Right to Palliative Care and End-of-Life Decisions in Kerala

Source: Supreme Court of India, Common Cause v. Union of India, (2018) 5 SCC 1 (passive euthanasia / advance medical directives); National Health Policy, 2017; NMC Regulations 2023

Reviewed by the Commoner Law Editorial Team. Sourced from Indian central (Union) law — Constitution of India, central Acts of Parliament, and Supreme Court decisions. State-level information reflects each state's own Acts and High Court rulings. Written in plain language for general understanding — this is educational content, not legal advice. Our editorial standards

Indian Central Law

What is this right?

The Supreme Court in Common Cause (2018) recognised the right of a terminally ill patient to refuse life-sustaining treatment — upholding the concept of "dying with dignity" as part of Article 21.

Passive euthanasia is legal in India — withdrawal of life-sustaining treatment (ventilator, artificial nutrition) at the patient's informed refusal is permitted, and courts have allowed it with procedural safeguards.
Advance Medical Directive (Living Will): The Supreme Court (Common Cause, 2018) permitted competent adults to make a valid advance directive specifying that they do not wish to be put on artificial life support in terminal illness. The directive must be:
- In writing, signed by the person and two witnesses.
- Countersigned by a Judicial Magistrate First Class.
- A Nominated Representative must be named to carry out the directive.
Palliative care: The National Health Policy, 2017 recognises the need for universal access to palliative care — pain management (including opioid analgesics for terminal patients) is a part of the right to health under Article 21.
Opioid access: The Narcotic Drugs and Psychotropic Substances Act (amended 2014) allows essential narcotic medicines (morphine, oxycodone) for pain management in palliative care through government hospitals and licensed institutions.
Right to information: A terminally ill patient has the right to know their diagnosis and prognosis — doctors cannot withhold a terminal diagnosis from a competent patient (though family wishes can be considered).

When does it apply?

You or a family member is terminally ill and wishes to refuse further curative treatment and focus on comfort/palliative care.
You want to make an advance medical directive (Living Will) specifying your wishes for end-of-life care.
A terminally ill person is in severe pain and requires access to opioid pain management.

What to Do If a Terminally Ill Person in India Is Being Denied Adequate Palliative Care

To make an Advance Medical Directive: prepare a written document specifying your wishes, have it signed before two witnesses and a Judicial Magistrate First Class (JMFC), and keep a copy with your nominated representative and your family doctor.
Discuss palliative care options with the treating doctor — every major government hospital must have a palliative care wing (National Health Policy mandate). Ask for a referral to the hospital's palliative care team or a specialist palliative care facility.
If a family member is dying in pain and opioid medication is being withheld due to prescription reluctance, escalate to the hospital's pain management department or request a palliative care specialist's involvement.

What should you NOT do?

Do not confuse passive euthanasia (legal) with active euthanasia (illegal) — the Supreme Court has only permitted withdrawal of life-sustaining treatment, not active steps to end life.
Do not make an advance directive without the proper formalities (magistrate's countersignature) — an informal written note does not have the legal standing of the advance directive under Common Cause.
Do not keep the advance directive secret from your nominated representative, family doctor, and the hospital — it must be accessible at the time of need to be acted upon.

Kerala Law

How Kerala differs from central law

Kerala is a global leader in community-based palliative care. The state's Neighbourhood Network in Palliative Care (NNPC) model, pioneered in Kozhikode district in the late 1990s, involves trained community volunteers who provide home-based palliative care to patients with chronic and terminal illnesses. This model has been recognized by the World Health Organization (WHO) as an exemplary approach to community palliative care.

Kerala became the first Indian state to announce a palliative care policy in 2008 and declared palliative care as an integral part of the state's primary healthcare system. The state government provides funding for palliative care units in every primary health centre and community health centre. The Institute of Palliative Medicine (IPM), Kozhikode, is a WHO Collaborating Centre for Community Participation in Palliative Care and Long-Term Care.

Kerala amended its rules under the NDPS Act to simplify access to morphine and other essential opioid analgesics for pain relief. The state has among the highest per-capita morphine consumption in India for medical purposes, reflecting better access to pain management for palliative care patients. Every district hospital and most taluk hospitals in Kerala have dedicated palliative care units.

Additional Steps in Kerala

For palliative care services, contact the nearest primary health centre or the Institute of Palliative Medicine, Kozhikode at 0495-2740005. The Pain and Palliative Care Society (PPCS) can be reached through district-level palliative care units. DISHA helpline: 1056 or 0471-2552056. For issues with access to pain medication, contact the Kerala Drug Control Department.

Relevant Law: Kerala Palliative Care Policy, 2008 (revised 2019); NDPS Act, 1985 (as amended 2014); Kerala State NDPS Rules

Common Questions

When does right to palliative care and end-of-life decisions apply?

You or a family member is terminally ill and wishes to refuse further curative treatment and focus on comfort/palliative care.You want to make an advance medical directive (Living Will) specifying your wishes for end-of-life care.A terminally ill person is in severe pain and requires access to opioid pain management.

What should I do if a hospital in India is refusing to allow my terminally ill family member to refuse further curative treatment?

To make an Advance Medical Directive: prepare a written document specifying your wishes, have it signed before two witnesses and a Judicial Magistrate First Class (JMFC), and keep a copy with your nominated representative and your family doctor.Discuss palliative care options with the treating doctor — every major government hospital must have a palliative care wing (National Health Policy mandate). Ask for a referral to the hospital's palliative care team or a specialist palliative care facility.If a family member is dying in pain and opioid medication is being withheld due to prescription re...

What mistakes should I avoid with right to palliative care and end-of-life decisions?

Do not confuse passive euthanasia (legal) with active euthanasia (illegal) — the Supreme Court has only permitted withdrawal of life-sustaining treatment, not active steps to end life.Do not make an advance directive without the proper formalities (magistrate's countersignature) — an informal written note does not have the legal standing of the advance directive under Common Cause.Do not keep the advance directive secret from your nominated representative, family doctor, and the hospital — it must be accessible at the time of need to be acted upon.

Right to Palliative Care and End-of-Life Decisions in other states

Same topic, different jurisdiction. Pick the one that applies to you.