Introduction
Euthanasia—deliberate actions to end a person’s life to relieve intractable suffering—remains one of the most ethically charged and legally contested issues worldwide. Over the past two decades, jurisdictions have adopted disparate approaches: some permit voluntary active euthanasia or physician-assisted suicide under strict conditions, while others allow only passive withdrawal of life support; many retain absolute prohibitions. In India, judicial intervention began with the Aruna Shanbaug case in 2011 and culminated in comprehensive guidelines for passive euthanasia and advance medical directives in 2018 and 2023. This explainer surveys the global euthanasia framework, recent legislative developments, and India’s evolving jurisprudence, concluding with considerations for future reform.
I. Global Legal Approaches to Euthanasia
A. Countries Permitting Active Euthanasia and Physician‐Assisted Suicide
As of mid-2025, nine jurisdictions explicitly legalize active voluntary euthanasia (AVE) or assisted dying:
- Netherlands (2002): Pioneered AVE under the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, requiring unbearable suffering, voluntary request, and review by district review committees.
- Belgium (2002) and Luxembourg (2009): Adopted near-identical statutes, extending AVE to minors with parental consent in Belgium.
- Canada (2016): Enacted Medical Assistance in Dying (MAiD), permitting both physician-administered and physician-assisted deaths for adults with grievous and irremediable conditions. In 2023, eligibility expanded to those suffering solely from mental illnesses and neurodegenerative conditions, contingent on competence and specialist approvals.
- Colombia (2015) and Ecuador (2024): Constitutional court rulings recognized the right to euthanasia for terminal illnesses, later codified in regulatory frameworks.
- Spain (2021): The Organic Law on Euthanasia grants AVE to competent adults enduring serious, incurable illness or unbearable suffering, subject to multi-stage medical, psychological, and legal reviews.
- New Zealand (2021): Following a referendum, the End of Life Choice Act permits assisted dying for terminally ill adults with less than six months to live, overseen by two independent physicians and a voluntary assisted dying practitioner.
B. Jurisdictions Allowing Only Assisted Suicide or Passive Euthanasia
Several countries differentiate between active euthanasia (where a physician administers a lethal agent) and physician‐assisted suicide (PAS, where the patient self‐administers). Switzerland, Germany, and select U.S. states permit PAS but not AVE:
- Switzerland: Article 115 of the Swiss Penal Code allows any person acting without selfish motives to assist suicide; prominent for “death tourism.”
- Germany: The Federal Constitutional Court (2020) struck down bans on assisted suicide services, affirming a general right to self-determination, but active euthanasia remains illegal.
- United States: PAS is legal in 10 states and Washington, D.C., under “Death with Dignity” laws—Oregon (1997), Washington, California, Colorado, Vermont, Hawaii, Maine, New Jersey, New Mexico, and the District of Columbia—with common criteria: terminal illness, mental competence, waiting periods, and multiple physician approvals.
Passive withdrawal of life-sustaining treatment—passive euthanasia—is widely accepted under informed consent doctrines in most Western jurisdictions and many common-law countries, provided it aligns with patient wishes or advance directives.
II. Recent Legislative Developments
A. Europe’s Assisted Dying Momentum
In June 2025, the UK Parliament narrowly approved the Terminally Ill Adults (End of Life) Bill, which would legalize assisted dying for mentally competent adults with a prognosis of six months or less. The bill mandates two independent medical assessments, a 14-day reflection period, and judicial oversight for vulnerable applicants. Scotland’s Parliament is concurrently considering similar legislation.
Portugal’s Law on Voluntary Termination of Life passed in 2025 but awaits detailed regulations. In Australia, all six states and territories now permit AVE or PAS under uniform “voluntary assisted dying” statutes enacted between 2017 and 2023, stipulating residency, terminal illness, and stringent procedural safeguards.
B. Canada’s Expansion
Canada’s MAiD regime broadened eligibility in March 2023 to include persons with severe non-terminal conditions, such as refractory psychiatric disorders and dementia, contingent on rigorous capacity assessments. Provinces have implemented regional protocols, and the federal government is reviewing further expansion to mature minors and mature minors facing grievous suffering.
C. Belgium and Netherlands: Data on Practice
Belgian and Dutch euthanasia commissions published 2024 reports demonstrating progressive uptake: in Belgium, over 3,400 cases in 2024 (6% of all deaths) and in the Netherlands, 7,200 cases (4.8% of deaths). Belgium’s 2023 amendments eliminated age thresholds for minors and removed the requirement of imminent death, triggering ethical debates on non-terminal suffering and advance directives in dementia.
III. Euthanasia in India: Judicial Evolution
A. Aruna Shanbaug (2011)
In 2011, the Supreme Court of India considered a plea by journalist Pinki Virani to permit active euthanasia for Aruna Shanbaug, a nurse in a persistent vegetative state since 1973. The Court rejected the plea but, in obiter dicta, recognized the legality of passive euthanasia—withdrawal of life support—where consented by the treating hospital, effectively initiating legal acceptance of end-of-life directives.
B. Common Cause: Living Wills and Advance Directives (2018)
A five-judge Constitution Bench in Common Cause v. Union of India (2018) unequivocally held that the Right to Life under Article 21 encompasses the “Right to Die with Dignity.” It sanctioned passive euthanasia for terminally ill or vegetative patients and upheld the validity of Living Wills (advance medical directives). The Court framed detailed guidelines: (i) living wills must be executed by mentally competent adults in the presence of attesting witnesses; (ii) passive euthanasia requires approvals by a three-member medical board, with High Court oversight; and (iii) hospitals must constitutionally uphold patient autonomy in end-of-life care.
C. Streamlining Passive Euthanasia Procedures (2023)
Responding to concerns about the 2018 guidelines’ procedural burdens, the Supreme Court on 24 January 2023 simplified the process. The revised protocol eliminated High Court approval, substituting it with: a medical board of two specialists and a primary physician at the treating hospital; expedited formalities for terminally ill patients; and time-limited validity of living wills, reviewable every five years. This modification aims to enhance accessibility and uphold patient dignity without compromising legal safeguards.
IV. Ethical, Social, and Legislative Considerations
A. Vulnerable Populations and Safeguards
Legalization debates center on protecting vulnerable groups—elderly, disabled, mentally ill—from coercion while respecting self-determination. Jurisdictions like Canada and Belgium require competency assessments by psychiatrists for non-somatic cases. The U.K. bill introduces independent advocacy support for persons with mental health conditions or disabilities, reflecting a trend toward inclusive safeguards.
B. Palliative Care Integration
Opponents of euthanasia emphasize strengthening palliative and hospice care to reduce demand. In jurisdictions like Switzerland and the Netherlands, integration of palliative services with assisted dying programs has improved holistic care, suggesting a balanced model where euthanasia complements rather than substitutes comprehensive end-of-life support.
C. Legislative Pathways in India
While judicial pronouncements have framed the right to die with dignity, India lacks specific euthanasia legislation. Parliament could codify the Supreme Court guidelines into a “Dying with Dignity Act,” delineating living will procedures, medical board composition, and institutional responsibilities. Proposed amendments to the Indian Penal Code would need to carve out exceptions for passive euthanasia and living wills, aligning statutory provisions with constitutional jurisprudence.
Conclusion
Euthanasia remains a contested yet progressively regulated domain. Globally, a spectrum of legal regimes—from comprehensive AVE frameworks in the Benelux and Canada to PAS statutes in Switzerland and select U.S. states—reflects evolving societal values on autonomy and dignity. India’s trajectory—from the Shanbaug ruling to streamlined passive euthanasia guidelines—shows judicial leadership but underscores the need for legislative action. As jurisdictions refine procedural safeguards, expand eligibility, and integrate palliative care, India must enact clear statutory provisions that balance individual rights, public interest, and ethical imperatives, ensuring that the right to die with dignity is both accessible and responsibly regulated.
