In a significant move that upholds the right to die with dignity, the Karnataka Health Department has issued a historic circular to implement the Supreme Court’s directive on withholding or withdrawing life-sustaining treatment (WLST) for terminally ill patients with no hope of recovery. This decision provides much-needed legal and ethical clarity for families and healthcare providers and enables a more humane approach to end-of-life care.
The circular, issued under Government Circular No. HFW 256 FPR 2024, titled “Giving effect to advance medical directives and withholding/withdrawing medical treatment under the order of the Supreme Court dated 24.01.2023, in Miscellaneous Application No. 1699 of 2019 in Writ Petition (Civil) No. 215 of 2005,” aligns Karnataka with the Supreme Court’s landmark judgment modifying Paragraphs 198 and 199 of the Common Cause v Union of India ruling (2018) 5 SCC 1.
Right to Die with Dignity: Supreme Court’s Recognition
The Supreme Court of India, in its judgment, has reaffirmed that the right to life under Article 21 of the Indian Constitution also includes the right to die with dignity. The ruling clarifies that life-sustaining treatment may be withheld or withdrawn if a patient is terminally ill, in a persistent vegetative state, and no longer benefits from continued medical intervention.
Furthermore, the Court has laid down structured guidelines for executing Advance Medical Directives (AMDs)—also known as living wills—enabling individuals to express their preferences regarding future medical treatment. This directive is aimed at preventing unnecessary medical interventions that may prolong suffering rather than provide relief.
Guidelines for Withholding or Withdrawing Life-Sustaining Treatment (WLST)
The Supreme Court has specified a detailed procedure for WLST, ensuring both medical and legal oversight. The key provisions include:
- Approval by the Treating Doctor – WLST can be considered only if recommended by the primary treating physician.
- Medical Boards Review –
- A Primary Medical Board, comprising three registered medical practitioners, must assess the patient’s condition.
- A Secondary Medical Board, also with three registered medical practitioners, including a nominee from the District Health Officer, must confirm the decision.
- Family Consent & Judicial Oversight – The Boards’ decisions must be made in consultation with the patient’s next of kin or the person nominated in their AMD. The final decision must be submitted to the Judicial Magistrate of the First Class (JMFC), who will forward a copy to the Registrar of the High Court for official record-keeping.
Advance Medical Directives (Living Wills) to Empower Patients
An Advance Medical Directive (AMD) allows individuals to outline their future medical preferences in case they lose decision-making capacity. This document should include:
- Specific instructions on medical interventions the patient wishes to accept or refuse.
- The nomination of at least two trusted persons to make healthcare decisions on their behalf.
- A record of the AMD should be maintained with an appointed government officer and also included in paper/digital health records stored by medical establishments.
This move by the Karnataka government reinforces its commitment to progressive, humane, and equitable healthcare policies. By ensuring that patients have the right to make informed end-of-life decisions, the state is at the forefront of ethical medical practices in India.
The implementation of this circular is expected to bring immense relief to patients and their families, sparing them from prolonged medical suffering while respecting personal autonomy and dignity in healthcare decisions.