Ethics, communication and palliative care

Withholding and withdrawing treatment in India (law and process)

Reviewed Nov 2026·5 references
New· views rounded down, updated weekly

The legal basis after Common Cause 2018 and the 2023 modification, DNAR, the two-medical-board process and ISCCM guidance.

Definition
The Supreme Court (Common Cause v Union of India, 2018) recognised the right to die with dignity under Article 21, permitting withholding and withdrawal of life-sustaining treatment (passive euthanasia) and advance directives. In January 2023 the Court simplified the procedure. Active euthanasia remains illegal.

At the bedside

  1. 1

    Establish futility or the patient's wish

    Terminal illness or irreversible condition with no reasonable hope of recovery, or a capable patient refusing treatment, or a valid advance directive.

  2. 2

    Capable patient

    An adult with capacity may refuse any treatment including life support; document the capacity assessment and informed refusal.

  3. 3

    Primary Medical Board

    ≤ 48 h

    Hospital board of the treating physician and at least two subject experts with ≥ 5 years experience; decision within 48 h (2023 modification).

  4. 4

    Secondary Medical Board

    ≤ 48 h

    Hospital board including a registered medical practitioner nominated by the district Chief Medical Officer and at least two subject experts (≥ 5 years); decision within 48 h; the JMFC is informed.

  5. 5

    Family consent

    Consent of the next of kin / guardian recorded; if the board refuses, family may approach the High Court.

  6. 6

    DNAR / limitation orders

    Withholding CPR or escalation (DNAR, 'allow natural death') is a medical decision taken with the family, documented with reasons and reviewed; it does not mean withdrawing other care.

  7. 7

    Implement compassionately

    Continue comfort care, symptom control and family support; withdraw treatments in a planned sequence (see palliative-symptom-care).

Key legal points (India)

IssuePosition
Active euthanasiaIllegal
Withholding/withdrawing futile life supportLawful following the Common Cause procedure
Capable adult refusing treatmentRight to refuse recognised
Advance directive (living will)Valid; signed before 2 witnesses and attested by notary or gazetted officer (2023)
Medical boardsPrimary and secondary boards, each within 48 h; JMFC informed

Summary for clinicians, not legal advice; check hospital policy and legal counsel.

Red flag · call your senior now
Withdrawing life support without documented board decisions and family consent exposes the team to legal risk - follow the process.
Pitfall
Equating DNAR with 'no treatment' - patients with DNAR orders still receive all appropriate non-CPR care.
Pitfall
'Discharge against medical advice' used as a substitute for an honest end-of-life plan.
Pearl
Withholding and withdrawing are ethically equivalent (ISCCM) - starting a time-limited trial does not oblige indefinite continuation.

References

  1. 1

    Supreme Court of India. Common Cause (A Regd. Society) v. Union of India and Another, Writ Petition (Civil) No. 215 of 2005, judgment of 9 March 2018, (2018) 5 SCC 1.

  2. 2

    Supreme Court of India. Common Cause (A Regd. Society) v. Union of India, Miscellaneous Application No. 1699 of 2019 in WP (C) 215 of 2005, order of 24 January 2023, [2023] 1 SCR 1137.

  3. 3

    Chawla R, Kapadia F, Rajagopalan S, Amin P, et al. Guidelines for end-of-life and palliative care in Indian intensive care units: ISCCM consensus ethical position statement. Indian J Crit Care Med 2012;16:166-81.

  4. 4

    Kapadia F, Rajagopalan S. The ISCCM/IAPC position statement: ending the Sisyphean struggle to practice ethical end-of-life care in India. Indian J Crit Care Med 2024;28(3):189-90.

  5. 5

    Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008;36:953-63.

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