INTRODUCTION
In the landmark judgment of Harish Rana v. Union of India & Ors. (2026), the Supreme Court of India fundamentally reshaped the legal and ethical landscape of end-of-life care by delivered a significant ruling on the constitutional framework governing passive euthanasia and withdrawal of life-sustaining treatment.
The word “euthanasia” is derived from the Greek words “eu” and “thanatos”, which literally mean “good death.” It is commonly described as mercy killing. Euthanasia refers to the intentional acceleration of the death of a terminally ill patient through active or passive means in order to relieve the patient from unbearable pain or suffering. The term appears to have been used in the 17th century by Francis Bacon to denote an easy, painless, and peaceful death, emphasizing that it was the duty and responsibility of physicians to alleviate the physical suffering of patients. The House of Lords Select Committee on Medical Ethics in England defined euthanasia as “a deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering.”
India’s approach to passive euthanasia reflects a careful balance between constitutional values, medical ethics, and human dignity. Through landmark rulings such as Aruna Shanbaug v. Union of India and Common Cause v. Union of India, the Supreme Court of India recognised passive euthanasia and the validity of living wills under the broader ambit of Article 21 and the right to die with dignity. Recent judicial developments in the Harshit Rana Case further emphasise compassionate end-of-life care while ensuring safeguards against misuse. Delivered by a two-judge Bench comprising Justices J.B. Pardiwala and K.V. Viswanathan, it cannot be fully understood without tracing the line from Aruna Shanbaug’s case in 2011 through the constitutional ruling in Common Cause v. Union of India in 2018 (”Dying with dignity,” Frontline, March 28, 2018) and examining why the distance between those decisions and the March 11 judgment was so difficult to close.
Going forward, a comprehensive legislative framework can strengthen this humane approach and provide clarity to patients, families, and medical practitioners alike.
What is Euthanasia ?
Euthanasia refers to the practice of an individual deliberately ending their life. This practice is often linked with getting relief from an incurable condition or intolerable pain and suffering.
Euthanasia is generally classified into two categories: active and passive
A. Active Euthanasia :-
Active euthanasia, also known as positive euthanasia, the process by which lethal substances uses to deliberately end a patient's life (e.g., a lethal injection) is called active euthanasia. It is Illegal in India.
B.Passive Euthanasia:-
Positive euthanasia, also known as negative euthanasia, it is defined by the omission of such acts; instead, it involves the withdrawal or withholding of life-sustaining medical treatments, such as ventilators or feeding tubes, that would otherwise preserve or prolong a patient's life.
It is further classified as voluntary and non-voluntary, Voluntary euthanasia is where the consent is taken from the patient. In non- voluntary euthanasia, the consent is unavailable on account of the condition of the patient for example, when he is in coma.
It is legal in India but with certain guidelines.
In this recent supreme court judgement in Harish Rana addresses non-voluntary passive euthanasia. Because in this case, the patient suffers from in a Persistent Vegetative State (PVS), an irreversible coma, or also in unsound mind state. Due to all of these reasons he was unable to provide his consent.
Constitutional status in India
In 2018 the Supreme Court recognised the right to die with dignity as a fundamental right and prescribed guidelines for terminally ill patients to enforce the right. In 2023 the Supreme Court modified the guidelines to make the right to die with dignity more accessible. On March 9th 2018, a five-Judge Bench comprising Dipak Misra CJI, A K Sikri, A. M. Khanvilkar, D Y Chandrachud and Ashok Bhushan JJ held that the right to die with dignity is a fundamental right.
They addressed these key issues in this case:-
1. Whether the constitutional guarantee of the Right to Life includes the Right to Die.
2. Whether euthanasia can be made lawful only by legislation.
3. Whether there is a difference between passive and active euthanasia.
4. Whether individuals can give ‘advance directives’ on medical treatment for if they lose the ability to communicate in the future.
The court held that every person has their right to decide what happens to their own body, including medical treatment in the future. These rights come from the bodily integrity (over your own body) and self-determination (freedom to make your own choice).
Most important point is even if there is no law made by the government, still right exists because of basic human rights, it will not depends on the permission from the state or government to take the decision for their own body.
Judicial Jurisprudence Shaped the Legality of Passive Euthanasia in India
Historically, the Indian judiciary has evolved with whether the "Right to Life" (Article 21) included a "Right to Die or not? " The path to the Harish Rana judgment was paved by decades of legal deliberation. For years and years, the legal stance was defined from P. Rathinam Case to Harish Rana case, where the Supreme Court emphasizing article 21( rights to life) and the preservation of life.
The Jurisprudential Journey: From P. Rathinam Case to Harish Rana
A. P. Rathinam Case SC (1994) :-
The supreme court held that right to life includes rights to die.
SC drew a parallel by comparing other fundamental right article 19 with article 21, the right to freedom of speech under Article 19 gives the right to speak but also includes the right to not speak, similarly the right to live under Article 21 includes the right to not live. However, the SC later overruled this judgment in Gian Kaur Case (1996).
B. Gian Kaur Case SC (1996) :-
The Court overruled the earlier decision in P. Rathinam v. Union of India and held that Article 21 protects life and personal liberty, and cannot be interpreted to include the right to end one’s life and suicide represents an unnatural extinction of life.
The Supreme Court upheld the constitutional validity of Section 306 IPC (abetment of suicide) and Section 309 IPC (attempt to suicide).
C. Aruna Shanbaug Case SC (2011):-
In this landmark case, the Supreme Court dealt with the issue of passive euthanasia for Aruna Shanbaug, who had been in a persistent vegetative state for decades.
The Supreme Court of India allowed passive euthanasia under strict safeguards.
a. The Court held that withdrawal of life support for an incompetent patient can be permitted in certain circumstances, but such a decision cannot be taken solely by relatives or doctors.
b. Instead, the concerned High Court must approve the decision under Article 226 of the Constitution of India, acting under the parens patriae doctrine, to protect the interests of the patient.
The Court also laid down a procedure requiring the opinion of a medical board of experts and consultation with relatives/next friend before granting approval
D. Common Cause vs. Union of India SC (2018):-
The Constitution Bench declared that the Right to Die with Dignity is a fundamental right under Article 21. It legalized Passive Euthanasia and recognized the validity of "Living Wills.
a. The guidelines laid down in 2018 were further refined in 2023, and together they are known as the Common Cause guidelines.
b. These guidelines rest on two key principles: the intervention must qualify as “medical treatment,” and its withdrawal must be in the patient’s “best interest.”
c. The Court also introduced safeguards, including approval from primary and secondary medical boards, to prevent misuse.
E. Harish Rana v. Union of India & Ors. (2026):-
The Supreme Court of India authorised passive euthanasia for 32-year-old Harish Rana, who had remained in a persistent vegetative state since a 2013 accident.
a. The Court held that Clinically Assisted Nutrition and Hydration (CANH) qualifies as medical treatment as it requires specialised medical supervision and continuous monitoring. Since recovery was impossible and the treatment provided no therapeutic benefit, its withdrawal was considered to be in the patient’s best interest.
b. The Court shifted the focus towards "allowing a dignified exit," mandating that the withdrawal process must be supported by a robust Palliative Care Plan at AIIMS to ensure the patient suffers no pain.
Guidelines for passive euthanasia
The new judgment emphasizes or governed on the "best interests of the patient" principle. This test does not ask if it is in the patient's interest to die, but rather if it is in their interest to continue life-sustaining treatment that offers no hope of recovery.
1. Permanent vegetative state with no possibility of recovery.
2. A living will or a designated guardian to make decisions.
3. Two independent medical boards:-
- A primary board of 3 doctors (treating doctor plus two with 5+ years of experience).
- A secondary boards of 3 independent doctors, mandated by the district medical officer.
4. The hospital must verify the authenticity of the document and inform the judicial magistrate first class about the decision.
To prevent misuse, the Court reiterated a streamlined two-tier medical review process:
a. Primary Medical Board: A team of experts at the treating hospital must certify the condition as irreversible.
b. Secondary Medical Board: An independent board, including experts nominated by the Chief Medical Officer, must concur with the primary board's findings.
If both boards agree that recovery is impossible and the family provides written consent, the treatment may be withdrawn without further court intervention.
Conclusion
The evolution of passive euthanasia in India signifies a profound shift from biological preservation to the preservation of human dignity. It is simply that the patient has, as he is entitled to do, declined to consent to treatment which might or would have the effect of prolonging his life, and the doctor has, in accordance with his duty, complied with his patient's wishes.