The Supreme Court of India, on 24 January 2023, modified and simplified the procedural guidelines for passive euthanasia and Advance Medical Directives (living wills) that were originally laid down in the 2018 judgment in Common Cause (A Regd. Society) v. Union of India. A five-judge Constitution Bench comprising Justice K.M. Joseph, Justice Ajay Rastogi, Justice Aniruddha Bose, Justice Hrishikesh Roy, and Justice C.T. Ravikumar removed several onerous procedural requirements that had rendered the 2018 framework practically unworkable.
Background
In 2018, the Supreme Court recognised the right to die with dignity as a facet of Article 21 and laid down a detailed framework for passive euthanasia and Advance Medical Directives (AMDs). However, the 2018 guidelines imposed stringent procedural conditions — including attestation by a Judicial Magistrate First Class (JMFC), a requirement that medical board members have twenty years of experience, and a cumbersome multi-tier approval process — that effectively prevented any person from executing a valid living will. In the five years following the 2018 judgment, the framework remained largely non-functional due to these procedural barriers. The Court took up the matter suo motu to address these practical impediments.
Key Holdings
The Constitution Bench modified the 2018 guidelines as follows:
Attestation simplified: The requirement that a living will be attested before a Judicial Magistrate First Class has been removed. A Notary Public or a Gazetted Officer can now attest the Advance Medical Directive, making execution far more accessible.
Medical board experience reduced: The minimum experience requirement for members of the Medical Board constituted to evaluate a patient's condition has been reduced from twenty years to five years. The Board must include one registered medical practitioner nominated by the District Chief Medical Officer (CMO) and two subject-matter experts.
48-hour decision timeframe: The Medical Board is now required to provide its opinion within 48 hours of being constituted, replacing the previously undefined timeline that contributed to delays.
Advance Medical Directives reaffirmed: The Court reaffirmed the validity of Advance Medical Directives as an exercise of the right to die with dignity under Article 21, and emphasised that no person should be denied this right merely due to procedural hurdles.
Custodian and communication: The simplified framework retains the requirement that a copy of the AMD be provided to the local hospital, the District Chief Medical Officer, and a designated family member or custodian.
Implications for Practitioners
This modification transforms the passive euthanasia framework from a theoretical right into a practically exercisable one. Medical law practitioners should immediately advise clients that living wills can now be executed before any Notary Public, without the need to approach a Magistrate's court.
Healthcare institutions should update their protocols to recognise AMDs attested by Notary Public or Gazetted Officers. Hospital administrators need to establish internal review mechanisms compatible with the 48-hour decision timeline, which represents a significant operational change.
For elder law practitioners and estate planners, the simplified guidelines make Advance Medical Directives a realistic component of end-of-life planning. Advisors should consider integrating AMD discussions alongside traditional succession planning.
The reduced experience threshold for Medical Board members addresses a practical bottleneck: in smaller towns and district hospitals, finding practitioners with twenty years of relevant experience was often impossible. The five-year threshold ensures that qualified medical professionals across India can constitute review boards.
Practitioners should monitor whether state governments issue complementary notifications to operationalise these guidelines at the district level.