CITATION : 2026 INSC 222 | SLP (Civil) No. 18225 of 2024
BENCH : J.B. Pardiwala & K.V. Viswanathan, JJ
COURT : Supreme Court of India | Decided: March 11, 2026
Introduction
On March 11, 2026, a division bench presided by Justice J.B Pardiwala and Justice K.V Viswanathan passed a landmark judgement in the case of Harish Rana V. Union of India & Ors expanding the scope of Indian constitutional jurisprudence. It extended the legal framework for passive euthanasia, or more precisely, the “Withdrawal and Withholding of Medical Treatment”, to enompass Clinically Assisted Nutirtion and Hydratio (CANH). It withheld, that CANH administered via PEG tube is a form of medical treatment is not just a basic sustenance and can be lawfully withdrawn in cases where continuation no longer serves the purpose of treatment and is contrary to the patient’s best interest.
Facts of the Case
Harish Rana, a 32 year old, faced severe injuries and had been in Permanent Vegetative State (PVS) for over thirteen years. His situation was irreversible, and all the medical assessments and opinions confirmed that there was no prospect of recovery. Nutrition and hydration were being administered to him through Percutaneous Endoscopic Gastrostomy (PEG) tube, which is a clinically supervised procedure falling under the umbrella of Clinically Assisted Nutrition and Hydration (CANH) where liquid food and fluid are pumped in the body through a tube to sustain life.
In 2024, unable to bear the financial, emotional and moral burden of witnessing their son’s prolonged undignified un-improving existence, petitioned the Delhi High Court, seeking permission to withdraw CANH. The Delhi High Court rejected the petition, concluding that Harish was not on mechanical ventilation which means he could breath on his own and only needed medical assistance for food and fluids. So withdrawal of CANH would amount to starvation and thus could not be treated as passive euthanasia.
Passive Euthanaisa: Euthanasia originating from greek roots, “mercy killing” means allowing the person to die by stopping or not starting any new medical treatment which is artificially keeping them alive.
The family appealed to the apex court through a Special Leave Petition. The court initially deferred the matter and faciliated the family a welfare package from Government of Uttar Pradesh. However, when this arrangement proved to be inadequate and failed to be a deterrent to the exisitng problems, a miscellaneous application was filed in 2025 and the matter was revived and taken up afresh, ultimately resulting in the historic judgement.
Issue
The following key legal questions arose before the court for determination
1. What is the standard of “best interest of the patient” and does it entail the context of end-of-life decision0 making for incompetent patients ?
2. Whether Clinically Assisted Nutrition and Hydration (CANH) constitutes “medical treatment” capable of being lawfully withdrawn under the passive euthanasia framework ?
3. Whether passive euthanasia as a constitutionally protected right is permissible even in the absence of mechanical ventilation?
4. What is the delineation beteween Active Ethunasia and Passive Ethunasia and what is their respective constitutional status under Article 21 of the Constitution of India ?
Legal Provisions and precedents
(i) Article 21, Constitution of India : The fundamental right safeguards and guarantees right to life, however in the interpretation of court, the ambit of it was given a wider meaning. “right to live with dignity” was also integral to it. It also included the right to die with dignity through withdrawal of futile medical treatment in extreme cases.
(ii) Common Cause V. Union of India, (2018) 5 SCC 1: The constitution bench landmark case that recognized passive euthanasia and advanced medical directives (AMDs) in India, forming the fundamental bedrock of the court’s reasoning in this present case.
(iii) Common Cause V. Union Of India, (2023) 14 SCC 131: A subsequent decision that attempted to modify and streamline the procedural guidelines for carrying out passive euthanasia to make the process more ascertainable to patients and families.
(iv) Gian V. State of Punjab, (1996) 2 SCC 648: Held that there is no inherent inclusion and nuanced interpretation of right to die under the umbrella of Article 21, however it protects the right to dignified dying.
(v) Aruna Ramchandra Shaunbaug V. Union of India, (2011) 4 SCC 454: Reaffirmed the limited right to dignified death exclusively in the cases of extreme medical futility.
Drawing from the comparative jurisprudence, Court took inspiration from Airedale NHS Trust V. Bland [1993] AC 789 (House of Lords, UK), Cruzan V. Director, Missouri Dept. of Health, 497 U.S. 261 (US Supreme Court), and the European Court of Human Rights decision in Lambert V. France (2016) 62 EHRR 2, all deal with withdrawal of treatment from patients in persistence vegetative state where continuation of treatment is considered a futile attempt.
Reasoning of the Court
(i) CANH as Medical Treatment : Rejecting the view of Delhi High Court on CANH which said that it merely constitutes basic sustenance, the apex court held CANH to be technologically and clinically supervised medical intervention which includes the tube feeding via PEG. Merely because CANH can in some circumstances, be administered at home does not strip it of its medical character. The court held it as a vital part of a patient’s medical management and must be treated like any other life-sustanining medical interventio, subject to certain ethical, legal and clinical standards governing initiation, continuation, withholding or withdrawal.
(ii) Extension of Passive Euthanasia Framework : Building on the precedents, the court held that the absence of mechanical ventilation is not a determinative factor in deciding whether passive euthanasia is permissible. The relevant inquiry lies in the fact whether the continuation serves any therapeutic purpose and whether its withdrawal is in the patient’s best interests. The preferred terminology adopted by the court in the further procedure is “ Withdrawal or Withholding of Medical Treatment”, reserving the term “euthanasia” strictly for active euthanasia which remains legally and constitutionally impossible in India.
(iii) The “Best Interest” Standard : To determine the credibility of the decision, the court undertook the nuanced articulation of “Best interests” principle. It held that holistic development, that is both medical and non- medical, is required, including the parent’s values,wishes and feelings. The best interest shall incorporate a strong element of substituted judgement standard i.e the decision-maker shall put herself in the shoes of the patient and consider what that patient would have wanted.
(iv) Active Vs Passive Euthanasia : The Court reitirated that distinction between active and passive euthanasia moves beyond the simplistic binary of acts and omission.
Active Euthanasia includes administering lethal injections introducing an external, intrusive agency which “causes death”.
Passive Euthanasia constitutes withdrawing or withholding treatment that allows the orginial harm-casuing event to persist on its natural course and “letting death occus”.
While Active Euthanasia is an act of administering “death causing” medication, Passive euthanasia is an omission of medication that prohibits death.
Judgment and Direction
The division bench held that all medical treatment being administered to Harish Rana, including CANH via PEG tube, be withdrawn and/or withheld. The court ordered that the process be carried out at AIIMS, New Delhi, under careful medical monitoring and a structued palliative and end-of-life (EOL) care plan, in order to preserve the dignity of the patient in his final days.
The court also issued guidelines regarding the constitution of the board which has Chief Medical Officers, and High Courts in handling this entire procedure. The Court ended its judgment with an impassioned call to Parliament to put in place legislation that comprehensively regulates end-of-life decision-making, stating that in the absence thereof, decisions of this nature are likely to be made on the basis of factors as irrelevant to medical science as financial hardship, and the distinction between determining what is in the best interest and what is done out of economic exhaustion becomes tenuous.
Critical Analysis
(i) Historical Lens : Harish Rana v. Union of India is arguably likely to be the first withdrawal of CANH in India under judicial authority, a historic milestone in the development of Indian end-of-life law. It plugs an important gap left untouched in Common Cause (2018) and (2023), where the decisions were taken in more general constitutional and procedural terms without directly dealing with CANH.
(ii) The Legislative Vacuum : One of the more interesting aspects of this judgment is its candid acknowledgment of the complete lack of legislative action on this subject in Parliament. The whole regime, beginning with Common Cause (2018) onwards, has been entirely judge-made under the exceptional jurisdiction of Article 142. The recommendations of the Law Commission in its 196th Report (2006) and 241st Report (2012), along with the draft MoHFW Bill of 2016, have still not seen legislative action. The strong exhortation made by the Court needs to be acted upon without further delay.
(iii) Dignity over Bare Existence : Finally, there is a clear and careful philosophical shift, a move away from a strict sanctity-of-life approach to one that balances quality and dignity of life. In the face of an irreversible PVS with no chance of recovery, the Court has balanced the scales, carefully and appropriately, in favor of dignity and autonomy rather than artificially prolonging bare existence. This is a mature and humane approach to Indian constitutional law
Conclusion
The case of Harish Rana Vs Union Of India is a landmark judgment of constitutional significance and a jurisprudential evolution in the Legal Developments of the country. It widens the scope of Article 21 in the context of end of life care, clarifying the legal status of CANH. It enriches the “best interest’ standard. While the lack of legislation remains a glaring lacuna, once again, the Supreme Court has stepped in and upheld the values of dignity, autonomy, and compassion that form the core of the Constitution of India. The ball now firmly lies in Parliament’s court.
THIS ARTICLE IS WRITTEN BY ANUSHKA JHA FROM CHANAKYA NATIONAL LAW UNIVERSITY
