Competent Person Has Fundamental Right To Refuse Medical Treatment: Apex Court Clarifies While Allowing First Passive Euthanasia

The Supreme Court, while allowing passive euthanasia for a man in a vegetative state for 13 years, has observed that a competent person has the right to refuse medical treatment within their right to self-determination under Article 21 of the Constitution of India. The Court noted that, it is only when the patient becomes incompetent the decision to withdraw or withhold medical treatment needs to be built upon the determination of whether it is in the 'best interest' of the patient.

The Supreme Court has also 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.

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, "However, before delving into that exercise, we must reiterate that a competent person has the right to refuse medical treatment within their right to self-determination under Article 21 of the Constitution of India. It is also clear that the autonomy of a competent person in refusing to take or continue a medical treatment needs to be respected. This means that until the patient is competent and is in a position to exercise his right to refuse medical treatment, he may do so. However, it is only when the patient becomes incompetent and is unable to make an informed decision for himself that the need to construe the best interest principle comes into play, because in such circumstances, the decision to withdraw or withhold medical treatment needs to be built upon the determination of whether it is in the best interest of the patient."

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

While analysing the issue of meaning, scope, and contours of the principle of “best interest of the patient”, the Court held, "Having said that, a reading of the guidelines as set out in Common Cause (supra), particularly with respect to cases where there is an AMD, shows that the treating physician triggers the process under Para. 198.4.1 of the guidelines for withdrawal or withholding of medical treatment upon the fulfilment of five broad conditions in his opinion. They are: (i) the Executor becomes terminally ill, (ii) is undergoing prolonged medical treatment, (iii) with no hope of recovery, (iv) no cure of ailment, and (v) the patient does not have decision-making capacity i.e., the patient is incompetent."

The Court said that had the patient been competent to make an informed decision, he would have exercised his right to refuse medical treatment, but it is only when he is not in a position to exercise that right and where no AMD exists in this regard that the treating physician, and patient’s next of kin/next friend/guardian, followed by the primary medical board and secondary medical board, undertake this task on behalf of the patient. 

"During this entire exercise as described above, at every stage, the need to adhere to the best interest principle while determining whether withdrawal or withholding of medical treatment must be proceeded with, is of paramount importance, for all the stakeholders including the medical boards, the patient’s next of kin/next friend/guardian, and the courts (if involved)...The discussion above provides clarity as to when the best interest principle ought to be applied and who should consider it", the Court said.

The Court also dealt with the question of why they have to adopt the best interest principle when determining whether treatment ought to be withheld or withdrawn. It said, "The answer lies somewhere between the realms of a doctor’s continuing duty to provide treatment and the lawful discharge of that duty once the threshold conditions/medical parameters are satisfied. In this context, the decision of a doctor to withdraw or withhold medical treatment on the basis of the best interests of the patient is not one directed towards causing death, but towards relieving pain, suffering, and indignity in circumstances where continued treatment no longer serves any therapeutic purpose. A doctor’s duty to provide treatment obliges until the provision of treatment is capable of conferring some therapeutic benefit upon the patient. Where, however, the patient is in the terminal stage of illness or in a vegetative state with no reasonable prospect of recovery, and the continuation of treatment merely prolongs biological existence without any therapeutic benefit, that duty no longer mandates continuing with life-sustaining treatment. In determining whether or not such a stage has been reached, the best interests of the patient must be the driving force."

It was concluded that the cumulative effect of prolonged legislative inaction is leaving citizens, particularly those situated at the most vulnerable threshold of life, exposed to serious and systemic risk. In the absence of a clear and comprehensive legislation, end-of-life decisions stand imperilled by the possibility that considerations wholly extraneous to medical science or the patient’s autonomy, most notably financial distress, lack of insurance coverage, or socio-economic vulnerability, may imperceptibly shape outcomes.

Such a vacuum creates the danger that decisions ostensibly grounded in compassion or clinical futility may, in reality, be driven by the inability of families to sustain prolonged and expensive medical intervention, thereby blurring the line between a genuine best-interest determination and an act compelled by economic exhaustion, it added.

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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