The Karnataka government, led by Chief Minister Siddaramaiah, has taken a significant step in ensuring the right to die with dignity by directing hospitals across the state to establish medical boards for processing requests for dignified deaths.  

This move aligns with the 2023 Supreme Court ruling, which simplified the guidelines for passive euthanasia for terminally ill patients. With this decision, Karnataka becomes one of the few states in India to comply with the apex court's order on living wills.  

What is a Living Will?  

A living will is a legal document that allows individuals aged 18 and above to specify their preferred medical care in case they develop a terminal illness or a condition with no chance of recovery and are unable to make decisions for themselves. This ensures that their medical treatment aligns with their wishes, preventing prolonged suffering.  

Karnataka's Order on Living Wills  

The Karnataka government has directed all District Health Officers to appoint medical experts to secondary medical boards, which will assess and certify Withdrawal of Life-Sustaining Therapy (WLST) for terminally ill patients with no hope of recovery or those in a persistent vegetative state.  

Last week, Health Minister Dinesh Gundu Rao called the move "historic," stating that it upholds the Right to Life under Article 21, which also includes the right to die with dignity. He emphasized that this order will benefit terminally ill patients who no longer respond to life-sustaining treatment.  

A circular issued on January 30, 2025, instructs hospitals to establish primary and secondary medical boards to evaluate requests from the patient's next of kin for WLST based on a living will.  

Implementation Process 

Following the Supreme Court's directive, Karnataka's circular outlines that:  

1. The treating doctor must first approve the patient's living will.  

2.  A Primary Medical Board (three registered doctors) and a Secondary Medical Board (including a doctor nominated by the District Health Officer) will evaluate the request.  
 

3. The next of kin or the nominated representative must give consent before proceeding with WLST.  

4. Decisions by both medical boards will be submitted to the Judicial Magistrate of the First Class (JMFC) for final review, with copies sent to the High Court Registrar for record-keeping.  

Medical experts authorized under The Transplantation of Human Organs and Tissues Act, 1994, as amended in 2011, will be eligible to serve on these boards. 

Additionally, a patient must nominate at least two individuals to make healthcare decisions on their behalf if they lose decision-making capacity. Copies of Advance Medical Directives (AMDs) can be stored in paper or digital health records maintained by medical establishments.  

Legal Framework for Passive Euthanasia in India  

In 2018, the Supreme Court allowed passive euthanasia for terminally ill patients under strict guidelines. Passive euthanasia involves withdrawing or withholding life-preserving treatment to allow natural death.  

While living wills are legally recognized, they remain uncommon in India due to societal taboos around death and concerns about misuse. 

In June 2023, Justice MS Sonak of the Bombay High Court (Goa Bench) became the first person in Goa to register a living will. Goa was reportedly the first state to implement Advance Medical Directives (AMDs).  

In September 2024, the Union Health Ministry proposed draft guidelines outlining four conditions for evaluating passive euthanasia cases, inviting feedback from stakeholders. However, the Indian Medical Association (IMA) has raised concerns about the draft rules, arguing they could subject doctors to legal scrutiny.  

Despite legal recognition, awareness about living wills remains low in India. Karnataka's move is seen as a progressive step in providing terminally ill patients a humane and legally sanctioned option for end-of-life care.