End-of-life decisions

Why in News?

  • The constitution bench has prescribed new modifications in advance medical directives and passive euthanasia.


  • In 2018, Supreme Court (SC) granted legal status to the concept of ‘advance medical directives’ and allowed passive euthanasia (subject to certain conditions). 
  • It was seen as an important decision in terms of both the patient’s autonomy over end-of-life decisions and the right to a dignified death. It was later suggested by doctors that some specific conditions turned out to be “insurmountable obstacles”.

New Modifications: 

  • On 3rd February 2023, a Constitution Bench modified the earlier directions to make it more workable and simpler. Some of the new modifications are: 
  • The advance directive need not be countersigned by a judicial magistrate and can just be attested before a notary or a gazetted officer. This implies that it is enough to have the satisfaction of the notary or officer that the document is executed voluntarily, without coercion or inducement, and with full understanding. 
  • In the earlier ruling, it was directed that the executor should name a guardian or a close relative who would be authorized to facilitate consent to refuse or withdraw medical treatment, in case the patient is incapable to take a decision. This has been amended to include multiple guardians or relatives. 
  • Earlier it was the responsibility of the magistrate to inform the family members about the document (if they are absent at the time of its execution). This has been modified and now the onus is on the persons themselves to provide a copy of the advance directive to the guardians or close relatives named in it and the family physician. 
  • The advanced directive may also be included in digital health records.
  • As per the new guidelines, the hospital would be required to constitute a primary medical board that would certify the instructions on refusal or withdrawal of treatment. 
  • A secondary board should also be formed at the hospital level. This board must include a doctor nominated by the district’s chief medical officer. The task of the board is to endorse the primary board’s certificate. 
  • It should be noted that in the original guideline (2018) the District Collector was supposed to constitute the second medical board. 
  • The new guidelines also prescribe the experience and specializations of the members of the medical boards. 
  • These guidelines are important and useful for the concept of “living will” and advanced medical directives.
  • It is also suggested that the Parliament should formulate a comprehensive law in this regard. Such a law should also have the provision of a repository of advance directives.
Share Socially