In a rare and significant ruling, the Supreme Court on Wednesday permitted passive euthanasia for a 31-year-old man who has been in a permanent vegetative state for more than a decade. The court also laid down procedural safeguards and guidelines to regulate similar decisions in the future.
A bench of Justices JB Pardiwala and KV Viswanathan delivered separate but concurring opinions, stating that withdrawing life-sustaining support in a palliative care environment would be consistent with the patient’s dignity and best interests.
Allowing a petition filed by the parents of Harish Rana, the court approved the withdrawal of clinically assisted nutrition and hydration (CANH) under strict medical supervision. It directed that the procedure be carried out in the palliative care unit of the All India Institute of Medical Sciences (AIIMS), Delhi.
Court clarifies nature of medical support
While reading portions of the judgment, the bench clarified that CANH should not be treated as ordinary care.
“Clinically assisted nutrition and hydration cannot be considered basic caregiving. It is a medical procedure that relies on technology and requires supervision by trained healthcare professionals, even when it is administered outside a hospital setting. Therefore, medical boards are authorised to take an informed call on whether such support should continue,” the court observed.
The judges emphasised that the core question in such cases is not whether a patient should be allowed to die.
“The real issue is not deciding whether the patient ought to die, but determining whether life should continue to be prolonged through medical intervention when recovery is medically impossible,” the bench said.
Medical boards and family in agreement
The court noted that Rana’s parents, close family members, and the medical boards that examined him had all reached the same conclusion — that continuing CANH and treatment would not serve any therapeutic purpose and that withdrawal would be in his best interest.
“Ordinarily, once medical boards have expressed their opinion, the matter may not require judicial intervention. However, since this is the first instance of its kind, the court felt it necessary to examine the issue in greater depth,” the bench said.
Withdrawal must be humane and dignified
The judges underlined that ending life-sustaining treatment should not be interpreted as abandoning the patient.
“The process must be carried out with compassion and sensitivity. It should not amount to neglect but must follow a structured procedure that reduces suffering and preserves the patient’s dignity,” the court stated.
The bench also clarified that end-of-life care decisions do not necessarily have to be implemented in hospitals.
“Where an end-of-life care plan exists, such measures need not be confined to an institutional setting and may also be carried out at home,” it added.
Background of the case
Rana, a former Panjab University student from Ghaziabad in Uttar Pradesh, suffered severe head injuries in 2013 after falling from the fourth floor of his paying guest accommodation.
Since the accident, he has remained bedridden and unresponsive, surviving through feeding tubes that provide nutrition and hydration.
Although he is not dependent on a mechanical ventilator, he requires constant care and has shown no neurological improvement for more than ten years.
After prolonged treatment and rehabilitation efforts, his parents approached the Supreme Court seeking permission to withdraw life-sustaining treatment. They argued that continued medical intervention offered no therapeutic benefit and only prolonged his suffering.
Multiple medical evaluations conducted
During the proceedings, the court ordered several medical assessments.
On December 11, it directed that a secondary medical board be formed at AIIMS after a primary board comprising doctors from Ghaziabad and Meerut reported that Rana had 100 per cent disability with quadriplegia and extremely limited chances of recovery.
The AIIMS medical board, in its report dated December 16, concluded that there was virtually no possibility of improvement and described his condition as medically irreversible.
Before delivering the final judgment, the court also interacted personally with Rana’s family members.
Recording the interaction earlier this year, the court noted the emotional distress expressed by his parents and younger brother, who unanimously said they did not want him to continue suffering if medical treatment could no longer improve his condition.
Safeguards and future framework
While granting permission to withdraw CANH, the court also introduced safeguards aimed at guiding similar cases in the future.
It directed chief medical officers across districts to prepare panels of medical experts who can evaluate requests for passive euthanasia.
These panels would assist in forming medical boards required to assess such applications in accordance with the framework established in the Supreme Court’s 2018 Common Cause judgment, which recognised the right to die with dignity.
The bench also waived the 30-day waiting period typically required under the Common Cause framework, noting that in this case both the family and the medical boards were unanimous in their opinion.
Call for legislation
The court urged the Union government to consider introducing a law on passive euthanasia, pointing out the absence of a comprehensive legislative framework.
“We have asked the Union government to examine the possibility of enacting legislation on passive euthanasia, as there is currently a gap in the statutory framework,” the bench said.
