The story so far:
On March 11, in India’s first judicial approval of passive euthanasia, the Supreme Court allowed the withdrawal of life support for Harish Rana, 32, who had been in a vegetative state for nearly 13 years following a fall. The Bench of Justices J.B. Pardiwala and K.V. Viswanathan said that medical boards and Mr. Rana’s family had both said that treatment had become futile and was not in his best interest. It held that the right to life included the right to die with dignity.
What is passive euthanasia?
A simplistic view holds that passive euthanasia involves a negative act or an omission, such as withdrawing or withholding life support, while active euthanasia is an intrusion or positive act, such as administering a lethal injection. Active euthanasia is currently illegal in India.
However, the latest judgment helps us understand the difference in a more nuanced way. The Court noted that withdrawing life-sustaining treatment, such as switching off a ventilator, is a positive act. Relying on a simplistic ‘act versus omission’ test could wrongly place withdrawal of life support outside legal protections for passive euthanasia. Justice Pardiwala explained that the distinction lies in the source of harm: active euthanasia introduces a “new, external agency of harm, such as a lethal injection.” Passive euthanasia does not involve a new risk of death, but the removal of an artificial barrier, which then allows the natural trajectory of life to continue and reach its inevitable conclusion. When a ventilator is withdrawn, death is “accelerated” only in the sense that the patient dies sooner than they would have if the machine had continued.
What did the Court say about the ‘right to die’?
The Court said there comes a point when even the state’s interest in preserving life must yield to an individual’s right to die with dignity. It said, “Temporarily keeping alive a terminally-ill patient who is brain dead or in a persistent vegetative state, solely because doctors are able to leverage the technological advancements in medicine, and compelling such patients to endure a slow, agonising death, cannot fully be compatible with the constitutional ideal of dignity.” The Court observed that as the end of life approaches, a loss of control over human faculties denudes life of its meaning. It declared that the right to live with dignity under Article 21 of the Constitution extends beyond the preservation of life to encompass the right to die with dignity for a patient with an irreversible medical condition.
The Court also remarked that the term ‘passive euthanasia’ is obsolete. It said the term ‘euthanasia’ in India would strictly refer only to active euthanasia. The usage ‘withdrawing or withholding of medical treatment’ would replace the term ‘passive euthanasia’.
What is the ‘best interests’ test?
The test is based on the common law principle that any medical treatment constitutes a trespass against the person and must always be justified. The ‘best interests’ inquiry does not ask whether it is in the patient’s best interest to die, but whether continuing life support through Clinically Assisted Nutrition and Hydration, as was done in Mr. Rana’s case, artificially serves their best interest. The Supreme Court said there is no narrow, straight-jacket formula to understand what would be in the best interest of an unconscious or incompetent patient; that would require both medical and non-medical considerations. The Court explained that, at its core, the ‘best interests’ inquiry is anchored in a strong presumption in favour of preserving life, reflecting the sanctity of life. But this presumption was not absolute and may be displaced when medical treatment artificially and futilely prolongs the suffering of a patient with an irreversible medical condition.
What have been the past positions in India on the ‘right to die’?
The Supreme Court and the Law Commission of India have often addressed the right to die. In 1996, in Gian Kaur v. State of Punjab, a Constitution Bench distinguished between an attempt to suicide and abetment of suicide from “acceleration of the process of natural death”. It held that the right to live with dignity also includes the right of a patient to die with dignity when life was already ebbing out.
In 2006, the 196th Law Commission of India Report recommended that a terminally ill patient’s decision to discontinue medical treatment should not attract criminal liability if such withdrawal was in their best interests.
In 2011, the tragic case of the nurse, Aruna Shanbaug, in Maharashtra, saw the Supreme Court grapple with questions on the right to die amid a legislative vacuum. It prompted the Court to draw guidance from comparative jurisprudence and foreign legal frameworks. The Court then laid down guidelines permitting withholding of medical treatment for terminally ill patients with no chance of recovery.
A year later, the Law Commission, in its 241st Report, reiterated its 2006 suggestions. Four years later, the Health Ministry published a draft law, The Medical Treatment of Terminally-Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2016, but no follow-up has been made in the past decade.
In 2018, a Constitution Bench of the Supreme Court, in Common Cause v. Union of India, laid down fresh guidelines detailing procedures, including constitution of medical boards, to deal with applications for withdrawal of life support and advanced medical directives (AMDs). The need for judicial intervention arose in the absence of law. One of the judges on the Bench expressed a “pious hope” that Parliament would wake up to enact a specific law.
In 2023, the Court intervened again to simplify the procedure for AMDs. In June 2024, the government released guidelines on withdrawal of life support for public consultations. However, no action has followed.
Published – March 15, 2026 01:54 am IST
