Karnataka has become the second state in India to implement the 'Right to Die with Dignity' policy, providing terminally ill patients with the right to withdraw life-sustaining treatment under specific criteria. This significant decision aligns with the Supreme Court’s directive issued on January 24, 2023, which recognized the right to die with dignity as part of the fundamental right to life protected under Article 21 of the Indian Constitution.
On January 30, 2025, Karnataka Health Minister Dinesh Gundu Rao announced the enforcement of this policy, anticipating it will bring relief to individuals suffering from incurable diseases and those existing in persistent vegetative states. "My Karnataka Health Department, @DHFWKA, passes a historic order to implement the Supreme Court’s directive for the patient's Right to Die with dignity," Rao declared on the X platform, formerly known as Twitter.
The decision marks Karnataka as the second state, following Kerala, to enact such legislation, reinforcing the rights of patients to make informed choices about their own end-of-life care. Under this new framework, patients who are terminally ill and face no hope of recovery can opt to forgo life-support measures if it is determined they no longer benefit from such treatments.
A detailed government circular clarifies the operationalities of this policy, stating life-sustaining treatments may be withheld or withdrawn (WLST) for eligible patients. It emphasizes strict adherence to the guidelines proposed by the Supreme Court, which assert the necessity of ensuring medical evaluations are thoroughly followed. Rao noted, "This important step will bring great relief and a dignified sense of closure to many families and individuals," highlighting the compassionate nature behind the initiative.
The process to withdraw life support requires the approval of both a Primary Medical Board and Secondary Medical Board, comprising qualified medical practitioners. Initially, three doctors will evaluate the patient's condition before the Secondary Medical Board conducts its review, which includes additional certified experts, according to the procedure set forth by the health department.
The decision to withdraw treatment cannot be made lightly; it necessitates careful consideration and will only proceed with the family's formal request. If both boards validate the need for stopping the treatment, their findings will then be submitted to the judicial authorities for final consent before any actions are taken.
Rao articulated the emotional backdrop surrounding this policy, recognizing the painful circumstances families often endure when faced with making these difficult decisions for their loved ones. "We have been told by care specialists how heartbreaking it is to see patients lying unresponsive, suffering, with families overwhelmed by the decision-making burden, often feeling guilt as the pain continues long past the point of reasonable recovery," he explained.
One of the cornerstone elements of the legislation is the introduction of the Advance Medical Directive (AMD), commonly known as a living will. This enables patients to delineate their preferences for medical treatment should they become incapacitated and unable to express their wishes. This living will can be executed by any adult of sound mind and can significantly streamline the decision-making process for families during challenging times.
The AMD allows individuals to nominate representatives who can oversee healthcare decisions on their behalf, effectively communicating their medical treatment preferences. The addition of this directive is seen as not just beneficial, but transformative, allowing patients to retain autonomy over their healthcare, even as they near the end of life.
The guidelines stipulate the necessity of maintaining records of the AMD, establishing either paper or digital formats to be included within the broader National Health Digital Record framework. This accessibility aims to facilitate smoother healthcare processes, ensuring medical directives are honored across different healthcare providers.
The response to the implementation of this policy has been largely positive, with many applauding Karnataka's progressive stance. The health minister emphasized, "Karnataka is always at the forefront of upholding liberal and equitable values for a just society," positioning the state as an exemplar for others to follow.
Governor Rao's proclamation about the moral advancements of the newly instated law resonates with broader movements advocating for the dignity of patients. Such progressive legislation fosters hope and direction for other Indian states considering similar measures, reflecting changing attitudes toward end-of-life care.
This landmark order positions Karnataka as a beacon of compassionate healthcare reform, illustrating the urgent need for legislation addressing the complex dynamic of life-sustaining treatment and patient autonomy. By adopting these standards, Karnataka sets the stage for thoughtful discussions on life, dignity, and the rights of those facing terminal illnesses throughout the country.