Autonomy at the End of Life: Legal and Educational Challenges in Implementing Living Wills and Passive Euthanasia in India

Abstract

The right to end-of-life autonomy has evolved in India from a peripheral ethical issue to a constitutional question. The apex court of our country has recognised passive euthanasia, advance medical directives as legal manifestations of dignity, bodily integrity and decisional autonomy under Article 21 of the Constitution. This legal recognition has not rendered living wills socially intelligible, clinically usable and accessible for persons with disabilities, older persons, persons with communication barriers and families contending with terminal illness. The paper uses a multi-tiered legal-educational framework to look into the legal and pedagogic issues in India regarding living wills and passive euthanasia. It employs a doctrinal and analytical method founded upon Supreme Court decisions, statutory materials, Law Commission documents, medical ethics guidelines, palliative care literature, the disability rights literature and inclusive education literature. According to this analysis, the Common Cause (2018)  constitutionalised the right to end-of-life self-determination, and the 2023 modification simplifies the operations and implementation of advance directives. The 2026 decision in Harish Rana provided additional clarity on the position of clinically assisted nutrition and hydration as treatment and the best-interest standard for people unable to currently express preferences. Though there is effort to implement the Convention, it is hampered by public ignorance, procedural anxiety of health professionals, inaccessible legal-medical phrasing, weak institutional ethics infrastructure, and lack of training to communicate in a disability-inclusive fashion. Unless India builds an ecosystem around legal literacy, supported decision-making, palliative counselling, professional curricula and accessible public communication, living wills are likely to be a formal right than an effective safeguard.  A proposed model for developing disability-inclusive policies that balance autonomy and protection from abuse medical ethics and educational preparedness.