Common Cause (A Regd. Society) v. Union of India (2018)

The decision in Common Cause (A Regd. Society) v. Union of India is a landmark constitutional ruling on the scope of Article 21 of the Constitution of India, particularly in relation to dignity at the end of life, individual autonomy, and bodily integrity. Decided by a Constitution Bench of the Supreme Court of India on 9 March 2018, the case authoritatively clarified the legal position on passive euthanasia and recognised the validity of Advance Medical Directives, commonly referred to as living wills. 

The judgement represents a significant development in Indian constitutional jurisprudence by harmonising the right to life with dignity with contemporary medical realities and ethical considerations.

Case Details

• Case Name: Common Cause (A Regd. Society) v. Union of India and Others
• Date of Decision: 9 March 2018
• Bench: Dipak Misra, C.J.I., A.M. Khanwilkar, A.K. Sikri, Dr. D.Y. Chandrachud and Ashok Bhushan, JJ.
• Jurisdiction: India
• Case Type: Civil Writ Petition
• Citation: (2018) 5 SCC 1; AIR 2018 SC 1665

Facts of Common Cause v. Union of India Case

The writ petition was filed by Common Cause, a registered society, seeking judicial recognition of the “right to die with dignity” as an integral part of the “right to live with dignity” guaranteed under Article 21 of the Constitution. The petitioner also sought directions to allow persons suffering from terminal illness or those in a deteriorated medical condition to execute Advance Medical Directives or living wills, so that their wishes regarding medical treatment at the end of life could be respected.

The matter was initially placed before a three-Judge Bench of the Supreme Court. However, due to conflicting judicial precedents on the question of the right to die, the case was referred to a Constitution Bench for authoritative determination.

The controversy had its roots in earlier decisions of the Supreme Court. In P. Rathinam v. Union of India (1994), Section 309 of the Indian Penal Code, 1860, which criminalised attempt to commit suicide, was held unconstitutional on the ground that the right to life under Article 21 included the right to die. This view was later overruled by a five-Judge Bench in Gian Kaur v. State of Punjab (1996), where the Court held that the right to life did not include the right to die, and upheld the constitutional validity of Sections 306 and 309 of the IPC.

Subsequently, in Aruna Ramachandra Shanbaug v. Union of India (2011), the Supreme Court permitted passive euthanasia under exceptional circumstances and laid down detailed guidelines to be followed until appropriate legislation was enacted. Against this evolving legal background, the Constitution Bench in Common Cause was called upon to clarify the constitutional position.

Issues for Determination

The Constitution Bench in Common Cause v. Union of India framed and examined the following key issues:

1. Whether the right to live with dignity guaranteed under Article 21 of the Constitution includes within its ambit the right to die with dignity.
2. Whether passive euthanasia, whether voluntary or in certain circumstances involuntary, is legally permissible, and if so, under what conditions.
3. Whether a living will or Advance Medical Directive can be legally recognised and enforced, and if so, what safeguards are necessary.

Relevant Legal Provisions

The Court examined the issues primarily in light of the following statutory and constitutional provisions:

• Article 21, Constitution of India: Protection of life and personal liberty.
• Article 14, Constitution of India: Equality before the law and equal protection of laws.
• Section 306, Indian Penal Code, 1860: Abetment of suicide.
• Section 309, Indian Penal Code, 1860: Attempt to commit suicide.

Contentions of the Parties

Contentions of the Petitioners

The petitioner contended that individual autonomy and self-determination are core components of personal liberty and dignity under Article 21. It was argued that when the process of death has already commenced and the patient has reached an irreversible and incurable stage, forcing continuation of life-support measures amounts to an intrusion upon bodily integrity and personal dignity.

It was further submitted that the right to die with dignity is distinct from the right to die, and forms an inseparable facet of the right to live with dignity. According to the petitioner, advancements in medical technology have resulted in situations where the dying process is artificially prolonged, causing unnecessary pain, suffering, and indignity to patients who are terminally ill or in a persistent vegetative state.

The petitioner also emphasised that refusal of unwanted medical treatment is a recognised common law right and that no individual can be compelled to undergo medical treatment without consent. In this context, the execution of Advance Medical Directives was presented as a necessary mechanism to ensure respect for patient autonomy and to remove uncertainty faced by medical professionals.

Contentions of the Respondents

The respondent State submitted that serious consideration had been given to the regulation of euthanasia, including through reports of the Law Commission of India. However, the Ministry of Health and Family Welfare had not favoured legislative enactment on the subject.

It was argued that the right to life under Article 21 does not include the right to die, and that the concept of living with dignity refers to access to basic necessities such as food, shelter, and healthcare. According to the State, recognising a right to die with dignity would amount to reading into Article 21 something that the Constitution does not envisage.

The State also emphasised that preservation of life is a primary duty of the State, and any dilution of this obligation could have serious consequences.

Analysis and Reasoning of the Court in Common Cause v. Union of India

Constitutional Position on the Right to Die

The Court undertook a detailed analysis of earlier precedents. In P. Rathinam, the right to life was interpreted expansively to include the right not to live a forced life, leading to the invalidation of Section 309 IPC. However, in Gian Kaur, the Constitution Bench rejected this approach and reaffirmed the sanctity of life, holding that extinction of life could not be read into Article 21.

At the same time, Gian Kaur recognised that the right to life includes the right to live with dignity up to the end of natural life. The Court in Common Cause clarified that this observation supports the notion that dignity must be preserved even during the process of dying, particularly in cases of terminal illness or irreversible medical conditions.

Passive Euthanasia and Aruna Shanbaug

The Court examined the ruling in Aruna Shanbaug, which permitted passive euthanasia under judicially prescribed guidelines. The Constitution Bench held that the two-Judge Bench in Aruna Shanbaug had erred in suggesting that passive euthanasia could be made lawful only through legislation. The Court clarified that passive euthanasia is fundamentally different from active euthanasia, as it involves withdrawal or withholding of life-sustaining treatment rather than a positive act to cause death.

It was observed that across jurisdictions, passive euthanasia has been accepted either through legislation or judicial interpretation, subject to strict safeguards.

Right to Refuse Medical Treatment

The Court recognised that refusal of medical treatment by a terminally ill patient does not amount to suicide or euthanasia. While suicide involves a positive overt act with the intention to end life, refusal of treatment merely allows the underlying disease to take its natural course. In such cases, the cause of death is the illness itself and not any self-initiated act.

The Court acknowledged the “principle of necessity” or “emergency principle,” which allows medical treatment without consent in life-threatening situations. However, this principle cannot override a valid Advance Medical Directive that clearly expresses the patient’s informed wishes.

Autonomy and Self-Determination

The judgement strongly affirmed that autonomy and self-determination are intrinsic to the right to life and personal liberty. All competent adults have the right to refuse medical treatment, even if such refusal may result in death. The Court emphasised that medical decisions must be guided by the patient’s best interests and expressed wishes, rather than abstract notions of societal or State interest.

Advance Medical Directives and Safeguards

A substantial portion of the judgement was devoted to laying down an exhaustive framework for the execution, preservation, and implementation of Advance Medical Directives. The Court held that such directives serve as an effective means to safeguard the right to live with dignity by ensuring that medical decisions at the end of life reflect the patient’s informed choices.

The Court specified who may execute an Advance Directive, the conditions for its validity, its contents, the manner of recording and preservation, and the procedure to be followed when giving effect to it. Detailed safeguards involving medical boards, the jurisdictional Collector, and the Judicial Magistrate of First Class were prescribed to prevent misuse and to ensure transparency.

The Court also addressed situations where no Advance Directive exists and laid down parallel procedures to ensure that decisions are taken in the best interests of the patient, with due involvement of family members and independent medical experts.

Common Cause v. Union of India Judgement

The Constitution Bench in Common Cause v. Union of India concluded that the right to live with dignity under Article 21 includes the right to die with dignity in cases where life is ebbing out due to terminal illness or irreversible medical conditions. It reiterated that passive euthanasia is legally permissible subject to stringent safeguards.

The Court expressly declared that:

• The right to die with dignity stands recognised as part of Article 21, consistent with the principles laid down in Gian Kaur.
• An adult of sound mental capacity has the right to refuse medical treatment, including withdrawal of life-sustaining measures.
• Advance Medical Directives or living wills are legally valid and enforceable, subject to the detailed procedural safeguards prescribed by the Court.

By harmonising dignity, autonomy, and sanctity of life, the judgement in Common Cause v. Union of India represents a humane and constitutionally grounded approach to end-of-life decision-making in India.