CHENNAI: In a landmark order, the Supreme Court has allowed passive euthanasia for 32-year-old Harish Rana, who has been in a coma for more than 12 years, and directed that he be admitted to palliative care at AIIMS before the withdrawal of life-sustaining treatment under strict safeguards. The decision has renewed focus on India’s laws governing end-of-life care and the right to die with dignity.
Rana, a student from Ghaziabad studying at Panjab University, suffered severe head injuries in 2013 after falling from the fourth floor of his paying guest accommodation. Since then, he has remained in an irreversible permanent vegetative state with 100 per cent disability.
He survives only through clinically assisted nutrition and hydration administered via a feeding tube. Doctors said the treatment merely sustains biological survival and offers no possibility of recovery.
Accepting medical opinion, the Supreme Court allowed doctors to withdraw life-sustaining support. A bench of Justices JB Pardiwala and KV Viswanathan directed AIIMS to admit Rana to palliative care before the medical treatment is withdrawn.
Passive euthanasia means allowing a patient to die naturally by stopping medical treatment that artificially prolongs life when recovery is considered impossible.
This may include:
withdrawing ventilator support
stopping artificial feeding
discontinuing dialysis
ending life-sustaining medication
It differs from active euthanasia, where a deliberate act is performed to end a patient’s life. Passive euthanasia instead allows the illness to take its natural course once treatment is withdrawn.
(According to doctors quoted in media reports)
Comfort-focused care: Rana will receive supportive treatment aimed at comfort and dignity, not recovery.
No aggressive intervention: Doctors will avoid intensive procedures such as ventilators or ICU care that only prolong life.
Basic medical support: Routine care like pain management, hygiene and monitoring will continue.
Natural course allowed: If his condition worsens, doctors will not escalate treatment, allowing the illness to take its natural course.
India’s public debate on passive euthanasia began with the case of Aruna Shanbaug, a nurse at Mumbai’s King Edward Memorial Hospital.
In 1973, she was sexually assaulted and strangled by a hospital employee, which deprived her brain of oxygen and left her in a permanent vegetative state.
Journalist Pinki Virani later approached the Supreme Court seeking permission to withdraw life support.
In its 2011 judgment, the court rejected the plea because the hospital staff caring for Shanbaug opposed withdrawing treatment.
However, the ruling marked a turning point by stating that passive euthanasia could be allowed in exceptional circumstances under strict safeguards.
Shanbaug remained under hospital care until she died of pneumonia in 2015.
In Common Cause vs Union of India (2018), a Constitution Bench ruled that the right to die with dignity is part of the fundamental right to life under Article 21.
The judgment also recognised living wills or Advance Medical Directives, allowing people to specify whether they want life-sustaining treatment if they become terminally ill or unable to communicate.
In January 2023, the Supreme Court modified its earlier guidelines to simplify the process.
Under the revised rules:
Hospitals must form primary and secondary boards; doctor experience reduced from 20 to 5 years. Life support can be withdrawn only after both confirm no recovery.
No Judicial Magistrate First Class countersignature required; can be attested by a notary or gazetted officer with two witnesses.
Magistrate only needs to be informed, not approval needed; district collector to form review board rule removed.
Despite legal recognition, passive euthanasia remains uncommon due to several challenges.
Complex procedures : Hospitals must follow multiple approvals and documentation requirements.
Fear of legal scrutiny: Doctors often hesitate to withdraw treatment due to possible legal consequences.
Social and religious beliefs: Many families struggle with the idea of stopping life-sustaining treatment.
Limited awareness of living wills: Few people formally record their end-of-life wishes.
The Harish Rana case has once again highlighted the difficult questions surrounding end-of-life care.
Supporters say passive euthanasia protects the right to die with dignity and prevents prolonged suffering. Critics argue that strict safeguards are necessary to prevent misuse.
For now, India’s legal framework attempts to balance both concerns: recognising the right to die with dignity while maintaining strong checks before life-support systems are withdrawn.
