Death is something that people have always seen as the end of a life. For a long time, the law did not have much to say about life and death because doctors did not have the power to change how people die. A doctor could help with pain, make the person who is dying feel better or try to treat them but most of the time they just let nature take its course. Because of all the advances in medicine and development of life-sustaining technologies like mechanical ventilation, artificial nutrition and hydration, cardiopulmonary resuscitation, death is very different today than it was in the past as now it is possible to keep the human body functioning for some time even after recovery becomes impossible. This means that now death is not just a thing that happens, it has become a process which can be delayed or prolonged for some time.[1]
This change has led constitutional law to answer questions that previous generations of lawyers would not have considered. If medicine has the ability to keep someone alive for an indefinite period, must the State also act to perpetually preserve your biological existence? Conversely, if the Constitution guarantees you dignity and independence as an individual, does that right extend to those deeply personal choices that must be made as you approach the end of natural life? The answers to these questions are neither solely legal nor solely medical in nature. Rather, they exist at the intersection of constitutional values, medical ethics and human experience.[2]
The Constitution of India, in Article 21, does not specifically state a ‘right to die’.[3] The Constitution provides that a person’s life and personal liberty may not be violated except after following due process. While the courts were originally interpreting this provision as a guarantee that judges would follow established procedures before depriving people of their lives and liberty, over time, the courts have interpreted the ‘right to life’ to be both a procedural right and a source of substantive rights. The Supreme Court has held on a number of occasions that the right to life means much more than mere animal existence.[4] An individual has the right not only to have a physical existence, but that the right also includes: the right to live with dignity; to have privacy; to have bodily integrity; and to have the ability to make decisions about one’s own life, that is, the way in which someone will be able to live.[5]
The Constitution’s discussion on Death and Dignity has evolved gradually with time. In P. Rathinam v Union of India, the Supreme Court held that the right to life could include a concurrent right not to live[6] although this ruling was subsequently overturned by a Constitution Bench in Gian Kaur v State of Punjab, which rejected the existence of a general right to die under Article 21 according to the Constitution of India.[7] Nevertheless, the Supreme Court held that it was possible for the right to life to include the right to a dignified natural death, particularly in cases where a terminally ill individual was dying naturally and was being allowed to die with dignity instead of being deprived of life.[8] What was thought at the time to be a cautious statement became the basis of Indian end-of-life jurisprudence.
The next milestone event took place after more than ten years, in the case of Aruna Ramachandra Shanbaug v Union of India. The Supreme Court, in this case, was faced with the tragic circumstance of a woman who had been in a continuous vegetative state for several decades. The court recognised passive euthanasia but under strict judicial supervision.[9] The case dealt largely with whether to withdraw life-sustaining treatment, but it also evidenced an emerging awareness by the Supreme Court that the constitutionally protected right of dignity cannot be separated from the experience of a person who is suffering for long periods of time and is irreversibly unable to communicate.
This evolution of constitutional principles reached its most important stage when the Supreme Court in Common Cause v Union of India held that the right to life under Article 21 of the Indian Constitution includes a qualified right to die with dignity.[10] The Supreme Court confirmed that advance directives regarding end-of-life treatment choices are valid and that individual autonomy does not lose its constitutional protection merely because an individual is in the last stages of life. Justice D.Y. Chandrachud, in his separate opinion, stated that the idea of dignified death is part of the constitutional commitment to autonomy, self-determination of every individual and the inherent worth of every individual. Instead of treating life and death as different constitutional categories, this case recognised that dignity accompanies individuals throughout the continuum of human existence.[11]
More recently, the decision of the Supreme Court in the matter concerning Harish Ranav Union of India[12]has demonstrated that the constitutional principles articulated in Common Cause are no longer confined to abstract judicial discourse. The Court’s willingness to permit the withdrawal of life support in appropriate circumstances reflects an important shift from constitutional recognition towards practical implementation.[13] Yet this constitutional evolution reveals another equally significant story: the slow and often incomplete movement from the recognition of dignified death as a constitutional value to its meaningful implementation within everyday medical practice.
The progressive acknowledgement of the right to die with dignity has given rise to many legal and institutional mechanisms through which individuals may exercise their autonomy near the end of their lives. Competent people may use living wills or advance directives to state how they would like to be medically treated in the future if they were unable to communicate these choices to someone else. Passive euthanasia allows for the withholding and withdrawal of life-sustaining measures under strict regulations. In addition to these developments, Do-Not-Resuscitate (DNR) orders are another important but relatively neglected way to make end-of-life choices. DNR orders do not intend to result in a person’s death, in contrast to active euthanasia. Nor do they necessarily involve the withdrawal of ongoing treatment. They simply reflect a decision that cardiopulmonary resuscitation should not be attempted where such intervention would merely prolong the process of dying without offering any realistic prospect of recovery.[14]
Considerable scholarly attention has been focused on obtaining judicial recognition for the constitutional right to die with dignity; however, there has been little emphasis on how to actually implement this constitutional promise through routine medical practice. While passive euthanasia and advance directives may be referenced in discussions about arrangements for the end of life, they do not address the practical impact of Do-Not-Resuscitate (DNR) orders as an immediate mechanism to exercise one’s autonomy at the end of life. In fact, DNR orders are generally the most commonly used practical clinical mechanisms through which individuals can exercise end-of-life autonomy.[15] Their importance extends beyond patient choice alone. Clear and legally recognised DNR protocols may also reduce uncertainty for physicians, minimise the risk of unnecessary or non-beneficial interventions, and alleviate the emotional and legal burden that often accompanies end-of-life decision-making.[16]
This article argues that the journey from Gian Kaur to Common Cause and, more recently, to the implementation witnessed in the Harish Rana decision reflects a remarkable constitutional evolution. However, the constitutional promise of dignity remains incomplete unless it is accompanied by coherent institutional mechanisms capable of protecting end-of-life autonomy in practice. By examining the constitutional development of the right to die with dignity alongside living wills, advance directives, passive euthanasia, and particularly Do-Not-Resuscitate orders, this article seeks to explore whether the Indian Constitution has truly begun to accompany individuals through the final and most personal decisions of human existence.
[1] TL Beauchamp and James F Childress, Principles of Biomedical Ethics (8th edn, Oxford University Press 2019) 157-162.
[2] Ronald Dworkin, Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom (Alfred A Knopf 1993) 179-217.
[3] Constitution of India 1950, art 21.
[4]Francis Coralie Mullin v Administrator, Union Territory of Delhi (1981) 1 SCC 608.
[5]Justice KS Puttaswamy (Retd) v Union of India (2017) 10 SCC 1.
[6]P Rathinam v Union of India (1994) 3 SCC 394.
[7]Gian Kaur v State of Punjab (1996) 2 SCC 648.
[8] ibid.
[9]Aruna Ramachandra Shanbaug v Union of India (2011) 4 SCC 454.
[10]Common Cause (A Registered Society) v Union of India (2018) 5 SCC 1.
[11]Common Cause (A Registered Society) v Union of India (2018) 5 SCC 1, paras 664–671 (per Chandrachud J).
[12]Harish Rana v Union of India [2026] INSC 222.
[13]Ibid.
[14] Indian Council of Medical Research, Do Not Attempt Resuscitation (DNAR): Consensus Guidelines for Shared Decision-Making and Limiting Life-Sustaining Treatment (2020).
[15]Ibid.
[16] Vidhi Centre for Legal Policy, ‘ICMR Guidelines on Do Not Attempt Resuscitation: Move the Needle on End-of-Life Care’ (2020).