In a first, Supreme Court allows passive euthanasia of man in vegetative state since 2013- Right to die with dignity

Subject

In a first, Supreme Court allows passive euthanasia of man in vegetative state since 2013- Right to die with dignity

Harish Rana

The Supreme Court’s judgment on Wednesday (March 11) permitting the withdrawal of life-sustaining treatment from 32-year-old Harish Rana – who has been in a permanent vegetative state since he fell from the fourth floor of his paying guest accommodation near Panjab University in Chandigarh on August 20, 2013 – has been widely and rightly described as a landmark.

Passive Euthanasia

India has had a legal framework for passive euthanasia since March 2018, when a constitution bench decided Common Cause v Union of India ((2018). The court held that the right to life under Article 21 – interpreted since Maneka Gandhi (1978) as encompassing the right to live with dignity – extends to the manner of dying. A person in a permanent vegetative state with no prospect of recovery cannot be compelled to remain alive by medical intervention.

Detailed guidelines were laid down for a two-tier process: a primary medical board certifying the patient’s condition; an independent secondary medical board reviewing that finding. In January 2023, a fresh constitution bench ((2023) simplified the procedure after years of complaints that the original guidelines were unworkable.

In June 2024, the directorate general of health services released draft guidelines for public consultation intended to give the framework administrative grounding. As of today, these guidelines remain unfinished. And the framework had produced not a single case in which passive euthanasia was actually permitted before the Supreme Court. A right declared by the constitution bench, refined twice, and for eight years remained effectively a dead letter.

The Delhi high court had held that Harish was not “terminally ill” and therefore fell outside the Common Cause framework. This reasoning – which would have excluded all PVS patients without terminal illness from the passive euthanasia framework – is wrong, and Justice Viswanathan says so plainly. The 2018 framework applies equally to patients in a permanent vegetative state with no hope of recovery.

The significance is practical:

it removes a threshold that, if allowed to stand, would have given other high courts a basis to turn away the same class of cases.

At para 318, the court notes that once both medical boards had concurred, the decision could have been implemented automatically, without judicial intervention – the guidelines do not require court approval when boards agree.

The court intervened not because procedure demanded it, but because this was the first case in which the Common Cause guidelines were being applied in their full measure, and it wished to expound on the law. There is a candour in this worth marking: the court is acknowledging that it is using this case to build out the doctrinal architecture that eight years of declared right had left undeveloped.

Aruna Ramachandra Shanbaug (2011)

That architecture should long since have been built by Parliament. Aruna Ramachandra Shanbaug (2011) called for legislation. Common Cause in 2018 called for legislation. The 2023 modification order exists because the court’s own eight-year-old guidelines had proved too cumbersome to use. The 2024 Draft Guidelines remain in consultation.

Parliament has produced nothing. There is no statute on passive euthanasia. The framework under which Harish Rana’s treatment will be withdrawn is court-made, subject to modification by the next bench, and navigable in practice only by families with the resources and persistence to sustain prolonged litigation.

Today’s judgment contains a warning about this, expressed more pointedly than in previous rulings. Para 289 notes that in the absence of legislation, end-of-life decisions risk being shaped by considerations “wholly extraneous to medical science” – particularly financial distress and the inability to sustain expensive medical care – blurring the line between a genuine best-interest determination and one compelled by economic exhaustion. The court is no longer merely calling for legislation. It is identifying what the structural failure of legislative inaction costs.

The sequence in the Rana case underscores the point. The Supreme Court declared a right under Article 21 in 2018. When the family came to exercise it, the Delhi high court denied it on reasoning that was, on any fair reading of that judgment, mistaken. The Supreme Court deferred rather than corrected, substituting a welfare arrangement that lasted less than a year.

When the arrangement failed, the family returned. Only then – with both boards constituted, both counsel having visited the family, and the judges having personally met the parents – did the court apply what it had itself decided eight years earlier.

Judgment

That sequence is not a framework functioning well. It is a framework functioning under pressure from a family that refused to stop. Today’s judgment is a genuine and significant contribution to Indian constitutional law. It is also, seen clearly, a record of how much the broader architecture – of legislative action, consistent adjudication, and institutional follow-through – still needs to do