First Author and Corresponding Author – Dr Vineeth Thomas, Head, Department of Political Science, SRM University, Amaravati, India, Email: vineethmthomas@gmail.com
Second Author –Dr James Ralte, Assistant Professor, Department of Political Science, SRM University, Amaravati, India Email: raltejames12@gmail.com
Third Author - Dr Loitongbam Jaya Devi, Assistant Professor, Department of Political Science, Kristu Jayanti College, Bangalore, India, Email: jayaloi02@gmail.com
Karnataka’s enforcement of the Supreme Court’s directive on the right to die with dignity is being hailed as a landmark moment in India’s legal and ethical discourse. By institutionalising the Advance Medical Directive (AMD), or living will, the state claims to uphold an individual's autonomy over their body and medical decisions, reinforcing the constitutional right to personal liberty under Article 21. While this move is undoubtedly progressive, offering terminally ill patients control over their end-of-life choices, it also opens a Pandora's box of ethical dilemmas, legal ambiguities, and socio-economic vulnerabilities that cannot be overlooked.
At first glance, the policy seems to champion personal freedom. The AMD allows individuals to outline their wishes regarding life-sustaining treatments should they become incapacitated, ensuring that their autonomy is respected even when they can no longer voice their preferences. Karnataka’s decision operationalises the Supreme Court’s 2018 ruling that recognised the right to die with dignity as part of the fundamental right to life. However, the implementation of this right introduces practical challenges. The risk of misuse is significant, particularly among vulnerable populations who may feel pressured to sign AMDs to avoid becoming a ‘burden’ on their families. The ambiguity in defining medical conditions such as “terminal illness” or “persistent vegetative state” also complicates the ethical landscape. Medical prognoses are often uncertain, and the line between a terminal condition and a treatable one can be blurry, leaving room for subjective interpretations that could affect the application of AMDs. Without stringent protocols, the very law designed to protect dignity could become a tool for hastening death without sufficient medical justification.
The role of medical practitioners in this framework is both pivotal and precarious. Traditionally bound by the Hippocratic Oath to preserve life, doctors must now navigate a moral tightrope, balancing their duty to sustain life with the ethical obligation to respect a patient’s autonomy and alleviate suffering. This shift necessitates a transformation in medical training, focusing on ethical decision-making, legal literacy, and end-of-life care. However, expecting healthcare providers to seamlessly adapt to these changes without systemic support is unrealistic. Institutional safeguards, such as multidisciplinary ethics committees, are essential for reviewing complex cases, verifying the authenticity of AMDs, and mediating disputes to ensure ethical compliance.
While the legal and medical dimensions are critical, societal acceptance of the right to die with dignity remains a major challenge. The concept of passive euthanasia or the withdrawal of life support can be perceived as conflicting with traditional beliefs about the sanctity of life and the natural course of death. Public misconceptions equating passive euthanasia with suicide further complicate the issue. Karnataka’s policy, while legally sound, risks resistance unless accompanied by robust public education campaigns. An equally pressing concern is the intersection of end-of-life decisions with socio-economic realities. In a country marked by stark healthcare inequalities, there is a legitimate fear that the right to die with dignity could be disproportionately exercised by those lacking access to quality palliative care or facing overwhelming financial burdens. If individuals are opting for AMDs because they cannot afford care, the policy risks becoming a reflection of systemic healthcare failures rather than an exercise of personal freedom. To prevent this, Karnataka must ensure that the right to die with dignity is complemented by investments in palliative care, mental health support, and social welfare systems that address the root causes of end-of-life suffering. The legal safeguards surrounding Karnataka’s directive also warrant scrutiny. The process of drafting, registering, and revoking AMDs must be foolproof to prevent fraud, coercion, and legal disputes. Current provisions lack clarity on key issues: How do we ensure that an AMD was made voluntarily and with full understanding of its implications? What happens when there is a conflict between an AMD and the wishes of family members or treating physicians? Who has the final authority in such disputes—the family, the doctors, or the courts? Without clear answers, Karnataka’s policy could lead to prolonged legal battles that ironically prolong the very suffering it seeks to alleviate.Beyond the immediate legal and medical concerns, the success of such frameworks depends not just on legislative or judicial action but also on broader societal acceptance and a gradual shift in public attitudes toward death and dying. Karnataka’s move highlights the need for a broader national dialogue on end-of-life care. While the Supreme Court’s directive provides a legal foundation, the absence of uniform national legislation creates inconsistencies in how the right to die with dignity is implemented across different states. A centralised legal framework, informed by Karnataka’s experiences, is essential to ensure equal protection and clarity for all individuals making end-of-life decisions.
Karnataka’s enforcement of the right to die with dignity is a bold step toward respecting individual autonomy and humanising end-of-life care. However, the policy’s success depends not just on legal reforms but on ethical integrity in its implementation. The Karnataka government must ensure that its passive euthanasia framework is transparent, accessible, and ethically sound, setting a precedent for other states and shaping national healthcare policies on end-of-life care. This framework must serve as both a blueprint and a cautionary tale—a reminder that dignity in death is achieved through diligence in life, policy, and practice.
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