Supreme Court Classifies CANH As "Medical Treatment"; Says Medical Board Can Exercise Clinical Judgment For Its Continuation Or Withdrawal

The Supreme Court has ruled that Clinically Assisted Nutrition and Hydration (CANH) is to be considered a medical treatment, and it is permissible for the medical board to exercise their clinical judgment with regard to the continuation, withdrawal or withholding of the CANH, like any other form of medical treatment.

The Court authorized the withdrawal of life-sustaining treatment, including Clinically Assisted Nutrition and Hydration (CAN), for 32-year-old Harish Rana, who has remained in a persistent vegetative state (PVS) since 2013.

Previously, the Court expressed its desire to meet the parents of a 31-year-old man, lying in a comatose condition for more than 12 years. The Bench perused a report containing Harish Rana's medical history filed by a secondary medical board of doctors from the All India Institute of Medical Sciences (AIIMS) here and remarked that it is a "sad" report.

The Bench of Justice JB Pardiwala and Justice KV Viswanathan observed, "The continuation of such CANH requires an ongoing clinical decision-making process, through routine medical supervision, periodic evaluation, and emergency medical management in case of infection or dislodgment of the CANH device. Consequently, it is beyond question that administration of CANH in this case is to be considered as medical treatment. Further, as we have already explained hereinabove, the fact that the applicant is administered CANH at home does not displace the status of such CANH as being considered as a medical treatment... Therefore, in line with our considered view that CANH constitutes medical treatment, it is permissible for the primary medical board and secondary medical board to exercise their clinical judgment with regard to the continuation or withdrawal or withholding of the CANH, like any other form of medical treatment, in accordance with the guidelines as laid down in Common Cause (supra)."

Advocate on Record Rashmi Nandakumar appeared for the Applicant, whereas Additional Solicitor General Aishwarya Bhati appeared for the Union of India.

The Delhi High Court had dismissed a writ petition in July 2024, ruling that Rana did not require judicial intervention because he was not being kept alive "mechanically."

The Supreme Court initially disposed of the matter in November 2024 by directing the respondents to provide and fund necessary home care for the applicant. However, Rana's parents subsequently filed this MA seeking further directions from the Court.

Facts of the Case

The case concerns Harish Rana, a 32-year-old man who was once a promising B.Tech student. In August 2013, he suffered a tragic fall from a fourth-floor balcony, resulting in a severe brain injury. Despite extensive medical interventions at PGI Chandigarh and AIIMS, Harish lapsed into a Persistent Vegetative State (PVS) with 100% permanent disability. For 13 years, he has remained bedridden and quadriplegic, kept alive by a tracheostomy for breathing and a surgically placed PEG tube for Clinically Assisted Nutrition and Hydration (CANH). Medical reports from 2025 confirmed that Harish has no awareness of his environment, no purposeful movement, and negligible chances of recovery. His family, having exhausted all treatment options, reached the difficult conclusion that further medical intervention only prolonged his agony and stripped him of his dignity.

The Court had directed the constitution of a Primary Medical Board and a Secondary Medical Board from AIIMS. The doctors found that Harish’s brain damage was non-progressive and irreversible. They reported that he experienced sleep-wake cycles but exhibited no evidence of awareness or response to pain or sound. The boards concluded that the chances of his recovery were negligible and that while the continued administration of nutrition and hydration sustained his survival, it did not improve his underlying medical condition.

Submissions on Behalf of the Applicant

Applicant argued that the PEG tube constitutes a form of medical treatment rather than basic care, citing the Common Cause (2018) precedent. It was emphasized that the core judicial inquiry should not be whether it is in the patient’s best interest to die, but whether it is in their best interest to artificially prolong life through futile intervention. The Applicant highlighted that Harish’s family was forced to approach the Court due to a lack of institutional mechanisms for home-based patients to access medical boards. It was urged that the Court link the right to dignity with the freedom from an undignified vegetative state, requesting that the 30-day reconsideration period be waived to allow a humane passing.

Submissions on Behalf of the Union of India

The Additional Solicitor General supported the permissibility of passive euthanasia in this instance, noting that the withdrawal of treatment is a lawful omission rather than an unlawful positive act. The Union agreed that CANH administered via medical devices qualifies as "medical treatment" and can be legally withheld if it no longer serves a therapeutic purpose. Based on the reports from the Primary and Secondary Medical Boards, the government acknowledged that Harish’s condition is irreversible and continued treatment is medically futile. The Union expressed support for the family’s well-considered decision and proposed that the government provide palliative care to ensure Harish's comfort during the withdrawal process.

Issues for the determination of the Court

The following questions fell for the consideration of the Court:

(1) Whether the administration of CANH is to be regarded as “medical treatment”?

(2) What is the meaning, scope, and contours of the principle of “best interest of the patient” in determining whether medical treatment should be withdrawn or withheld?

(3) Whether it is in the best interest of the applicant that his life be prolonged by continuation of medical treatment?

(4) What are the further steps to be undertaken in the event that a decision to withdraw or withhold medical treatment is arrived at?

Observations of the Court

For the issue of whether administration of CANH is to be regarded as “medical treatment", the Court said, "Since the applicant is being sustained through the provision of CANH, through a PEG tube, it is essential for us to first determine whether the administration of CANH constitutes ‘medical treatment’ and would therefore be amenable to being lawfully withheld or withdrawn. In other words, it is only in the event that CANH is recognised as a medical treatment, as opposed to being regarded as basic primary care that the withholding or withdrawal of such treatment would be permissible. In order to analyse this issue, we have delved into some landmark cases across developed common law jurisdictions, including briefly revisiting those cases already referred to in our preceding discussion, to answer the limited question whether CANH is a form of “medical treatment” and therefore, is amenable to the same principles governing the withholding or withdrawal of any other form of medical treatment."

The Court clarified that by the term CANH, they refer to all forms of enteral nutrition and parenteral nutrition which are administered upon clinical indication, which is not inclusive of oral feeding, by cup, spoon, or any other method of delivering food or nutritional supplements into the patient’s mouth.

The Court primarily categorised CANH in two categories i.e. enteral nutrition and parenteral nutrition. It said that Enteral nutrition, also known as “tube feeding”, is a method of providing nutrition directly into the gastrointestinal (GI) tract through an enteral access device (feeding tube) that is passed either through the nose, mouth or directly through the abdominal wall, up to the stomach or small intestine. Whereas Parenteral nutrition is a method for patients to receive nutrition other than through the gastrointestinal (GI) tract, and may comprise a unique sterile intravenous (IV) solution administered directly into the bloodstream via a catheter inserted into a vein.

The Court observed, "The recognition accorded to CANH as a ‘medical treatment’ is of particular importance as it enables doctors acting in good faith and with due medical propriety to undertake such treatment and be able to take further decisions regarding its discontinuation, in the same manner as any other decision the doctor is duty-bound to make concerning the appropriateness of continuing a medical intervention. In other words, recognising CANH as a medical treatment brings decisions regarding its administration, refusal, withholding or withdrawal squarely within the realm of clinical judgment, thereby making physicians duty-bound to evaluate whether it is in the best interest of the patient to continue such treatment, or whether it has lost its therapeutic purpose and has become futile, thereby outweighing its intended benefits. It cannot be said that a patient should be made a passive subject of medical technology without allowing the doctors to engage in clinical decision-making regarding such technological intervention."

The Court also said that merely because routine feeding in the form of CANH can be administered at home, by an informed lay person, it cannot be relegated to a non-medical status. CANH, even when administered at home, remains a medical procedure because such administration of nutrition and hydration must necessarily be performed under regular medical and nursing supervision, involving skills and protocols which the lay person would need to specifically obtain by drawing upon medical knowledge, it added.

The Court applied the "best interest principle" to determine whether medical treatment should be withdrawn. It ruled that the correct inquiry was not whether it was in the best interest of the patient to die, but whether it was in his best interest that his life be prolonged by the continuance of treatment. The bench observed that a doctor’s duty to continue treatment no longer subsisted when a patient was in a PVS with no hope of recovery, as such treatment merely prolonged biological existence without therapeutic benefit.

The Court clarified that a patient did not need to be "terminally ill" to qualify for the withdrawal of treatment. It held that if a person was in a permanent vegetative state, it would qualify for the constitution of medical boards. The Court noted that survival was not always the same as living and that medicine should not artificially prolong life when it no longer heals or meaningfully improves the state of the patient.

The Court acknowledged the "boundless love and resilience" of Harish’s parents and siblings, who never abandoned him. It noted that the greatest tragedy in life was not death, but abandonment. The Court then issued the following directions:

a. It ordered the withdrawal or withholding of medical treatment, including CANH.

b. It waived the 30-day "reconsideration period" because all stakeholders were unanimous in their opinion.

c. It directed AIIMS to admit the applicant to its Palliative Care Department to ensure the withdrawal was carried out in a humane and dignified manner.

d. It urged the Union Government to enact comprehensive legislation on end-of-life care to provide clarity and certainty for the future.

The bench concluded that the decision was not a choice for death, but a decision to allow nature to take its course with dignity.

The Court concluded, "The right to die with dignity is inseparable from the right to receive quality palliative and EOL care. It is imperative to ensure that the withdrawal process is not marred by pain, agony, or suffering. Therefore, we deem it necessary to issue certain directions to the respondent no. 2/AIIMS as regards the further steps to be undertaken for giving effect to the withdrawal or withholding of the applicant’s medical treatment."

The Court also remarked, "For the past thirteen years, the applicant has lived a life defined by pain and suffering. A suffering made all the more cruel by the fact that, unlike most of us, he was stripped of the ability to even give voice to his anguish. However, while this case highlights how unforgiving life can be, it is easy to lose sight of another vital fact. We note with immense respect that the applicant’s parents and siblings have stood as unyielding pillars of support. They have exhausted every effort to care for him and continue to do so with unwavering dedication. We can only place on record our deepest appreciation for their boundless love, endurance, and kindness in the face of such adversity." 

Justice K.V. Viswanathan authored a concurring opinion and clarified a significant point of law regarding the 2018 Common Cause guidelines. He noted that the High Court had previously dismissed Harish’s petition because it believed his case did not fit the "four corners" of the law, as he was not "terminally ill."

Justice Viswanathan corrected this, stating that a person does not need to be terminally ill to qualify for the withdrawal of treatment. He affirmed that if a patient is in a Persistent Vegetative State (PVS), it is sufficient to constitute medical boards and consider passive euthanasia, even if the patient is not facing immediate death from a terminal disease.

Citing Dr. William J. Mayo, Justice Viswanathan emphasized that the "best interest of the patient is the only interest to be considered." He said that when a patient cannot make an informed decision, the legal and medical framework must shift entirely toward what is best for that individual's dignity.

In his concurring thoughts, he touched upon the "fragility and transient nature of life." He noted that the decision sat in a space between medicine and mercy. He expressed that while the family’s vigil was a "testament to the true meaning of love," the legal system had a duty to ensure that survival was not artificially prolonged when it no longer constituted "living." He concluded that allowing Harish to pass was an act of "profound compassion" rather than an act of surrender.

Cause Title: Harish Rana v. Union of India [Neutral Citation: 2026 INSC 222]

Appearances:

Applicant: Advocate on Record Rashmi Nandakumar, Advocate Dhvani Mehta, Advocate Shivani Mody, Advocate Anindita Mitra, Advocate Yashmita Pandey, Advocate Manish Jain, Advocate Vikash Kumar Verma, Advocate Jugul Kishore Gupta.

Respondents: Additional Solicitor General Aishwarya Bhati, Advocate on Record Sudarshan Lamba, Advocate on Record Amrish Kumar, Advocate Sushma Verma, Advocate Shreya Jain, Advocate Shivika Mehra, Advocate B. L. Narasmma Shivani, Advocate Arun Kanwa.

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