Breaking: Supreme Court Allows Passive Euthanasia For Man In Vegetative State For 13 Years; Applies 'Best Interest Principle'

The Supreme Court on Wednesday 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.

The Court heard the plea of the father seeking to remove all life-sustaining treatment from his son. 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 ordered, " In this case, the family and the Medical Boards are unanimous: continuing CAN is not in Harish's best interest. The medical treatment, including CAN, shall be withdrawn or withheld. The 30-day reconsideration period is waived. AIIMS shall admit the applicant to its Palliative Care Department to give effect to this order.  AIIMS shall ensure a robust palliative and end-of-life care plan that minimizes pain and preserves dignity. High Courts shall direct Magistrates to receive intimations regarding these decisions as per guidelines. The Union of India shall ensure CMOs maintain a panel of RMPs for Medical Boards. The Registry shall notify this matter in one month to report compliance with directions A to E, and again in August 2026 for other directions."

The Court ordered, " Life by preferring to die. The famous Shakespearean dilemma of 'to be or not to be,' which had so far remained as a literary quote, is now being used for judicial interpretation to converse the liberty to die." This is how we started the judgment...The core concepts underlying the decision in Common Cause (2018) have been divided into four subparts: the essential distinction between active and passive euthanasia, and the permissibility of passive euthanasia under Article 21 of the Constitution. Then there are subheadings: A: The unifying and omnipresent force of dignity in the discourse on the right to die with dignity.  B: Viewing the right to die with dignity through the prism of self-determination, individual autonomy, and privacy. C: Recognizing non-voluntary passive euthanasia within the framework of Article 21. Within these, there are further subheadings: Dignity as the standalone basis for the recognition of non-voluntary passive euthanasia; unconscious or incompetent patients and their right to bodily integrity; and authorized omission in consonance with the duty of care of doctors."

It said that the third chapter deals with the impermissibility of active euthanasia under Article 21 of the Constitution of India, establishing the permissibility of advanced medical directives and the procedural framework for passive euthanasia.

It said, "Then, we formulated the issues for determination: 1. Whether the administration of CAN (Clinically Assisted Nutrition and Hydration) 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?"

The Court discussed the "best interest of the patient" in other countries—USA, United Kingdom, Ireland, Italy, Australia, New Zealand, and the European Union—as well as in India. This included medical considerations, non-medical considerations, and the application of the best interest principle.

The Court also addressed whether it is in the best interest of the applicant that his life be prolonged by the continuation of medical treatment, and what further steps should be undertaken if a decision to withdraw or withhold treatment is reached. We also discussed streamlining and contextualizing the Common Cause guidelines, safeguarding checkpoints to remove hesitation among doctors, the role of the patient’s next of kin or guardian, and bridging the procedural gap for patients undergoing treatment in a home setting.

It also touched upon the nomination of Registered Medical Practitioners (RMPs) by the Chief Medical Officer (CMO), the 30-day reconsideration period provided in Common Cause, court intervention, legislative inaction, and the need for legislation (referencing the 196th Law Commission report, the Aruna Shanbhag decision, the 241st Law Commission report, and the draft guidelines of 2024).

The Court ordered, "CAN is a medical treatment. The "best interest" principle is paramount. There is a need for a comprehensive statutory framework. On a cumulative reading of Common Cause, it is clear that any decision to withdraw or withhold medical treatment must withstand scrutiny on two primary grounds: 1. The intervention must qualify as medical treatment. 2. Its withdrawal must strictly be in the patient's best interests. Adverting to the facts, Harish Rana (now 32) was once a bright 20-year-old pursuing a B.Tech degree when he met with a tragic accident. On August 20, 2013, he fell from the fourth floor of his accommodation and sustained a severe traumatic brain injury. This left him in a Persistent Vegetative State (PVS) with 100% quadriplegia. He exhibits no awareness of his environment and is dependent on others for all care. He has been on a tracheostomy, urinary catheter, and CAN administered through a PEG tube. Medical reports indicate no improvement in 13 years."

It added, "Regarding the first issue, we observe that the administration of CAN involves clinical factors and medical protocols. Therefore, CAN is a technologically mediated medical intervention—a medical treatment. It is permissible for Medical Boards to exercise their clinical judgment regarding its withdrawal...Regarding the second issue, the "best interest" principle applies when a patient cannot make an informed decision. A doctor’s duty to provide treatment no longer subsists where the patient is in PVS with no hope of recovery and the treatment merely prolongs biological existence without therapeutic benefit. The inquiry is not whether it is in the best interest of the patient to die, but whether it is in their best interest to have life prolonged by such treatment."

The Court formulated and answered several key legal issues. It ruled that the administration of CAN—delivered through a PEG tube—constitutes "medical treatment" rather than basic sustenance. The bench observed that CAN involves clinical assessment, surgical installation, and medical supervision, making it a technologically mediated intervention that can be legally withdrawn.

The judgment relied on the "best interest" principle, which applies when a patient is unable to make an informed decision. The Court clarified that the correct inquiry is not whether it is in the patient’s best interest to die, but whether it is in their best interest to have their life prolonged by continued treatment.

Justice KV Viswanathan also gave a concurring opinion and penned his opinion separately. Justice Viswanathan noted that the High Court had previously dismissed the family's petition on the grounds that Harish’s condition did not fit within the "four corners" of the 2018 Common Cause judgment because he was not technically terminally ill.

In its concluding remarks, the bench praised the "unyielding support" of the parents, noting they had never abandoned their son in 13 years. The Court characterized the decision not as an act of surrender, but as an act of compassion.

The bench also urged the Union Government to consider enacting comprehensive legislation on end-of-life care to provide clarity and certainty in such sensitive matters. The Registry has been directed to report on compliance with these directions within one month.

Background

Twelve years ago, a 32-year-old man named Harish Rana fell from a building. The accident was devastating. He ended up in a "vegetative state," which meant he could not move, speak, or respond to the world around him. For over a decade, Harish stayed alive only because of medical machines. He breathed through a tube in his throat and ate through a tube in his stomach. His body was covered in painful sores from lying in bed for so many years.

In 2024, father of Harish went to the Supreme Court of India. He asked the judges for passive euthanasia, which means stopping the medical treatments that were keeping Harish alive. At first, the Court said no. They asked the government to pay for Harish’s medical care instead. But even with help, Harish did not get better. His father went back to the Court and told the judges that his son’s condition was only getting worse.

On November 26, the Apex Court asked the district hospital in Sector 39, Noida to constitute a primary board to explore the option of passive euthanasia for Rana, saying his health condition has gone from bad to worse. It had asked the district hospital to file its report within two weeks on an application filed by Rana's father, seeking passive euthanasia for his son.

On November 8 last year, the Court took note of the Union health ministry's report, suggesting that the patient be put in home care with assistance from the Uttar Pradesh government and regular visits by doctors and a physiotherapist.

The Court has said that if home care is not feasible, the patient should be shifted to the district hospital in Noida for ensuring the availability of proper medical care. Describing the case as a "very hard one", the Apex Court sought the Centre's response on August 20 last year on the plea of the parents of Rana, who was a student of the Punjab University and had suffered head injuries after falling from the fourth floor of his paying-guest accommodation in 2013. He has been completely bed-ridden and on an artificial support system for more than 12 years now.

The Supreme Court had agreed with the findings of the Delhi High Court, which had refused to constitute a medical board to consider the parents' plea that their son be allowed to undergo passive euthanasia. The Apex Court had said Rana was not on a ventilator or on other mechanical support to sustain life and rather, was being fed through a food pipe and hence, no case was made out for passive euthanasia.

The Court was, however, considerate of the fact that he has been in a vegetative state for more than a decade and his old parents are finding it difficult to sustain the life through treatment as they have even sold their house. In July last year, the Delhi High Court refused to refer Rana's case to a medical board for allowing him to undergo passive euthanasia.

The High Court had said the facts of the case indicate that the man is not being kept alive mechanically and he is able to sustain himself without any extra external aid.

Cause Title: Harish Rana v. Union of India [MA 2238/2025 in SLP(C) No. 18225/2024]