In a significant ruling, the Supreme Court of India on Wednesday permitted the withdrawal of life support for a 32-year-old man who has been in a permanent vegetative state for over 13 years, marking the first judicial application of the Court’s guidelines on passive euthanasia laid down in the landmark Common Cause v. Union of India judgment.

A bench comprising Justices J.B. Pardiwala and K.V. Viswanathan allowed the withdrawal of life-sustaining treatment for Harish Rana after considering medical reports and the recommendations of expert medical boards.

Harish Rana, now 32, suffered a severe brain injury after falling from the fourth floor of his paying guest accommodation more than a decade ago. Since the accident, he has remained in a persistent vegetative state with complete quadriplegia. Medical records presented before the Court showed that his condition had not improved during the past 13 years.

According to the bench, Rana’s survival depended entirely on clinically administered nutrition (CAN) delivered through surgically inserted PEG tubes. The Court observed that this form of nutrition constitutes medical treatment and can be withdrawn if medical boards determine that continuing such treatment is not in the patient’s best interest.

The judges noted that the continuation of treatment merely prolonged biological existence without any possibility of therapeutic recovery.

Both the Primary Medical Board and the Secondary Medical Board unanimously concluded that the continuation of CAN would not benefit the patient. Rana’s parents also supported the withdrawal of life support.

The Court observed that when both medical boards certify that life-sustaining treatment should be withdrawn, judicial intervention is ordinarily unnecessary. However, since this was the first instance where the passive euthanasia guidelines were being implemented, the matter was brought before the Court.

The bench issued several directions to ensure that the process is carried out in a humane and dignified manner:

• All life-sustaining treatment, including clinically administered nutrition, shall be withdrawn. The usual reconsideration period of 30 days has been waived.
• The patient will be admitted to the palliative care centre of the All India Institute of Medical Sciences, where the withdrawal of treatment will take place. AIIMS has also been directed to facilitate his transfer from his residence.
• Authorities must ensure that life support is withdrawn through a carefully tailored medical plan that preserves the patient’s dignity.
• High Courts across the country have been asked to instruct Judicial Magistrates to receive hospital intimations whenever Primary and Secondary Medical Boards unanimously decide to withdraw life support in accordance with the Common Cause guidelines.
• The Union Government must ensure that Chief Medical Officers in all districts maintain panels of registered medical practitioners for forming Secondary Medical Boards.

The Court also recommended that the Union Government consider enacting comprehensive legislation governing passive euthanasia.

While delivering the judgment, Justice Pardiwala recorded the Court’s appreciation for the patient’s parents, acknowledging their dedication and care over the years.

“His family never left his side… to love someone is to care for them even in the darkest times,” the judge observed.

Justice Viswanathan delivered a concurring opinion supporting the decision.

In 2018, a Constitution Bench of the Supreme Court in Common Cause recognised the fundamental right to die with dignity as part of Article 21 of the Constitution. The judgment laid down procedures permitting passive euthanasia and the withdrawal of life support under strict medical supervision. These guidelines were further streamlined by the Court in January 2023.

Under the framework, life support can be withdrawn only after approval from both Primary and Secondary Medical Boards.

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