Karnataka becomes first Indian state to allow 'right to die with dignity'

Indian state Karnataka's health department has issued orders to implement the Supreme Court's 2023 directive regarding a patient's right to die with dignity, becoming the first state to do so.

In orders issued on 30 January, the health department appointed medical experts to the secondary medical board to decide when life-sustaining treatment can be stopped for terminally ill patients.

Making the announcement on 31 January, state health minister Dinesh Gundu Rao said in a post on X: "My Karnataka Health Department, @DHFWKA, passes a historic order to implement the Supreme Court's directive for a patient's Right to Die with dignity."

The department has 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, he said.

This important step, the minister said, will bring great relief and a dignified sense of closure to many families and individuals. "Karnataka is a progressive state and we are always at the forefront in upholding liberal and equitable values for a more and just society," he said.

The Supreme Court in a ruling on 24 January 2023, allowed the withdrawal of life support in case a patient has no chance of recovery or is in a persistent vegetative state.

The health department order mandates district health officers across Karnataka to appoint registered medical practitioners to serve on the secondary medical board.

The order, signed by principal secretary to government, health and family welfare department, Harsh Gupta, on 30 January read: "In accordance with the order of the Supreme Court dated 24 January 2023, in Miscellaneous Application in Writ Petition of 2005, the District Health Officers of all districts in the state are required to nominate registered medical practitioners who can serve as members of the Secondary Medical Board to certify Withholding/Withdrawing of life-sustaining treatment (WLST) where the patient is terminally ill with no hope of recovery or is in a persistent vegetative state and where the patient no longer benefits from the life-sustaining treatment."

Additionally, medical specialists authorised under The Transplantation of Human Organs and Tissues Act, 1994, as amended in 2011, will be eligible to serve on the medical board. These professionals, including neurologists, neurosurgeons, surgeons, anesthetists, and intensivists, will play a key role in evaluating and certifying such cases.

The Centre last year also issued draft guidelines laying out four conditions on passive euthanasia for taking a "considered decision in a patient's best interests, to stop or discontinue ongoing life support in a terminally ill disease that is no longer likely to benefit the patient or is likely to harm in terms of causing suffering and loss of dignity".

The conditions were whether the individual has been declared brainstem death, if there is a medical prognostication and considered opinion that the patient's disease condition is advanced and not likely to benefit from aggressive therapeutic interventions, patient/surrogate documented informed refusal, following prognostic awareness, to continue life support and compliance with procedure prescribed by the Supreme Court.

The Draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients also stated that doctors should take a considered decision to not start a life supporting measure in a terminally ill patient that is unlikely to benefit the patient and is likely to lead to suffering and loss of dignity.

In March 2018, a constitution bench recognised a person's right to die with dignity, saying that a terminally ill person can opt for passive euthanasia and execute a living will to refuse medical treatment. It permitted an individual to draft a living will specifying that she or he will not be put on life support if they slip into an incurable coma.