Supreme Court allows passive euthanasia, orders life support withdrawal for man in vegetative state

New Delhi: In a landmark decision, the Supreme Court has allowed the withdrawal of artificial life support for a 32-year-old man who has been in a permanent vegetative state (PVS) for nearly 13 years. The court permitted the withdrawal of Clinically Assisted Nutrition and Hydration (CANH) being administered to him and also urged the Central government to introduce a comprehensive law governing passive euthanasia and end-of-life care.

The bench, comprising Justices J B Pardiwala and K V Viswanathan, said all medical and legal requirements necessary to withdraw treatment had been satisfied in this case. The court noted that continued medical intervention was no longer in the patient’s best interests and directed that the treatment, including CANH, be withdrawn or withheld in accordance with proper medical and palliative care protocols.

According to a report by The Indian Express, Harish Rana, a resident of Ghaziabad in Uttar Pradesh, suffered severe head injuries after falling from a fourth-floor apartment in Chandigarh in August 2013, when he was a student. Since the accident, he has remained in a permanent vegetative state (PVS).

The case arose from a plea filed by the patient’s family seeking permission to withdraw life support in accordance with the Supreme Court’s 2018 judgment in Common Cause vs Union of India, which recognised the legality of passive euthanasia for terminally ill patients. That judgment also established guidelines for situations involving advance directives or cases where patients had not left a living will.

Rana’s family had initially approached the Delhi High Court in 2024, but the petition was dismissed in July that year because he was not terminally ill. The family later approached the Supreme Court again through a miscellaneous application after earlier attempts did not result in relief.

In two concurring judgments, the bench said, “In the facts and circumstances of the present case, we record our satisfaction that the twin legal requirements for the withdrawal and withholding of medical treatment have been unequivocally met. First, it is established that the Clinically Assisted Nutrition and Hydration (CANH) currently being administered to the applicant … constitutes medical treatment. Secondly, it has been conclusively determined that the continued administration of the same is no longer in the best interests of the applicant.” 

The court further added, “In light of the unanimous consensus arrived at by the parents/ next of kin and the constituted medical boards respectively, we are of the opinion that the medical treatment ought not to be prolonged any further,” and directed that “the medical treatment, including CANH being administered to the applicant, shall be withdrawn and/ or withheld.”

Considering the specific circumstances of the case, the bench also waived the mandatory reconsideration period of 30 days that usually applies before implementing such a decision. The reconsideration period normally allows time for any aggrieved person to approach a court before life-support withdrawal is carried out.

The court directed the All India Institute of Medical Sciences, Delhi, to admit him to its palliative care department so that the withdrawal of medical treatment can be carried out in a medically supervised environment. The bench said AIIMS should arrange the transfer from his residence and ensure proper clinical management during the process.

The judges emphasised that the process must follow a carefully structured end-of-life care plan. The court said, “AIIMS shall ensure that such withdrawal and or withholding is carried out through a robust, palliative, and end-of-life care plan which is specifically tailored to manage symptoms without causing any discomfort to the applicant and ensuring that his dignity is preserved to the highest degree.”

Highlighting the absence of a comprehensive law on end-of-life decisions, Justice Pardiwala urged the government to legislate in this area. He observed that without a proper legal framework, such decisions may become vulnerable to factors unrelated to medical science or patient autonomy, including financial stress or lack of insurance.

Justice Pardiwala stated, “The right to die with dignity is inseparable from the right to receive quality palliative and EOL care. It is imperative to ensure that the withdrawal process is not marred by pain, agony, or suffering.” He further noted that the decision to withdraw medical treatment must still reflect the doctor’s duty of care toward the patient.

He added, “As the decision to withdraw or withhold a medical treatment is made keeping the best interests of the patient in mind, we deem it necessary to underscore that the same must be carried out in a manner that is humane, and reflects a responsible and sensitive extension of the doctors’ duty of care towards their patient. The resultant effect of the withdrawal or withholding of medical treatment must not be the abandonment of the patient. Due focus must be given to the comfort of the patient through pain and symptom management.”

The court also clarified that CANH should be regarded as a medical intervention rather than basic care. It said the therapy involves the administration of prescribed feed through a surgically installed PEG tube and is monitored by trained healthcare professionals under medical standards.

Justice Pardiwala also praised the patient’s family for their years of support, calling their actions an “act of profound compassion and courage.” Addressing them, he said, “You are not giving up on your son. You are allowing him to live with dignity. It reflects the depth of your selfless love and devotion towards him.”

In January 2023, another Constitution Bench modified the earlier guidelines to simplify the process for withdrawing life-sustaining treatment by introducing clearer timelines and limiting the role of the judicial magistrate.

In its directions, the apex court also asked the Centre, in coordination with State and Union Territory health departments, to ensure that Chief Medical Officers in every district prepare and maintain panels of registered medical practitioners eligible to serve on secondary medical boards under the guidelines laid down in the Common Cause judgment. The court said these panels should be periodically reviewed and updated at intervals not exceeding 12 months.

The Supreme Court has scheduled the matter for hearing again after a month to review whether its directions have been complied with.