India's Supreme Court has affirmed the legal right to passive euthanasia and recognized the validity of living wills — advance directives that let terminally ill patients specify when life-sustaining treatment should be withdrawn. The ruling places India among a small cohort of nations with formal end-of-life legal frameworks. On paper, this is a significant expansion of individual autonomy. The problem is the gap between the courtroom and the hospital bed. Families of terminally ill patients have little or no awareness of living wills, let alone the procedural knowledge to draft, register, and invoke one. The legal mechanism exists; the delivery system does not. This is a pattern India knows well — progressive jurisprudence layered atop administrative vacuum. The awareness deficit is not incidental. India's healthcare system serves 1.4 billion people across wildly uneven infrastructure. Rural and semi-urban families, who constitute the majority of the population, are unlikely to encounter the concept of a living will through any channel they currently use. The information asymmetry here is structural, not temporary. Who benefits from this gap? The status quo medical establishment, which continues to make end-of-life decisions through informal family-doctor negotiation rather than patient-directed legal instruments. Hospitals face no obligation to educate patients about living wills. The legal profession gains a new document type to draft, but only for clients wealthy and informed enough to ask. The ruling also raises questions about institutional readiness. Courts, hospitals, and municipal bodies would need to coordinate on registration, verification, and enforcement of living wills. None of that infrastructure appears to exist at scale. Without it, the right is notional — available in theory to all, in practice to a narrow urban, educated, legally literate minority. The emotional and ethical weight of end-of-life decisions makes this more than a bureaucratic gap. Families facing terminal diagnoses are in crisis. Expecting them to navigate unfamiliar legal instruments without institutional support is a design failure, not a knowledge failure. The system is asking the most vulnerable people to be the most informed. If this pattern holds — progressive ruling, no implementation mandate, no public education campaign — India will have created an end-of-life right that functions as a class privilege. The court opened a door. Nobody built the hallway.
