Authored By: Himanshu Dubey
SLS,CGC University, Mohali
Abstract
The Supreme Court of India’s decision Harish Rana v. Union of India ( 2026 INSC 222 ) . As a constitutional watershed, the Supreme Court decision in Harish Rana laid bare situations where passive euthanasia framework articulated in Common Cause v. Union of India [2018] was transformed from an abstract normative principle into clinical reality for the first time. In a judgment delivered on March 11, 2026, Justices J.B. Pardiwala and K.V. Viswanathan allowed the withdrawal of Clinically Assisted Nutrition and Hydration (CANH) from a patient in a Permanent Vegetative State (PVS) for more than thirteen years, ruling that CANH is not basic care but medical treatment, but both — subject to the full force of the law. The judgment expands the frontier of Article 21 jurisprudence of the Right to Die with Dignity explains the “best interests” doctrine, and provides a crystalised framework for procedure that medical practitioners and courts should follow. But it also lays bare the continuing vulnerability of a rights framework created exclusively by confirmation—as opposed to legislative action. This essay scrutinizes the doctrinal advances that this case makes, its fraught relationships within itself and with other cases, and the obstacles it faces in order for India’s end-of-life jurisprudence to be principled and functionally available.
Introduction
The law against death is never easy. The unquantifiability of life is an uncomfortable fit with a legal system that prefers clear categories, bright-line rules and verifiable outcomes . Death complicates such neat lines. This discomfort is no more acute than in the realm of end of life decision-making, where medicine, ethics and constitutional rights meet at a point that resists easy resolution.
India’s approach has been one of an unending dilemma : judicial progress recognising the right to die with dignity, juxtaposed with a vacuum in legislation leaving such rights dependent on access to the Supreme Court. While Harish Rana does not reconcile this paradox, it makes out a strong case in law and, importantly for the first time, establishes that passive euthanasia in India is not merely a constitutional wish but an actual ground of operation.
The article is structured as follows:
(Part I) The doctrinal evolution of end-of-life law in India
(Part II) The refined legal framework by Harish Rana
(Part III) Critical analysis of the judgement, and its tensions
(Part IV) Comparative perspective on Indian approach
(Part V) Emerging challenges
(Part VI) Legislative and institutional recommendations
Background: The Doctrinal Evolution
Initial Reluctance: Gian Kaur (1996)
The constitutional issue with regard to a right to die first came before the Supreme Court in P. Rathinam v. Union of India (1994) 3 SCC 394, where a two-judge bench held that the guarantee under Article 21 includes not only the right to live but also a right not to live i.e .the right not to be forced into living and therefore struck down Section 309 IPC. The logic extended: if Article 21 includes rights that are incidental to a dignified life, then what should stop it from also including the right to say no to life when that life is bereft of all dignity?
In Gian Kaur v. State of Punjab (1996) 2 SCC 648, the Constitution Bench resiled from this position. Article 21 guarantees and upholds life, therefore cannot be interpreted in a manner which permits its destruction. The Court divided the issue into two parts — Right of a person to live with dignity, which is guaranteed by Article 21 an endowed right and no man can be deprived of it, while denial of death or the right to die does not form part within its ambit. The bench held that active termination of life is philosophically at odds with constitutional protection of life.
Importantly, Gian Kaur allowed for a doctrinal loophole. The bench clearly recognised that the plight of a terminally ill, or PVS patient — in whose case the maintenance of life is artificially sustained against its natural course — may be constitutionally different from a suicidal desire to prematurely end an otherwise viable life. That qualification was the fertile ground in which all subsequent development of the principles of law came to bloom.
From the Constitution: Common Cause (2018)
The most important part is from the Constitution Bench in Common Cause v. Union of India (2018) 5 SCC 1, where it was finally decided that right to die with dignity as a fundamental right under Article 21. Taking cue from the nine-judge bench’s landmark judgement in K.S. Puttaswamy v. Union of India (2017) 10 SCC 1, which recognised personal autonomy . The Court held that a competent and major person can execute a valid Advance Medical Directive (AMD) setting out the circumstances when life-sustaining treatment should be withheld or withdrawn.
The Court laid down a three-stage mechanism through separate certification by medical boards followed by the approval of High Court — a structure that has seen widespread criticism for being rote-based and cumbersome. This was borne out by empirical data: the INDICAPS I and II studies of ICU practice found that rates of patient discharge ‘against medical advice’ — a type of institutional abandonment — increased after the Common Cause judgment, as medical teams considered the framework unimplementable in practice. A five judge bench relaxed the guidelines subsequently in 2023, substituting mandatory approval of high courts by a two-layer mechanism involving a medical board. This modified framework was implemented in practice for the first time by bringing Harish Rana on board.
III. Legal Framework and Related Judicial Pronouncements — Harish Rana
A. CANH as Medical Treatment
The resolution of the legal status of CANH is also the most doctrinally consequential holding in Harish Rana. The Court held unqualifiedly that CANH administered through a PEG tube is medical care — not routine or ordinary care — and therefore, the passive euthanasia framework applies with full force.
This ruling cannot be overstated with respect to its importance for practice. One remaining argument, at times used to resist requests for withdrawal of tube-fed nutrition, was that it was a form of “basic care” impervious to legal challenge. The Court laid this argument to rest: the clinical nature of an intervention is defined by its therapeutic end, its clinical delivery and the judicious medical discretion required in order to maintain it not by questions of routinisation or non-clinical access. When evaluated on those measures, CANH is clinically indisputable medical care. This is in keeping with the long-established position of Indian law and other English, American, and Canadian jurisprudence as exemplified by Airedale NHS Trust v. Bland [1993] AC 789 which has consistently been followed since its pronouncement in India.
Updated “Best Interests” Framework
Best interests analysis for patients who had executed no AMD, per the Court: “balanced” approach (a kind of “balance sheet”) as to
(1) Independent medical boards attesting to both that patient’s condition is medically futile and irreversible
(2) The continuation of treatment consists of invasive interventions causing suffering that impose a disproportionate burden on Ms. The presumption in favor of life is rebuttable, but this can only be overcome by clear and convincing evidence along these dimensions. Medical futility is not enough alone.
Palliative Care that is Mandatory Under Pain of Law
The Court also acknowledged the unfortunate reliance on patient status of ‘discharged against medical advice’ upon removal of treatment. The Court was clear that withdrawal of treatment does not amount to cessation of care. Any granted withdrawal must carry a condition of a structured palliative (and end-of-life) care plan prescribed and implemented, either in hospital or home. This direction creates a constructive legal duty on health services in a system which has historically favoured palliative care as optional.
Critical Analysis
Strengths of the Judgment
Harish Rana succeeds, first and foremost, for what no prior Indian judgment has even attempted . The transformation of constitutional promise into clinical reality. I find the judgment’s holding on CANH to make analytical sense and be indispensable in practice, resolving the doctrinal uncertainty that previously gave institutions room to resist withdrawal requests. The second disingenuousness in favour of the multi-factor best interests overview is that each, by declining to limit the inquiry to medical futility alone, signals as one judges that end-of-life judgements are applications of constitutional reason over dignity and autonomy, not just clinical exercise.
The guidance on palliative care solves a structural injustice. This previous reality — where withdrawal of treatment also meant withdrawal of clinical oversight — put families in ethical and logistical abandonment. Constitutionally and humanistically, there is a legal duty to combine withdrawal with carefully structured palliative care.
Internal Tensions
The most significant tension in the judgment concerns its substituted judgment component. In cases where there is no AMD left by a patient — Harish had not done so — the Court dares committees to imagine what the patient would have elected, if of capacity. This must be speculative, where Harish Rana is concerned—as a patient rendered incapable when nineteen and without any record of preferences. The danger is that “substituted judgment” becomes, in reality, a vision of what the family wants or what the judge believes rather than an authentic version of the patient’s autonomous choice.
The use of “like conditions” as justifications for passive euthanasia — alongside terminal illness and PVS (persistent vegetative state) — is even more alarming. The Dying with Dignity Act does not provide the Court with an explicit definition of what would constitute a grievous and irremediable condition, meaning that future courts could extend this framework beyond the scope contemplated in Harish Rana: leaving room for patients who may have permanent impairments to cognition but no terminal diagnosis, or those whose health conditions are uncertain rather than irreversible. This structural vulnerability is suggested by the Court’s repeated admonition that parliamentary intervention was necessary: a judge-made rights framework, however elegantly tailored, can atrophy in its doctrinal moorings without legislative anchoring.
Comparative Perspective
The structure of Indian passive euthanasia law strongly parallels English law, with perhaps more substantial differences in the institutional pathways. In Airedale NHS Trust v. Bland [1993] AC 789 — the authority which Indian Supreme Court cites and meets repeatedly with regularity — it was established that by withdrawing artificial nutrition from a patient suffering from PVS , murder is not being committed but rather a lawful omission, motivated by the best interests of the patient. What makes the English position unique is legislative consolidation: best interests have been codified in the Mental Capacity Act 2005, advance decisions are given statutory force and there are specialist courts known as Court of Protection. The UK Supreme Court in An NHS Trust v. Y [2018] UKSC 46 subsequently found that court approval in all cases of PVS withdrawal where practitioners and family agree is unnecessary – anything an Indian judgement to date has been prepared to go near.
This comparison is a powerful reinforcement of the legislative imperative. A common law style judge-made framework and a statutory framework that achieves similar outcomes in specific cases, are radically different with respect to accessibility, institutional infrastructure and democratic legitimacy. The recommendation from the Law Commission of India in its 241st Report (2012) was for legislation; and more than a decade since then, it is surely not too soon to need one.
Challenges and Emerging Issues
Three structural challenges demand attention.
First, the persistent lack of legislative action means that the entire end-of-life landscape is constitutionally dependent and procedurally inconsistent.
Second, very few Indians have any awareness of advance medical directives: claimed but rarely used, no centralise registry, no perfunctory click, no comprehensive legal literacy campaigns make the right to bequeath life on paper meaningless.
Third, the Harish Rana direction on palliative care assumes an infrastructure that does not yet exist at scale: India’s palliative care ecosystem is highly inadequate with major urban-rural gaps and no statutory entitlement to palliative services.
VII. Recommendations
Four concrete reforms are proposed. Parliament should take the initial steps: comprehensive end-of-life legislation that provides firm statutory placement of AMDs, a national registry, clear and determinate definitions for “best interests,” as well as an Medical Ethics Tribunal to adjudicate disputes (an institutional analogue in the UK is its Court of Protection). The other thing is to initiate a nationwide public legal awareness campaign on AMDs through the Ministry of Health, so that the litigated right to “die with dignity” will be made meaningfully — not just formally — realizable. Third, the National Health Policy should make palliative care infrastructure a statutory entitlement with enforceable minimum standards at the level of district hospital. Fourth, the National Medical Commission needs to amend its ethics regulations to give clinical practitioners some degree of guidance and professional protection for their actions under the Harish Rana framework.
VIII. Conclusion
Harish Rana v. Union of India (2026 INSC 222) is a landmark judgment by any measure. In authorising the actual clinical implementation of passive euthanasia for the first time in Indian legal history, the Court demonstrated that the constitutional right to die with dignity is operational, not aspirational. Its contributions — on CANH, on best interests, on palliative care obligations — are doctrinally durable and practically significant.
Yet the judgment makes visible, with unusual clarity, what courts cannot accomplish without legislative support. The rights it recognises are constitutionally grounded; their accessibility remains systemically constrained. Harish Rana passed away peacefully on 24 March 2026 — thirteen years after a fall rendered him permanently unconscious. The legal system that enabled that peaceful ending took two decades of judicial construction to build. The legislative system that could make the same dignity accessible to every Indian — not only those capable of reaching the Supreme Court — remains conspicuously absent.
The Supreme Court has shown, once again, both what the Constitution requires and the limits of what courts alone can deliver. Parliament’s turn is long overdue .
Footnote(S):
J.V. Divatia et al., Intensive Care in India in 2018–2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS-II), 25 Indian J. Critical Care Med. 1093 (2021); see also R.K. Mani, S. Simha & R. Gursahani, Simplified Legal Procedure for End-of-Life Decisions in India: A New Dawn in the Care of the Dying?, 27 Indian J. Critical Care Med. 374, 374–375 (2023).
Airedale NHS Trust v. Bland, [1993] AC 789, 868 (Lord Goff) (H.L.) (“Discontinuation of life support is, for present purposes, no different from not initiating life support in the first place. The doctor is simply allowing his patient to die from his pre-existing condition.”).
Bibliography
Cases
Airedale NHS Trust v. Bland, [1993] AC 789 (H.L.)
An NHS Trust v. Y, [2018] UKSC 46
Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454 • Common Cause v. Union of India, (2018) 5 SCC 1
Common Cause v. Union of India, 2023 SCC OnLine SC 99
Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990) • Gian Kaur v. State of Punjab, (1996) 2 SCC 648
Harish Rana v. Union of India, 2026 INSC 222
K.S. Puttaswamy v. Union of India, (2017) 10 SCC 1
Maneka Gandhi v. Union of India, (1978) 1 SCC 248
P. Rathinam v. Union of India, (1994) 3 SCC 394
Statutes, Constitutional Provisions, and Reports
Constitution of India arts. 14, 21, 32
Mental Capacity Act 2005, c. 9 (U.K.)
Law Commission of India, 196th Report, Medical Treatment of Terminally Ill Patients (2006)
Law Commission of India, 241st Report, Passive Euthanasia: A Relook (2012)
Books
Gautam Bhatia, The Transformative Constitution (HarperCollins, 2019) • Jonathan Herring, Medical Law and Ethics (8th ed., Oxford University Press, 2020)
John Keown, Euthanasia, Ethics and Public Policy: An Argument Against Legalisation (Cambridge University Press, 2002)
M.P. Jain, Indian Constitutional Law (8th ed., LexisNexis, 2018)
Journal Articles
R.K. Mani, S. Simha & R. Gursahani, Simplified Legal Procedure for End-of-Life Decisions in India: A New Dawn in the Care of the Dying?, 27 Indian J. Critical Care Med. 374 (2023)
J.V. Divatia et al., Intensive Care in India in 2018–2019: The Second INDICAPS Study, 25 Indian J. Critical Care Med. 1093 (2021)
