In a landmark judicial decision, the Supreme Court of India on Wednesday permitted passive euthanasia for a 31-year-old man who has been in a permanent vegetative state for more than a decade. The court also laid down safeguards and procedural guidelines to regulate such decisions in the future.
Delivering separate but concurring opinions, a bench comprising Justices JB Pardiwala and KV Viswanathan said it would be in the patient’s best interest and dignity for life-sustaining support to be withdrawn in a palliative care setting.
The court allowed the plea filed by the parents of Harish Rana and approved the withdrawal of clinically assisted nutrition and hydration under strict medical supervision. It directed that the process be carried out in the palliative care unit of the All India Institute of Medical Sciences.
While reading parts of the judgment in court, the bench clarified that clinically assisted nutrition and hydration cannot be treated as ordinary care. The judges explained that it is a technologically administered medical intervention that must be prescribed and supervised by trained healthcare professionals, even when provided at home. Because of this, medical boards are permitted to take informed decisions on whether such support should be withdrawn.
The court emphasised that the key question in such cases is not whether the patient should die, but whether medical intervention should continue when recovery is medically impossible. According to the bench, the correct approach is to examine whether life should be prolonged under the existing circumstances and ongoing medical interventions.
The court noted that the patient’s parents, other close family members and the medical boards set up to examine his condition unanimously concluded that continuing clinically assisted nutrition and hydration would serve no meaningful purpose. They agreed that withdrawing the support would be in his best interest.
The judges observed that ordinarily such a decision would not require the intervention of the Supreme Court after the opinion of medical boards. However, because this was the first case of its kind in India, the court decided to examine the issue in detail.
The bench also clarified that withdrawing life-sustaining treatment must not be seen as abandoning the patient. The process, it said, must be carried out in a humane and sensitive manner that minimises pain and ensures dignity.
The court further explained that end of life care decisions do not necessarily have to be implemented in hospitals. If a proper end of life care plan has been prepared, the process may also be carried out at home rather than only in an institutional setting.
Rana, a former student of Panjab University and a resident of Ghaziabad, suffered severe head injuries in 2013 after falling from the fourth floor of his paying guest accommodation. Since then he has remained completely unresponsive and bedridden, relying on feeding tubes for nutrition and hydration.
Although he is not dependent on mechanical ventilation, he requires constant care and has shown no neurological improvement for more than ten years.
After years of treatment and therapy, his parents approached the Supreme Court seeking permission to withdraw life sustaining treatment. They argued that continued medical intervention served no therapeutic purpose and only prolonged suffering.
During the proceedings, the court ordered several medical evaluations. On December 11 it directed that a secondary medical board be formed at AIIMS after a primary board of doctors from Ghaziabad and Meerut reported that Rana had 100 percent disability quadriplegia with almost no chance of recovery.
The AIIMS medical board submitted its report on December 16, stating that there was little or no possibility of improvement in his condition and describing the situation as medically irreversible.
Before delivering the verdict, the court also interacted personally with Rana’s family members. It recorded the distress expressed by his parents and younger brother, who said they did not want him to continue suffering if medical treatment could not improve his condition.
While allowing the withdrawal of clinically assisted nutrition and hydration, the court also established procedural safeguards for future cases. It directed chief medical officers in districts across the country to prepare panels of medical experts who can evaluate requests seeking passive euthanasia.
The bench said these expert panels would help form the medical boards required to review such requests in line with the framework laid down in the Common Cause v Union of India judgment, which recognised the right to die with dignity.
In this particular case, the court waived the usual 30 day waiting period required under that framework because the family members and the medical boards had unanimously agreed on the course of action.
Finally, the bench urged the Government of India to consider introducing legislation on passive euthanasia, noting that there is currently a legislative gap on the issue.
