By- R Priyanka Rao (Research Scholar) and Dr Aswathy Gopi (Assistant Professor)
Department of Psychology, SRM University AP
“Vāsāṁsi jīrṇāni yathā vihāya
navāni gṛhṇāti naro ’parāṇi
tathā śarīrāṇi vihāya jīrṇāni
anyāni saṁyāti navāni dehī.”
The Bhagavad Gita (2.22) describes the soul as leaving the body like a person discardsworn-out clothing and puts on new one. This metaphor of worn-out clothing shows that soul is eternal while the body is temporary. In the present era of medical advancements, philosophical reflection on death remains relevant. Similar to the ideology in the Bhagavad Gita, there are traditions like Prayopavesa, where a conscious decision is made by the individuals to surrender with dignity when the body is no longer capable of sustaining it. These two parallel ideas from ancient traditions are rooted in spiritual and philosophical practices, as they continue to echo contemporary debates on passive euthanasia and the broader notion of the dignity of death.
Current discussions in India have gained renewed attention with ethical and psychological questions about dignity in dying. Specifically, following the decision of the Supreme Court of India to permit the withholding/withdrawal of life-sustaining treatment in the case of Mr Harish Rana, a 31-year-old man who has remained in a vegetative state for 13 years. This case is also concerned with the role of medical technology in prolonging life and the rights of family in end-of-life decisions. Mr Harish Rana experiences sleep-wake cycles but exhibits no meaningful interactions and has been dependent on his family for all activities of self-care. The bench of the Supreme Court of India, which consisted of Mr J.B. Pardiwala and Mr K.V. Vishwanathan, mainly addressed the legal and medical considerations of allowing passive euthanasia. In addition, the bench also considered the end-of-life decisions ofhis family caregivers. Given this, it makes sense to discuss the psychological factors surrounding passive euthanasia decisions.
Personal autonomy and dignity are central psychological arguments supporting passive euthanasia. In psychological narrative, autonomy is closely associated with an individual’s sense of identity, individual volition, and control over life decisions (Keller, 2016). Keeping an individual alive for an unspecified period through artificial means may degrade his/her personal dignity, accompanied by physician dependency. Accordingly, passive euthanasia under strict legal and medical measures to prevent misuse may protect a person’s dignity when recovery is no longer possible.
At the same time, the emotional states of family members heavily influence choices about passive euthanasia. When an individual is biologically alive but lacks conscious awareness or meaningful interaction, it can cause anticipatory grief among the family members. This unrecoverable state can cause emotional exhaustion, moral distress, and uncertainty for the family. Wherein families start mourning long before the actual death of a loved one. In such instances, passive euthanasia may be considered a form of psychological resolution. Families may also finally be able to begin a more defined grieving process. Passive euthanasia provides a dignified acceptance of death, rather than keeping a person alive in a vegetative state.
When someone remains in a state of unresponsiveness, they may lose the mental and relational qualities that make them recognizable for who they once were. Psychological identity, or who a person is in terms of their mind, often expresses itself through memory, communication, emotions, and relationships that together create a coherent sense of self over time (McAdams, 2026 & Conway, 2005). Losing these abilities may prevent the person from connecting with the social and emotional world that shapes them. This situation makes people question whether keeping the body alive without consciousness truly represents a meaningful form of life.
Experiencing long-term life support situations causes deep psychological strain on family carers. Psychological strain includes going through chronic stress, financial pressure, disturbed daily life routines, and emotional fatigue (Schulz & Sherwood, 2008). Over time, this stress can cause depression, anxiety, and caregiver burnout (Moghaddam et al., 2023). Hence, families occasionally contemplate it to terminate years of prolonged emotional strain and suffering. Decision-making is not just influenced by what healthcare providers say but also by the prolonged emotional stress of the family.
Moral distress is one of the significant psychological factors experienced by families and medical professionals involved in end-of-life decisions. Deciding on whether to withdraw or withholding life support can create deep psychological conflict among the healthcare professionals (Odongo et al., 2025). Individuals often struggle between preserving life and acknowledging irreversible suffering. Long after making the medically justified decision, family members may also experience doubt, guilt, and emotional turmoil. Additionally, following passive euthanasia, the emotional pain of family members may cause feelings of personhood loss. Doctors and nurses involved in patient care for irreversible conditions may develop compassion fatigue. It is a psychological state caused by prolonged exposure to suffering (Sorenson et al., 2017). Emotional exhaustion among the healthcare providers can be seen due to repeatedly witnessing patients remain in a non-responsive state without any prospects for recovery.
The Aruna Shanbaug case v. Union of India (2011) and Common Cause v. Union of India (2018) clarified the legal circumstances under which passive euthanasia may be permitted in India. However, they remain cautious because these situations are legally and ethically delicate. Ethical clarity and structured guidelines regarding passive euthanasia may help reduce this psychological burden. In different cultures, dignity is associated with self-awareness, autonomy, and the capacity to engage in social relationships. When these abilities are permanently absent, a few individuals and families believe that allowing death to occur naturally may more effectively maintain the symbolic and emotional significance of dignity. Thus, this idea of dignity at the end of life is another major psychological component.
Even an ostensibly peaceful ending is shaped by intense suffering and often painful acts of letting go. Therefore, passive euthanasia continues to remain complex as it intersects cultural, religious, ethical, psychological, and legal aspects. Yet these philosophical reflections in ancient texts emphasize that questions about life, death, and dignity are not new to human thought. Although medical systems advance life-sustaining technology, societies encounter new ethical challenges. To address these, they must identify ways that balance the preservation of life with the autonomy, compassion, and psychological implications faced by patients and their families. After the withdrawal of life-sustaining treatment, a nurse’s gentle words to Mr Harish Rana, “Sabko maaf karte hue, sabse maafi maangte hue, ab jao,” captured the deep human acts of closure, forgiveness, and a sense of peace that accompanied the end of life.
