Brief Background
In a historic development, the Supreme Court in Harish Rana v. Union of India and Ors. (Miscellaneous Application No. 2238 of 2025 in Special Leave Petition (Civil) No. 18225 of 2024, decided on 11.03.2026) has permitted the withdrawal of life support for a 32 year old man who had been in a Persistent Vegetative State (PVC) for over thirteen years. This marks the first judicial application of passive euthanasia in India in accordance with the guidelines laid down in Common Cause v. Union of India reported in (2018) 5 SCC 1 and further modified in Common Cause v. Union of India reported in (2023) 14 SCC 131.
In the present case, the Applicant, now 32 years old, had suffered a severe diffuse axonal injury in August 2013 after falling from the fourth floor of his accommodation while pursuing a B. Tech degree at Punjab University, Chandigarh. Initially the Applicant was treated at PGI Chandigarh with ventilatory support, tracheostomy, and nasogastric feeding, however his condition showed no recovery and required admissions at AIIMS Trauma Centre for complications such as seizures, pneumonia, and bedsores. Since 2013, he has been on tracheostomy, urinary catheter and Clinically Assisted Nutrition and Hydration (CANH) administered through the Percutaneous Endoscopic Gastrostomy (PEG) Tube.
The present Miscellaneous Application was filed by Harish Rana through his parents, in the disposed SLP dated 08.11.2024. While resolving the matter in the SLP, this Court had directed that adequate care and treatment, including home care, be provided at the Respondents’ expense, with liberty to seek further directions if required.
In view of the Applicant’s continued vegetative state, violating his right to live with dignity under Article 21, the parents now seek: (i) referral of his case to a primary medical board; and (ii) a declaration that Clinically Assisted Nutrition and Hydration (CANH), administered via PEG tube, constitutes “medical treatment.”
Further, the parents have prayed that the suitability of continuing CANH be assessed in light of the five-judge Constitution Bench ruling in Common Cause v. Union of India (2018) 5 SCC 1 and the guidelines laid down therein, as subsequently modified in Common Cause v. Union of India (2023) 14 SCC 131.
Court’s Decision
The Court undertook a detailed analysis of the legal framework governing withdrawal or withholding of medical treatment, building upon the principles laid down in Common Cause (2018) 5 SCC 1. It reiterated that passive euthanasia defined as the withdrawal or withholding of life-sustaining treatment is constitutionally permissible under Article 21 when exercised in the patient’s best interests, while active euthanasia remains impermissible absent legislation.
The Court clarified that Clinically Assisted Nutrition and Hydration (CANH) constitutes medical treatment, not mere sustenance, as its administration involves surgical procedures, specialized nutritional formulations, infection control, and periodic medical supervision. Even when administered at home, CANH remains a medical procedure requiring oversight and clinical judgment.
In applying the “best interest of the patient” principle, the Court emphasized that the correct inquiry is not whether it is in the patient’s best interests to die, but whether prolonging life through continued treatment serves any therapeutic purpose. The principle requires a holistic assessment of medical and non-medical considerations, including futility of treatment, dignity, and the patient’s presumed wishes.
The Court clarified the procedure that in cases where the patient is terminally ill and undergoing prolonged treatment in respect of ailment which is incurable or where there is no hope of being cured, then the physician may inform the hospital which in turn shall constitute a primary medical board. Further, in the event the Primary Medical Board certifies the option of withdraw of further medical treatment, the hospital then shall constitute Secondary Medical Board. The Court emphasized that once both medical boards concur, judicial intervention is ordinarily unnecessary, however, given the facts and circumstances of this case and that this was the first case applying the Common Cause guidelines, it considered it appropriate to elaborate on the framework
In the present case, the Court was satisfied that both legal requirements for withdrawing and withholding medical treatment had been clearly met. It held, first, that the CANH being administered qualifies as ‘medical treatment,’ and second, that its continued use is no longer in the applicant’s best interests. With unanimous agreement from the parents/next of kin and the constituted medical boards, the Court concluded that the treatment should not be prolonged any further.
Common Cause 2023 Guidelines
The Supreme Court revisited its earlier framework on passive euthanasia and issued modified guidelines. The Court recognised that the 2018 directions had created procedural hurdles. By streamlining the requirements, the 2023 modifications sought to balance patient autonomy with necessary safeguards.
Key modifications in the common cause 2023 guidelines:
Need for a Comprehensive Legislation
The Supreme Court in Common Cause 2018 and 2023 laid down guidelines to permit withdrawal of life support in certain circumstances. Yet the Court itself emphasized that these were interim measures, not substitutes for parliamentary wisdom. Judges expressed a “pious hope” that Parliament would intervene, but nearly eight years have passed since Common Cause 2018 without legislative action. The Court observed that although two Law Commission Reports have examined the subject in depth, and several private members’ bills have been introduced in Parliament, yet these have not generated sustained legislative deliberation.
It was observed that following the Common Cause 2023 decision, the Directorate General of Health Services under the Ministry of Health and Family Welfare (MoHFW) had issued the guidelines for Withdrawal of Life Support in Terminally Ill Patients, 2024 for public consultation in June 2024. However, no fruitful conclusion has been reached to date, even on these guidelines.
The Court emphasised that this prolonged inaction has serious consequences. Families facing financial distress or lacking insurance may feel compelled to withdraw treatment, not because it is medically futile, but because they cannot afford to continue. In such cases, decisions that should be grounded in compassion and patient autonomy risk being shaped by economic exhaustion. The absence of a clear law leaves vulnerable patients exposed to uncertainty and systemic risk.
Further, the court observed that the responsibility lies with Parliament to enact a coherent, durable framework. Such legislation would provide clarity, safeguard dignity, and ensure that end‑of‑life decisions are made on medical and ethical grounds rather than financial pressures. As the Court has repeatedly underscored, judicial guidelines are limited in scope and thus only a comprehensive law can address the full range of medical, ethical, and social complexities involved.
Conclusion
The judgment represents a landmark application of passive euthanasia in India, firmly grounding the practice within the constitutional framework of Article 21. By recognising Clinically Assisted Nutrition and Hydration (CANH) as “medical treatment” and applying the principle of the patient’s best interests, the Court clarified that the true inquiry is whether continued treatment serves any therapeutic purpose, not whether it is in the patient’s interests to die.
The judgment also highlighted the significance of the 2023 modifications to the Common Cause guidelines, which streamlined procedures by reducing board size, lowering experience requirements, introducing time‑bound decisions, and expanding representation in Advance Medical Directives. Yet, the Court reiterated that these remain interim measures, stressing the urgent need for comprehensive legislation. Without a clear statutory framework, families risk making decisions driven by financial distress rather than medical futility. The judgement calls upon the Parliament to enact a coherent and durable framework to provide clarity, safeguard dignity, and ensure that end‑of‑life decisions are made on medical and ethical grounds.
By - C. George Thomas and Gurkaranbir Singh
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