What is Karnataka’s ‘historic’ order on ‘right to die with dignity’?

Karnataka has taken a landmark step in facilitating the right to die with dignity. The Siddaramaiah-led government has ordered the establishment of medical boards in hospitals across the state to enable requests for dignified deaths.

This comes after the 2023 Supreme Court ruling simplified its rules for passive euthanasia for terminally ill patients. With this, Karnataka is among the handful of states in India to comply with the apex court order on living wills.

Let’s understand better.

What is a living will?

A living will is a legal document that can be made by people aged 18 or above that allows them to choose the medical care they want if they become terminally ill or develop a condition with no hope of recovery and cannot make decisions for themselves.

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It gives autonomy to individuals over their healthcare, ensuring they get treatment as per their wishes instead of suffering for a prolonged period.

Karnataka’s order on living wills

The Karnataka government has approved the setting up of medical boards in hospitals to ensure the right to die with dignity for terminally ill patients.

As per the order, all District Health officers have been directed to nominate medical experts to the secondary medical board to certify Withdrawal of Life-Sustaining Therapy (WLST) for terminally ill patients with no hope of recovery, or those who are in a persistent vegetative state.

Taking to X last week, Karnataka Health Minister Dinesh Gundu Rao said the department has issued a “historic order” to implement the Supreme Court’s 2023 order that stated the Right to Life under Article 21 of the Constitution also includes the right to die with dignity.

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“This will immensely benefit those who are terminally ill with no hope of recovery, or are in a persistent vegetative state, and where the patient no longer benefits from life-sustaining treatment,” he said.

A circular issued by the health department dated January 30, 2025, has called for establishing primary and secondary medical boards in hospitals to examine requests by the nearest kin of patients for WLST based on living wills.

“We have also come out with an Advance Medical Directive (AMD), or a living will, in which a patient can record their wishes about their medical treatment in the future. This important step will bring great relief and a dignified sense of closure to many families and individuals,” Rao said in his post.

My Karnataka Health Department, @DHFWKA, passes a historic order to implement the Supreme Court’s directive for a patients Right to Die with dignity.

This will immensely benefit those who are terminally ill with no hope of
recovery, or are in a persistent vegetative state, and… pic.twitter.com/UxN2zMdN1c

— Dinesh Gundu Rao/ದಿನೇಶ್ ಗುಂಡೂರಾವ್ (@dineshgrao) January 31, 2025

“Karnataka is a progressive state and we are always at the forefront in upholding liberal and equitable values for a more and just society,” the minister added.

Bollywood actor Kajol has hailed the Karnataka government’s order as “historic”. Sharing a snippet of a newspaper report on her Instagram Stories, she wrote, “In a historic move, Karnataka becomes the first state in India to lay out a legal framework for the ‘Right to Die with Dignity ’ for terminally ill patients. This ensures a humane, legally sanctioned process while providing closure to families.”

How it will work

The Supreme Court in its 2023 order simplified guidelines for making living wills. Citing the apex court’s directive, the Karnataka circular mentioned that the treating doctor must approve the implementation of advanced medical directives, or the living will, of the patient.

After this, the request by a patient’s family will be assessed by two medical boards in the hospital.

“The hospital where the patient is being treated must also set up the Primary and Secondary Medical Boards, comprising three registered medical practitioners each. The Secondary Medical Board must also have a registered medical practitioner nominated by the District Health Officer,” the circular read.

“The Primary and Secondary Medical Boards will take decisions regarding WLST, after obtaining the consent of the patient’s next of kin or the person nominated in the patient’s advance medical directive. Copies of the decisions of the Boards regarding WLST are to be submitted to the Judicial Magistrate of the First Class (JMFC) before giving effect to them, and the JMFC will send copies to the Registrar of the High Court for record-keeping,” the government order stated.

Medical specialists authorised under The Transplantation of Human Organs and Tissues Act, 1994, as amended in 2011, will be allowed to serve on the medical board.

As per the state’s directive, the patient has to nominate at least two people “to take healthcare decisions on their behalf in case the patient has lost their decision-making capacity”.

“Any adult person of sound mind can execute an AMD and should send a copy of the AMD to a competent officer who is to be appointed for this purpose by the local government. AMDs can also be maintained in the paper/digital health records of the patient which are maintained by the Medical Establishment,” the circular added.

Does India have any guidelines?

The Supreme Court allowed passive euthanasia for terminally ill patients in 2018 under strict guidelines. Passive euthanasia includes withdrawing or withholding life-preserving treatments to allow a person to die naturally.

Karnataka’s order on passive euthanasia following the Supreme Court’s order is a rare move. Last June, Justice MS Sonak, who presides on the Goa Bench of the Bombay High Court, became the first person in Goa to register a living will, as per an Indian Express report.

Officials told the newspaper that Goa was the first state to implement advance medical directives.

In September 2024, the Union Health Ministry formulated draft guidelines, mentioning four conditions for evaluating the option of passive euthanasia for an individual. It also invited recommendations and feedback from stakeholders on the draft.

However, the head of the Indian Medical Association (IMA) has expressed reservations about the health ministry’s draft guidelines, saying the proposed regulations will put doctors under legal scrutiny.

While living wills are legal in India, the concept has yet to gain ground. As death remains a taboo subject and amid concerns about the misuse of AMDs, most people are unaware of their right to die with dignity.

With inputs from agencies