The Supreme Court on Wednesday permitted the withdrawal of life-sustaining treatment for 31-year-old Harish Rana, who has remained in a permanent vegetative state for more than a decade after suffering a severe brain injury in a fall in 2013. A Bench comprising Justices JB Pardiwala and KV Viswanathan allowed the plea for passive euthanasia filed by Rana’s family, observing that his condition had not improved despite years of medical treatment.
The court also said that the medical board may use its clinical judgment to withdraw life support in line with the guidelines established in the landmark 2018 judgment in Common Cause v. Union of India, which recognised passive euthanasia and living wills. This is the first case of its kind in the country. The Bench directed AIIMS to gradually withdraw Harish’s life-support system. The process must be carried out in a manner that preserves the patient’s dignity.
What is Passive euthanasia?
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Dr Anil Gomber, Director, Internal Medicine & Diabetologist, Yatharth Hospital, Model Town, New Delhi, explains, “Passive euthanasia refers to the withholding or withdrawal of life-supporting medical treatment from a terminally ill patient, allowing the patient to die naturally from their underlying disease. It means that medical interventions that prolong life are stopped.
Some examples include:
1. Turning off ventilators
2. Not performing cardiopulmonary resuscitation (CPR)
3. Discontinuing life-support systems
“The Supreme Court of India has recognized the right to die with dignity under Article 21 of the Constitution of India. Passive euthanasia is permitted under strict safeguards when life becomes incompatible with human dignity and the patient is suffering from an irreversible medical condition. Medical ethics in such situations require proper consent, medical board review, thorough documentation, and ethical oversight. These measures help balance patient autonomy while ensuring dignity and responsible medical decision-making.”
Law for Euthanasia in India
In 2005, an NGO named Common Cause filed a petition in the Supreme Court seeking recognition of the right to passive euthanasia. On March 9, 2018, a five-judge Bench led by Chief Justice Dipak Misra granted legal recognition to passive euthanasia. The Court held that this right is part of Article 21 of the Constitution, which guarantees not only the right to live with dignity but also the right to die with dignity.
There are two types of euthanasia:
Passive euthanasia: In this method, medical treatment or life support, such as a ventilator, feeding tube, or medicines, is withdrawn or stopped so that the patient can die naturally.
Active euthanasia: In this method, doctors use medicines or injections to deliberately cause the patient’s death. This is illegal in India. If someone intentionally administers drugs to end a patient’s life, it is treated as murder or as abetment of suicide under the relevant provisions of the Bharatiya Nyaya Sanhita (BNS).
What is assisted suicide?
As per the National Library of Medicine, “Article 115 of the Swiss penal code considers assisting suicide a crime if and only if the motive is selfish. It condones assisting suicide for altruistic reasons. In most cases, the permissibility of altruistic assisted suicide cannot be overridden by a duty to save life. Article 115 does not require the involvement of a physician nor that the patient be terminally ill. It only requires that the motive be unselfish. This reliance on a base motive rather than on the intent to kill to define a crime is foreign to Anglo-Saxon jurisprudence, but it can be pivotal in continental Europe.”
Swiss law does not consider suicide a crime or assisting suicide as complicity in a crime. It views suicide as possibly rational. Also, it does not give physicians a special status in assisting it. When an assisted suicide is declared, a police inquiry is started, as in all cases of “unnatural death.” Since no crime has been committed in the absence of a selfish motive, these are mostly open and shut cases. Prosecution happens if doubts are raised on the patient’s competence to make an autonomous choice, which is rare.
Data on attitudes and practices
Assisted suicide is a controversial topic in Switzerland, but data on public attitudes towards assisted suicide and euthanasia are scarce. According to one survey, half of 2411 army conscripts were willing to “shorten the life of a family member who suffered too much and who asked for euthanasia.”
In a 1999 survey of the Swiss public, 82% of 1000 respondents agreed that “a person suffering from an incurable disease and who is in intolerable physical and psychological suffering has the right to ask for death and to obtain help for this purpose.”
Of these, 68% considered that physicians should provide this help; 37% considered that the family, 22% that right-to-die societies, 9% that nurses, and 7% that religious representatives should be able to fulfil such requests. Legislation to allow euthanasia was favoured by 71% of all respondents.
No data are available on how well people believe the existing system is working in practice, even though this is one of the key points in the controversy.
Who is Harish Rana ?
Harish Rana, who was born in Delhi, was pursuing a BTech degree at Panjab University in Chandigarh. In 2013, he fell from the fourth floor of his hostel, which left his entire body paralysed and pushed him into a coma. He is unable to speak or feel anything.
Doctors diagnosed Harish with quadriplegia, a condition in which a patient is completely dependent on a feeding tube for food and water and on ventilator support to survive. There is no possibility of recovery. Since then, he has remained bedridden and dependent on others for all the daily life activities. His condition has been continuously deteriorating.
As per the court, Rana exhibits sleep–wake cycles but does not show any meaningful awareness of or interaction with his environment. This situation has been extremely painful for Harish, and it has become mentally very difficult for his family to see him in such a state.
Previous case of this kind: Aruna Shanbaug
Harish Rana’s case is the first of its kind in India where the rules for passive euthanasia, laid down by the Supreme Court, are actually being followed. In the 2018 Common Cause judgment, the Supreme Court framed guidelines for passive euthanasia; until now, those rules had not been applied in any case.
The case of Harish Rana is the first in which these guidelines are being implemented. However, the 2011 Aruna Shanbaug case was the first to make passive euthanasia legal, which later became the basis for the 2018 Common Cause judgment.
What was the Aruna Shanbaug Case
In 1973, Aruna Shanbaug, a nurse at KEM Hospital in Mumbai, was attacked and raped by a ward attendant. Due to severe brain injuries from the assault, Aruna went into a coma. She spent nearly 42 years in a persistent vegetative state after the sexual assault.
Considering her critical condition, in 2009, journalist Pinky Virani filed a petition in the Supreme Court on Aruna’s behalf, requesting that her life-support systems be withdrawn so that she could die naturally.
While hearing the case, the Supreme Court recognis ed euthanasia as a legal right, but it did not permit euthanasia for Aruna, because she was still able to breathe to some extent without life-support machines. Later, in 2015, Aruna Shanbaug died of natural causes.
(This article is based on information available in the public domain and on input provided by experts consulted.)
(Discussions on suicides can be triggering for some. But suicides are preventable. If you are looking for help, some suicide prevention helpline numbers in India are 011-40769002 from Sanjivini (Delhi-based, 10 am – 5.30 pm) and 044-24640050 from Sneha Foundation (Chennai-based, 8 am – 10 pm), +91 9999666555 from Vandrevala Foundation (Mumbai-based, 24×7).
