In an unprecedented judicial ruling in India, the Supreme Court on Wednesday permitted passive euthanasia for a 31-year-old man who has been in a persistent vegetative state for more than ten years, establishing safeguards and procedural guidelines to govern such decisions in the future. In their individual yet agreeing opinions, Justices JB Pardiwala and KV Viswanathan concluded that withdrawing life-sustaining support in a palliative care environment would best serve the patient's interest and dignity.
The court granted the request made by Harish Rana's parents to discontinue clinically assisted nutrition and hydration (CANH) under careful medical oversight, instructing that the procedure be conducted in the palliative care unit at the All India Institute of Medical Sciences (AIIMS) in Delhi.
While delivering parts of the judgment in court, the bench explained that CANH should not be considered a standard form of care. "CANH is not a basic method of primary care; rather, it is a medical intervention facilitated by technology, prescribed and overseen by qualified healthcare professionals, even if provided at home. Consequently, it is within the rights of the primary and secondary medical boards to make an informed decision about discontinuing this medical support," the bench stated.
It highlighted that the main consideration in these situations is not about whether the patient should pass away, but rather if medical treatment should persist in extending life when recovery is deemed medically unattainable. Regarding the principle of best interest, we have determined that the appropriate question is not whether the patient should die, but rather if their life should be extended given the present conditions and medical treatments.
The court observed that both the patient's parents and closest relatives, along with the medical boards assigned to assess his condition, unanimously agreed that continuing CANH and medical treatment would be futile and that it would be in his best interest to withdraw them. Typically, the court would not need to intervene following the medical board's opinion, but as this is the first case of its kind, the court has chosen to investigate the matter further, the bench stated.
The court emphasized that stopping life-support treatment should not be seen as neglecting the patient. "This process must be conducted with compassion and care. It should not be considered as leaving the patient, but rather executed in an organized way that reduces suffering and maintains dignity."
The court explained that decisions regarding end-of-life care do not always need to be executed in hospitals. "If an end-of-life care plan is established, it is not mandatory for it to be implemented in an institutional environment; it can also be done at home."Rana, who previously attended Panjab University and hails from Ghaziabad in Uttar Pradesh, sustained head injuries in 2013 after a fall from the fourth floor of his paying guest residence. Since that incident, he has been entirely unresponsive and confined to bed, relying on feeding tubes for sustenance and hydration.
Even though he is not using a mechanical ventilator, he needs constant care and has not exhibited any neurological progress for more than a decade.
Following years of treatment and therapy, his parents petitioned the Supreme Court for authorization to cease life-support measures, arguing that ongoing medical care offered no therapeutic benefit and only extended his suffering.
Throughout the proceedings, the court mandated several medical assessments. On December 11, it instructed the formation of a secondary medical board at AIIMS following a report from an initial board of doctors in Ghaziabad and Meerut, which indicated that Harish had 100% disability due to quadriplegia with minimal prospects for recovery.
In a report dated December 16, the AIIMS board determined that there was minimal to no chance of recovery in his condition, labeling the medical state as irreversible.
Prior to issuing its decision, the court engaged directly with Rana's family. Documenting this interaction earlier this year, the court observed the distress conveyed by his parents and younger brother, who collectively insisted that he should not endure additional suffering if medical treatment could not enhance his condition.
In allowing the withdrawal of CANH, the court established procedural safeguards to guide future similar cases. It instructed chief medical officers in various districts to form panels of medical experts to assess applications for passive euthanasia.
The bench stated that these panels would help in forming medical boards necessary to evaluate such requests, following the guidelines established in the Supreme Court's 2018 Common Cause ruling, which acknowledged the right to die with dignity.
The court eliminated the usual 30-day waiting period mandated by the Common Cause framework, highlighting that in this instance, there was complete consensus among the family members and the medical boards.
The bench encouraged the Union government to contemplate creating a law regarding passive euthanasia to fill what it termed as a legislative gap. "We have encouraged the Union of India to think about drafting legislation on passive euthanasia due to the existing legislative gap," the bench stated.