People with MND inevitably face a time when life turns into something unimaginable and not their own. The choice of assisted dying can help individuals retain some control over a relentless condition that turns even more cruel at some point.  With significant functions and independence long gone, the last stage turns into a bizarre circle of medical technology prolonging an irreversible condition while tackling the many complications that invariably show up. 

 

What is MND?

MND or ALS is a neurodegenerative condition where a person progressively loses muscle strength - mobility, speech, swallowing, and finally breathing. Cognitive and behavioural changes too are seen in many. A diagnosis means a limited time (18 months to 3 years) to live. There is currently no cure.

How tough does it get

The last stage of MND (the final 6 to 12 months) is a period of rapid clinical deterioration and escalation in care needs. The person becomes largely or completely immobile with paralysis of most muscles of the body. Speech is severely impaired or lost. Communication is down to eye gazes. Excessive drowsiness and sleeping for unusually long hours become normal. Infections and increased hospitalisations begin with increased risk of aspiration pneumonia. PEG tube (direct tube to the stomach for feeds) and tracheostomy (for suction of phlegm from the throat) may become inevitable. The risk of malnutrition and dehydration increase.

 

The last stage gets real, real fast 

Our 80+ dad who was otherwise healthy and active was diagnosed with MND in 2023. Sometime in mid-2025 he slipped into its last stages. A far-away look settled over his eyes as a textbook style deterioration set in. He had been stoic, strong, and smiling his heart-winning smile, until then. First, a microaspiration led to a bad lung infection. A long hospitalisation followed and the move to PEG tube. His post PEG tube recovery was marked by complications, confusion, pain, depression, and non-responsiveness.  Communication was left to eye gazes. He had lost his speech around 6 months back and had switched from using a digital slate to pointing out from an alphabet chart (not very successfully). His decision-making capabilities were long lost.

He seemed to be just holding on. An attempt to capture biometrics by a bank made us aware of the decline in his responsiveness. He wasn't able to voluntarily blink. The final hospitalisation was in December 2025. Sodium levels and other complications and challenges followed. Days went without clear eye contact or response to our presence. His eyes remained mostly shut. After more than a week and two blood transfusions later, we brought him home. By this time home for him was a room fitted with a hospital bed, suction machine, oxygen concentrator, and oxygen cylinders. But it was still home. He passed away there – respiratory failure. That is usually how they go.

 

Why support assisted dying or active euthanasia in India?

Compassion: Our current euthanasia laws seem lost in legal and ethical confusion

Passive euthanasia was legalised in 2018. Common Cause vs Union of India It allows withdrawal of life-support in cases deemed terminal and acknowledges the right to die with dignity as a fundamental right. It lays out detailed guidelines (later streamlined in 2023) for both an “advance directive” and “living will” to be made by the patient and for cases where no such directive is left behind. However, in July 2024, the Delhi High Court and subsequently a bench chaired by the CJI rejected the Harish Rana plea for passive euthanasia on the grounds that he wasn’t being kept alive by “mechanical” life-support means. Rana has been in a “permanent vegetative state” since 2013. After yet another plea, the Supreme Court finally permitted withdrawal of life-sustaining medical support to Rana in March 2026.

Dignity: Shortening the wait and suffering

Assisted dying can give adults the choice and dignity of a compassionate death within the law. They can be at peace knowing that if and when their suffering becomes too great, they have a dignified option.

Safety: Safeguarded assisted dying laws exist globally

Countries around the world where assisted dying is legal have not had to repeal the law. They have functioned effectively and safely for decades preventing misuse and protecting the vulnerable with stringent safeguards.

Empathy: Assisted dying eases suffering and fear

People continue to suffer without hope, incapacitated by conditions that have no cure, even when critical and palliative care is excellent. Assisted dying can offer relief safely and needs to be seen as an extension of compassionate care.

Clarity: Legal and ethical clarity will help individuals make the choice that is best for them. It can allow healthcare professionals be the experts they are instead of courts and lawyers.

Currently in India, assisted dying is treated as “murder”, or at the minimum, as “culpable homicide”.  A clear law can make assisted dying what it is – a compassionate and dignified way to relieve a terminally ill person from suffering.