In a first-of-its-kind court order in India, the Supreme Court on Wednesday allowed passive euthanasia of a 31-year-old man who remained in a permanent comatose state for more than a decade, and laid down safeguards and procedural guidelines to regulate such decisions in the future.
Delivering separate but concurring opinions, a bench of Justices JP Pardiwala and KV Viswanathan held that it would be in the best interest and dignity of the patient for life-sustaining support in a palliative care setting to be withdrawn. Track updates on the US-Iran conflict
After accepting the plea of Harish Rana’s parents, the court allowed withdrawal of the Medically Assisted Nutrition and Hydration (CANH) regimen under strict medical supervision, and ordered the operation to be carried out at the palliative care unit of the All India Institute of Medical Sciences (AIIMS), Delhi.
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Reading out parts of the judgment in court, the bench made it clear that CANH could not be treated as a form of ordinary care. “CANH cannot be considered an essential means of primary care, but is a technologically induced medical intervention that is prescribed and supervised by trained healthcare professionals, even when provided at home. Therefore, primary and secondary medical boards may exercise their informed decision on withdrawing this medical support.”
She stressed that the guiding principle in such cases is not whether the patient should die, but whether medical intervention should be continued to prolong life in circumstances where recovery is medically impossible.
“Based on the principle of best interest, we held that the correct inquiry would not be whether the patient should die, but rather whether his life should be prolonged under the existing conditions and medical interventions.”
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The court noted that the patient’s parents and relatives, as well as the medical boards set up to evaluate his condition, unanimously concluded that continuation of CANH and medical treatment would serve no purpose and that withdrawal would be in his best interest.
The bench said: “Normally, this court would not require intervention after the opinion of the medical councils, but since this is the first case of its kind, the court decided to delve deeper into this case.”
The court stressed that withdrawing life-sustaining treatment should not be equivalent to abandoning the patient. “Withdrawal must be done in a humane and sensitive way. It cannot be abandonment of the patient, but it must be done in an organized way that minimizes pain and ensures dignity.”
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The court explained that end-of-life care decisions do not necessarily need to be implemented in hospitals. “If an end-of-life care plan is in place, it is also not necessary to take such a step in an institutional setting; it can also be implemented at home.”
Rana, a former Punjab University student and resident of Ghaziabad in Uttar Pradesh state, suffered head injuries in 2013 after falling from the fourth floor of the guest accommodation where he was staying for pay. Since then, he has remained completely unresponsive and bedridden, relying on feeding tubes for nutrition and hydration.
Although he is not mechanically ventilated, he requires around-the-clock care and has shown no neurological improvement for over 10 years.
After years of treatment and medication, his parents applied to the Supreme Court for permission to withdraw the life-sustaining treatment, arguing that the ongoing medical intervention served no therapeutic purpose but merely caused long-term suffering.
During the proceedings, the court ordered multiple medical evaluations. On December 11, it had directed the formation of a secondary medical board at AIIMS after a primary board of doctors from Ghaziabad and Meerut reported that Harish was 100% quadriplegic with little chances of recovery.
The AIIMS board, in a report dated December 16, concluded that there was little possibility of his condition improving and described his medical condition as irreversible.
Before issuing the ruling, the court personally interacted with Rana’s family. Recording the interaction earlier this year, the court noted the pain expressed by his parents and younger brother, who unanimously urged that he should not suffer further if medical treatment could not improve his condition.
While the Court allowed the withdrawal of CANH, it established procedural safeguards intended to guide similar cases in the future. It directed that chief medical officers across the provinces prepare panels of medical experts to evaluate applications seeking passive euthanasia.
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The bench said that these committees will help constitute necessary medical boards to examine such applications as per the framework laid down in the Supreme Court’s 2018 Common Cause judgment, which recognized the right to die with dignity.
The court waived the 30-day waiting period normally required under the joint case framework, noting that in this case, there was unanimous agreement between the family members and the medical boards.
The authority urged the Union government to consider enacting a law on passive euthanasia to address what it described as a legislative vacuum. “We have urged the Indian Union to consider drafting legislation on passive euthanasia in view of the existence of a legislative vacuum,” the council said.
