Harish Rana v. Union of India & Ors.

CASE CITATION

Case: Harish Rana v. Union of India & Ors.

Citation: 2026 INSC 222, arising from Miscellaneous Application No. 2238 of 2025 in Special Leave Petition (Civil) No. 18225 of 2024

Court: Supreme Court of India

Bench: J.B. Pardiwala, J. (principal judgment) and K.V. Viswanathan,J. (concurring judgment)

Date of Decision: 11 March 2026, New Delhi

INTRODUCTION

This is the fist reported case in which the Supreme Court applied the guidelines on passive euthanasia in full measure laid down by the five – judge Constitution bench in Common Cause v. Union of India, (2018) 5 SCC 1, as later modified in the Common Cause v. Union of India, (2023) 14 SCC 131. The applicant, Harish Rana had remained in a permanent vegetative state (PVS) for over twelve years following a traumatic brain injury. His parents sought judicial sanction for withdrawal of Clinically Assisted Nutrition and Hydration (CANH). The Court used the occasion to definitively settle whether CANH constitutes “medical treatment” , to elaborate the contours of the “best interest of the patient” test through comparative analysis of US, UK, Irish, Italian, Australian, New Zealand, and EU law, and to streamline the Common Cause procedural guidelines that had proved difficult to operationalize on the ground.

FACTS OF THE CASE

Harish Rana, then a B.Tech student at Punjab University, fell from the fourth floor of his hostel accommodation on 20 August 2013, sustaining a severe traumatic brain injury with diffuse axonal injury. He developed quadriplegia and permanent vegetative state with 100% disability and complete sensorimotor dysfunction. He was treated at PGIMER Chandigarh, AIIMS New Delhi, RML Hospital, and Safdarjung Hospital, and was sustained through a tracheostomy, urinary catheter, and a PEG (Percutaneous Endoscopic Gastrostomy) tube for artificial feeding. For over a decade he was cared for at home by his parents and siblings, requiring frequent hospitalisations for seizures, pneumonia, and bedsores, with the most recent hospitalization in May 2025.

In April 2024, his family approached the Delhi High Court under Article 226 in Writ Petition (Civil) No. 492 of 2024, seeking constitution of medical boards under the Common Cause Guidelines to asses withdrawal of the PEG tube. The High Court dismissed the petition, reasoning that since Harish was not “mechanically” kept alive and could sustain himself without extraordinary external aid, intervention was unwarranted. The consequent Special Leave Petition was disposed of with the directions of the Union and the State of Uttar Pradesh to provide home – based care, with liberty to the family to return to the court to the Court if necessary.

Following further deterioration and a fresh tracheostomy in 2025, the family filed the present Miscellaneous Application. The Court, by orders dated 26 November 2025 and 11 December 2025, directed constitution of a primary and, subsequently, a secondary medical board at AIIMS. Both boards unanimously certified that Harish’s condition was irreversible and continued CANH served no therapeutic purpose, and that withdrawal would be in his best interest. His parents and siblings likewise expressed a consistent, considered wish for withdrawal.

LEGAL ISSUSES

The Court identified four issues for determination:

• Whether the administration of CANH is to be regarded as “medical treatment”?
• What is the meaning, scope, and contours of the principle of “best interest of the patient” in determining whether medical treatment should be withdrawn or withheld?
• Whether it is in the best interest of the applicant that his life be prolonged by continuation of medical treatment?
• What are the further steps to be undertaken in the event that a decision to withdraw or withhold medical treatment is arrived at?

ARGUMENTS PRESENTED

APPLICANT (Ms. RASHMI NANDAKUMAR AND COUNSEL)

Judicial intervention under Article 226/Common Cause was meant to be exceptional, triggered only on disagreement between medical boards; the family had approached the High Court only because no institutional mechanism existed for a home-cared patient.

CANH via a PEG tube is a recognised form of life-sustaining medical treatment, drawing on the concurring opinions of Sikri, J. and Chandrachud, J. in Common Cause 2018, and on an extensive line of UK Court of Protection authorities including Airedale NHS Trust v. Bland (1993), County Durham and Darlington NHS Foundation Trust v. PP [2014] EWCOP 9, and NHS South East London ICB v. JP [2025] EWCOP 4, holding that continued CANH in PVS cases is rarely in the patient’s best interest.

The real question, counsel argued, was not whether it was in Harish’s interest to die, but whether it was in his interest to have life artificially prolonged. Counsel also flagged systemic implementation failures of the Common Cause Guidelines, including misuse of “discharge against medical advice” forms, and proposed institutional reforms (nomination of AMD custodians, clearer board-constitution mechanisms, CMO panels of registered practitioners).

RESPONDENT – UNION OF INDIA (Ms. AISHWARYA BHATI, ASG)

Passive euthanasia is constitutionally permissible where treatment is medically futile and merely prolongs the dying process; CANH, following Airedale, is medical treatment and not basic care; withdrawal of artificial feeding is an omission allowing death from the underlying condition, not a positive act causing death. The medical boards’ unanimous findings of irreversible PVS and medical futility, combined with the family’s considered wishes over 13 years of caregiving, supported permitting withdrawal, coupled with arrangements for dignified palliative care.

COURT’S REASONING AND ANALYSIS

The Court undertook an extended re-examination of Common Cause 2018, refining the active/passive euthanasia distinction beyond a simple acts/omissions binary: the more robust test, it held, is the source of harm — active euthanasia introduces a new external agency causing death, while passive euthanasia merely permits an underlying fatal condition to resume its natural course.

On CANH as medical treatment, the Court conducted a comparative survey of enteral and parenteral nutrition practices and jurisprudence, concluding that CANH administered via medical devices upon clinical indication is a medical intervention subject to the same principles governing withdrawal of any other treatment, distinct from oral feeding, which remains basic care.

On the best interest principle, the Court surveyed the law of the USA, UK, Ireland, Italy, Australia, New Zealand, and the EU before articulating an Indian formulation combining medical considerations (irreversibility, prognosis, burden versus benefit of continued treatment) and non-medical considerations (the patient’s presumed wishes, values, and the views of family/caregivers as proxies for autonomy).

Applying this to the facts, the Court found both legal requirements satisfied: CANH was “medical treatment,” and its continuation was no longer in Harish’s best interest, given the unanimous, concordant opinions of the primary and secondary medical boards and the sustained, considered wishes of his parents and siblings.

The Court also streamlined the Common Cause Guidelines procedurally clarifying the role of next of kin, permitting home-cared patients to be admitted to a hospital of choice solely to designate a treating physician, mandating CMO panels of registered practitioners (nominated within 48 hours of a hospital’s request) to prevent delay in constituting secondary boards, and reaffirming the 30-day reconsideration period (subject to waiver by unanimous consent, as here) before which an aggrieved person may approach a court.

JUDGMENT AND RATIO DECIDENDI

The Court allowed the application and directed:

(a) withdrawal/withholding of CANH and other medical treatment;

(b) waiver of the ordinary 30-day reconsideration period given unanimous consent of all stakeholders;

(c) admission of the applicant to AIIMS’s Palliative Care department, with AIIMS to arrange transport;

(d) a structured palliative and end-of-life care plan to preserve dignity and manage symptoms without discomfort;

(e) directions to High Courts to instruct JMFCs to receive hospital intimations per the Common Cause framework; and

(f) directions to the Union, State Health Secretaries, and CMOs to maintain and periodically update (at least annually) panels of registered practitioners for secondary medical boards.

RATIO DECIDENDI

CANH constitutes “medical treatment” and may lawfully be withdrawn or withheld where the primary and secondary medical boards constituted under the Common Cause Guidelines unanimously certify that continuation is not in the patient’s best interest; such withdrawal, being an omission allowing an underlying fatal condition to take its course, does not offend Article 21 and requires no further judicial sanction once the boards concur; court intervention is warranted only on disagreement between the boards.

CRITICAL ANALYSIS

The judgment’s principal strength lies in resolving a long-standing ambiguity, whether CANH is “treatment” or “basic care”; through rigorous comparative analysis, bringing Indian law into closer alignment with UK Court of Protection jurisprudence built on Airedale. By reaffirming that unanimous board concurrence obviates the need for routine judicial sanction, the Court sought to correct the practical bottleneck that had made the 2018 Guidelines largely unusable, since families were often forced into litigation for want of an institutional trigger, precisely which happened here when the Delhi High Court initially declined relief.

The elaborate procedural streamlining (48-hour CMO nomination timelines, home-based admission pathways, annual panel review) reflects welcome pragmatism, though its efficacy depends entirely on administrative compliance by CMOs and State health departments, an area where the Court itself acknowledged past failure. The judgment’s candid acknowledgment that a decade of reliance on Common Cause Guidelines cannot substitute for dedicated legislation is a significant institutional signal, though the absence of any timeline or enforceable mechanism for that legislative call leaves it largely aspirational. Some may also observe that the Court’s extensive comparative survey, while doctrinally rich, arguably went beyond what was strictly necessary to dispose of a case where both medical boards and the family were already in complete agreement. Though the Court itself justified this as necessary given it was the first case to apply the Guidelines “in full measure.”

CONCLUSION

India’s passive euthanasia jurisprudence operationalises the 2018 Constitution Bench ruling through Harish Rana. By definitively classifying CANH as medical treatment amenable to withdrawal on a best – interest determination and by making broad – level consensus (rather than default judicial sanction) the operative trigger for such withdrawal, the decision meaningfully reduces the practical and emotional burden on families of PVS patients while reinforcing procedural safeguards against misuse. However, its lasting significance will depend on whether the administrative directions, particularly CMO panel maintenance and legislative follow – through are implemented in practice.