informed
refusal, withholding and withdrawal of life-sustaining treatment, CANH, medical
boards, palliative care, professional responsibility and dispute resolution.
Published Paper
Author Details
Authors: NAGARIKA DILEEP
Registration ID: 1013218 | Published Paper ID: IJLRA13218
Year: Sep-2026 | Volume: 3 | Issue: 6
Approved ISSN: 2582-6433 | Country: Delhi, India
Page No.: 1506-1530
Article Information
WITHHOLDING AND WITHDRAWAL OF LIFE-SUSTAINING TREATMENT IN INDIA: RECONCILING PATIENT AUTONOMY, BEST INTERESTS AND THE RIGHT TO DIE WITH DIGNITY
Authors: NAGARIKA DILEEP
- Journal IJLRA
- ISSN 2582-6433
- Volume 3
- Issue 6
About Journal
International Journal for Legal Research and Analysis
- AbbreviationIJLRA
- ISSN2582-6433
- AccessOpen Access
- LicenseCC 4.0
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