Why in news?

The Supreme Court permitted the withdrawal of life-sustaining treatment for Harish Rana, a 32-year-old man who has been in a vegetative state since 2013 after a severe head injury.

This marks the first Indian court order approving passive euthanasia in such a case.

A bench of Justices J. B. Pardiwala and K. V. Vishwanathan allowed the withdrawal of medical treatment, including clinically assisted nutrition, being provided to Rana. The Court directed AIIMS to implement a palliative end-of-life care plan, ensuring that his final stage is managed with comfort and dignity.

What’s in Today’s Article?

• Background of the Case
• Legal Position on Euthanasia in India
• Supreme Court’s Rulings on Euthanasia in India

Background of the Case

• Harish Rana has been in a vegetative state since 2013 following a fall that caused severe head injuries.
• In 2024, his father approached the Delhi High Court seeking permission to withdraw life-sustaining treatment.
• The High Court rejected the plea, stating that Rana was not terminally ill.
• The family subsequently approached the Supreme Court, which reconsidered the case based on medical assessments.
• In 2025, the Supreme Court constituted primary and secondary medical boards to assess Rana’s condition.
• Both boards concluded that his condition was irreversible with negligible chances of recovery, supporting the decision to withdraw treatment.
• Court’s Ethical Perspective
  • The Supreme Court emphasised that the decision was not about ending life but about avoiding the artificial prolongation of life without hope of recovery.
  • It described the case as lying at the intersection of love, loss, medicine, and compassion, stressing that dignity must guide end-of-life decisions.

Legal Position on Euthanasia in India

• India distinguishes between assisted dying (active euthanasia) and withdrawal of life-sustaining treatment (passive euthanasia), with different legal implications.
• Assisted Dying and Criminal Liability
  • Assisted dying involves intentionally causing death through methods such as a lethal injection.
  • In India, this is illegal and may amount to culpable homicide under the Bharatiya Nyaya Sanhita.
  • If a doctor assists a patient in ending their life, it may also attract criminal liability for abetment to suicide.
  • Attempted suicide remains an offence, although courts have emphasised the need for care and support rather than punishment.
• Passive Euthanasia and the Right to Dignity
  • Passive euthanasia refers to withdrawing or withholding life-sustaining treatment, allowing the illness or injury to take its natural course.
  • The Supreme Court has treated this differently because it does not actively cause death but ends medical intervention that artificially prolongs life.
• Constitutional Basis
  • The legal framework stems from Article 21 of the Constitution, which guarantees the right to life.
  • The Supreme Court has interpreted this right to include the right to live with dignity, which also extends to dignity in end-of-life decisions.
  • For terminally ill patients or those in a persistent vegetative state, the Court has recognised the right to refuse invasive or futile medical treatment, allowing them to avoid unnecessary suffering when recovery is unlikely.

Supreme Court’s Rulings on Euthanasia in India

• The Supreme Court’s decision permitting the withdrawal of treatment for Harish Rana marks the first practical application of India’s passive euthanasia framework, which has largely evolved through judicial rulings on end-of-life decisions.
• Aruna Shanbaug Case (2011): Foundation of Passive Euthanasia
  • In Aruna Ramchandra Shanbaug v. Union of India (2011), the Supreme Court laid down the initial framework for passive euthanasia.
  • The Court reaffirmed its earlier ruling in Gian Kaur v. State of Punjab (1996) that Article 21 does not recognise a general “right to die.”
  • Active euthanasia or assisted dying remained illegal.
  • However, the Court recognised that the right to live with dignity may, in certain situations, include the right to die with dignity, particularly for patients in a terminal condition or persistent vegetative state.
• Distinction Between Active and Passive Euthanasia
  • The Court clarified an important distinction:
    • Active euthanasia (assisted dying): Actively causing death; remains illegal.
    • Passive euthanasia: Withdrawing or withholding life-sustaining treatment; may be permitted in limited circumstances.
• Guidelines Laid Down in the Shanbaug Case
• Since no law existed on euthanasia at the time, the Court created interim guidelines:
  • The request for withdrawal of treatment could be made by family members, doctors, or a “next friend” acting in the patient’s best interest.
  • Approval from the High Court was required.
  • A two-judge bench would decide the case after consulting a committee of three doctors.
• Despite setting guidelines, the Court did not allow withdrawal of treatment in Shanbaug’s case, noting that she still showed signs of life and the hospital staff caring for her opposed the request.
• Common Cause Case (2018): Recognition of Right to Die with Dignity
  • In Common Cause v. Union of India (2018), a Constitution Bench expanded the legal framework.
  • Key rulings included:
    • The right to die with dignity is part of Article 21 (Right to Life).
    • Withdrawal or withholding of life-sustaining treatment is permissible because it allows the natural process of death to occur.
    • The Court recognised Advance Medical Directives (living wills), allowing individuals to specify in advance whether they want life-prolonging treatment.
• Practical Difficulties in Implementation
• The 2018 framework had complex safeguards, including:
  • Advance directives signed by two witnesses and countersigned by a judicial magistrate.
  • Multiple approvals from medical boards and authorities.
• These procedures made implementation difficult.
• Simplification of the Process in 2023
  • In 2023, the Supreme Court simplified the process for passive euthanasia.
  • Key changes included:
    • Advance Directives can now be attested before a notary or gazetted officer.
    • They can be stored in digital health records.
    • Hospitals must form two medical boards (primary and secondary) with experienced doctors.
    • The Collector’s role and mandatory magistrate visits were removed, though hospitals must still inform the magistrate before withdrawing treatment.
  • As of March 2026, the Parliament of India has not enacted a comprehensive, dedicated law governing euthanasia or end-of-life care, relying instead on evolving guidelines established by the Supreme Court of India.