The Supreme Court Wednesday permitted the withdrawal of life-sustaining treatment for 32-year-old Harish Rana, who has been in a vegetative state since 2013 when a fall left him with a severe head injury. This is the first ever Indian court order approving passive euthanasia.

A bench of Justices J B Pardiwala and K V Vishwanathan directed that “the medical treatment, including Clinically Assisted Nutrition, being administered to the applicant, shall be withdrawn and withheld”.

The court directed the All India Institute of Medical Sciences (AIIMS) to carry out a palliative end-of-life care plan so that his final stage is managed with comfort and dignity. It also waived the usual 30-day reconsideration period, a cooling-off window meant to allow objections before treatment is withdrawn, noting that both medical boards and the family were unanimous that treatment had become futile.

Reflecting on the nature of the decision, the court observed: “Our decision today does not neatly fit within logic and reason alone. It sits in a space between love, loss, medicine and mercy. This decision is not about choosing death, but is rather one of not artificially prolonging life.”

In 2024, Rana’s father approached the Delhi HC seeking permission to withdraw life-sustaining treatment, but the petition was dismissed on the ground that he was not terminally ill. The family then moved the Supreme Court, which, in 2025, constituted primary and secondary medical boards. Both concluded his condition was irreversible with negligible chances of recovery.

“In our considered opinion,” the bench said, “the greatest tragedy in life is not death, but abandonment.”

Assisted dying involves intentionally causing death through the administration of a lethal injection.

In India, this directly attracts criminal liability and may amount to culpable homicide under the Bharatiya Nyaya Sanhita. When a doctor assists the patient in performing the act, criminal liability arises for abetment to suicide. Attempted suicide continues to be an offence, even though the Supreme Court has repeatedly observed that a person attempting suicide requires care, not punishment.

Withdrawing or withholding life-sustaining treatment is treated differently because it involves stopping or not initiating medical intervention and allowing the underlying illness or injury to take its course. This distinction flows from Article 21, the “right to life”, which the Supreme Court has interpreted to include the right to live with dignity.

For terminally ill or persistently vegetative patients whose life is “ebbing out”, the court has held that the Constitution protects the choice not to be kept alive through invasive or futile medical intervention.

The Supreme Court’s order allowing the withdrawal of Rana’s treatment is the first application of its passive euthanasia framework, shaped largely by rulings on end-of-life decisions rather than law.

The judicial position was set out in Aruna Ramchandra Shanbaug v. Union of India (2011). The court reaffirmed its earlier decision in Gian Kaur v. State of Punjab (1996) that Article 21 does not include a general “right to die”. Assisted dying remained outside constitutional protection.

At the same time, the Bench recognised that the right to live with dignity may, in limited circumstances, include a dignified death.

The court observed that a premature end to life for a patient in a terminal condition or persistent vegetative state “may fall within the ambit of the ‘right to die’ with dignity as a part of right to live with dignity, when death due to termination of natural life is certain and imminent and the process of natural death has commenced”.

It drew a distinction. Assisted dying — actively causing death — remained illegal. But withdrawing or withholding life-sustaining treatment could be permitted.

Even so, the court declined permission in Shanbaug’s case. Shanbaug, a nurse at Mumbai’s KEM Hospital, was sexually assaulted in 1973 and remained in a vegetative state for decades. The court noted that she could “certainly not be called dead”: her brain stem was functioning, she breathed without a ventilator, and she showed responses such as blinking or reacting to food. The nurses who had cared for her opposed any withdrawal of treatment.

Since there was no legislation governing such decisions, the court framed interim guidelines. A decision to withdraw life support could be taken by family members, doctors, or a “next friend”, acting “bona fide in the best interest of the patient”.

But implementation required approval from the High Court. A Bench of two judges would consider the request after obtaining the opinion of a committee of three doctors.

The issue returned to the court in Common Cause v. Union of India (2018). A Constitution Bench held that the right to die with dignity is an inseparable facet of Article 21. Withdrawing or withholding life-sustaining treatment, the court said, merely “accelerat[es] conclusion of the process of natural death which has already commenced”. The judgment also recognised Advance Medical Directives, allowing adults to record in advance their wishes regarding refusal or withdrawal of medical treatment.

But the safeguards created in 2018 proved difficult to implement. Advance directives had to be signed by two witnesses and countersigned by a judicial magistrate, and hospitals had to involve multiple authorities and medical boards.

In 2023, the court acknowledged that the framework had created “insurmountable obstacles”.

It simplified the process: Advance Directives can now be attested before a notary or gazetted officer and stored in digital health records.

Hospitals constitute two medical boards — a primary board and a secondary board with an external nominee — with doctors having at least five years’ experience. The Collector’s role and mandatory magistrate visits were removed, though hospitals must inform the magistrate before implementing withdrawal of treatment.

Parliament has not enacted a comprehensive law governing euthanasia or end-of-life care.

The bench said Wednesday: “There are moments when legislative inaction speaks more loudly than legislative action, and the absence of regulation with regard to the issue at hand presents one such instance.”

The question before the court was whether the artificial feeding that had sustained Rana’s biological survival for more than a decade could legally be treated as a “medical treatment” and whether discontinuing that support would amount to unlawful euthanasia or a constitutionally permitted withdrawal of life support.

The Delhi High Court had previously rejected the family’s plea. It said that Rana was not dependent on mechanical life support because he could breathe on his own. The SC disagreed with that interpretation. Artificial nutrition delivered through a PEG tube, the bench held, cannot be equated with ordinary feeding. It is instead a part of a medically supervised intervention requiring clinical judgment and professional oversight.

The court described Clinically Assisted Nutrition and Hydration (CANH) as “a technologically mediated medical intervention that is prescribed, supervised and periodically reviewed by trained healthcare professionals in accordance with established medical standards.”

This classification was decisive for the legal analysis. Under the Common Cause framework, only medical treatment can be withdrawn when it ceases to serve the patient’s interests. If artificial feeding were treated merely as basic sustenance, doctors would have no legal basis to discontinue it even when it had become futile. By recognising CANH as medical treatment, the court placed decisions regarding its continuation or withdrawal “within the realm of clinical judgment”, allowing physicians to assess whether the intervention continued to serve any therapeutic purpose.

Once the court characterised CANH as medical treatment, it examined the issue through the constitutional framework governing euthanasia. Differentiating between “causing death” and “allowing death to occur”, the court held that active euthanasia involves a positive act designed to bring about death, such as administering a lethal drug. Passive euthanasia involves withdrawing or withholding medical treatment that artificially prolongs life. It said, passive euthanasia “allows life to ebb away and to end in the natural course,” whereas active euthanasia shortens life through a deliberate intervention.

The bench said that distinction does not occur simply from a physical act, but also “the source of the harm leading to death.” In cases of active euthanasia, the physician introduces a new agency of death. In passive euthanasia, the physician does not create a new cause but allows the patient’s underlying medical condition to take its natural course.

In this sense, the court explained, passive euthanasia represents an instance of “allowing death to occur” rather than causing it. Withdrawing a life-sustaining intervention does not amount to killing the patient, it removes the artificial barrier that had been delaying the natural progression of the underlying illness.

The ‘best interests’ test

One of the significant portions of the judgement is the applicability of the “best interest of the patient” test. The bench emphasised that the law does not ask whether death itself is desirable. It focuses on “whether it is in the patient’s best interests that life should be prolonged by the continuance of the particular medical treatment in question.”

Determining best interests, the Court said, requires a holistic assessment that goes beyond medical prognosis. Judges must weigh both medical and non-medical considerations, including whether the treatment offers any therapeutic benefit, the burdens imposed by continued intervention, and whether the patient is being kept alive in a state “devoid of awareness, autonomy, or human interaction.”

The court noted that the medical findings admitted “no ambiguity”, observing that “the treatment being administered to the applicant has become prolonged, futile, and offers no hope of recovery.”

The bench also took into account the views of Rana’s parents and siblings, who had cared for him throughout those years. “This decision can feel like an act of surrender, but we believe it is, in truth, an act of profound compassion and courage. You are not giving up on your son. You are allowing him to leave with dignity.”

In his concurring opinion, Justice Viswanathan recorded that the family had left “no stone unturned” in seeking treatment and had approached the Court only after the situation had reached a “point of no return”.

The court also used the case to address problems in how the Common Cause framework is working on the ground. It asked High Courts to issue directions to Judicial Magistrates so hospitals can formally notify them when medical boards decide to withdraw treatment, ensuring the process does not stall because of procedural confusion.

It also directed Chief Medical Officers across districts to maintain panels of doctors so that medical boards can be constituted quickly in future end-of-life cases.