The physician has a moral and legal obligation to communicate honestly and clearly with the patient`s poor prognostic state with justifications if additional aggressive support does not appear beneficial. The physician is required to engage in open discussions about imminent death or unbearable disability, the pros and cons of treatment options, and the appropriateness of natural tolerance of death. Patient self-determination with respect to medical decisions is not well articulated in our constitution. [41,54] Indeed, the position of the law regarding death with dignity is unclear, as Indian courts have only dealt with calls for euthanasia. [34,55] In the United States and Europe, relevant laws have evolved over the past three decades to reflect the paradigm shift,[56–58] while in India, legal advice has not yet fully explored the issue of end-of-life care. The guidelines were finalized by a 15-member committee made up of physicians from essential services such as cardiology, nephrology and emergency medicine, lawyers and experts in medical ethics. It was reviewed by a legal committee consisting of two lawyers. It was reported that in 81-93% of cases, European doctors had no difficulty making end-of-life decisions.  In contrast, these decisions were perceived as difficult in India due to a number of obstacles: ignorance of ethical issues, a culture of heroic “fight to the end,” lack of palliative guidance, and legal and administrative biases. [34,35] Recently, the Economist Intelligence Unit (EIU) ranked end-of-life care in India last out of 40 countries.  India performed poorly on all indices: baseline environment for end-of-life care, availability, cost and quality of end-of-life. The EIU gave India a score of 2/5 in public awareness of EOLC, which the report attributes in part to Indians` reluctance to openly discuss death and death. The EIU also reported a “woefully poor” palliative care system in all parts of India except Kerala, where there is a community-run palliative care service.
The palliative and palliative care movement, which has grown exponentially in the United States, is still rudimentary in India.  The hospices movement in the United States has gained broad public and professional support; 30% of dying patients receive palliative care.  It advocates abandoning all curative treatments when life expectancy is low. Such considerations are not to be confused with euthanasia. While the decision itself was limited to the specific question of whether euthanasia is constitutionally viable for an incapacitated adult, several comments on patients` rights were made by the court-appointed amicus curiae (legal expert): In a groundbreaking development, the Law Commission of India issued a bill in 2006 on “Medical Treatment of Terminally Ill Patients (for the Protection of Patients and Physicians).”  He reviewed the jurisprudence and legal guidelines of several countries and made some notable remarks: although the Indian Penal Code defines “death” under section 46 as “the death of a human being (unless the context otherwise requires),” the legal inconsistency occurs in light of other Indian laws, such as section 2(b) of the Births and Deaths Registration Act. 1969 , which does not make brain stem death a sufficient criterion for death. Therefore, a person whose brain stem has died and is breathing through a ventilator would be considered alive under this law. Since the publication of the last guideline in 2005, empirical information and discussion on this topic has increased exponentially.
The literature reviewed covers major surveys, observational studies, randomised and interventional controlled trials, as well as guidelines and recommendations for education and quality improvement from around the world and India. Established and developing bioethical and medico-legal opinions from around the world and in India will also be included in this review. The Supreme Court rejected active euthanasia by lethal injection. In the absence of a law regulating euthanasia in India, the court said its decision would become the law of the land until the Indian Parliament enacts an appropriate law.   Active euthanasia, including the administration of lethal compounds for the purpose of ending life, is still illegal in India and most countries.  The decision examines legal guidelines from other parts of the world. He cites Netherlands law (p. 44, Art. 53): “. with the exception of certain situations that are not at all subject to the restrictions of the law, as they are considered normal medical practice. These include: 1) stopping or not starting medically unnecessary (futile) treatment; 2) stopping or not initiating treatment at the patient`s request; 3) Acceleration of death as a side effect of the treatment needed to relieve severe suffering. The ISCCM guidelines address this aspect of patient care and do not address euthanasia issues.
The current case and the bill appear to be the beginning of a journey to resolve legal issues related to end-of-life and respect for people`s right to die with dignity.