Supreme Court: In a historic first, the Division Bench of J.B. Pardiwala and K.V. Viswanathan, JJ., on 11 March 2026, allowed the withdrawal of life-sustaining medical treatment for a patient living in Persistent Vegetative State (PVS) for 13 years. This landmark decision marks a massive step towards upholding the right to die with dignity.
The Court was considering an application filed by a young man through his parents, seeking assessment of his life support treatment.
The judgment touched upon several aspects concerning euthanasia, made a comparative analysis between Indian and foreign jurisdictions regarding permissibility of active or passive euthanasia, determining best interests of the patient, pan-India application of principles laid down in Common Cause v. Union of India, (2018) 5 SCC 1, which were modified in Common Cause v. Union of India, (2023) 14 SCC 131 (Common Cause Guidelines) and need for robust legislative framework.
Key Takeaways from the Passive Euthanasia Verdict
After cumulative perusal of Common Cause v. Union of India, (2018) 5 SCC 1 [Common Cause 2018], which distinguished between Active Euthanasia and Passive Euthanasia, the Court pointed out that any decision to withdraw or withhold medical treatment must withstand scrutiny on two primary grounds:
⮚ The intervention in question must qualify as “medical treatment”.
⮚ Its withdrawal must strictly be in the patient’s “best interests”.
Clinically Assisted Nutrition and Hydration (CANH) as Medical Treatment
⮚ Prescription and administration of CANH involves careful consideration of a multitude of clinical factors, ranging from installation of the CANH device (placed surgically or otherwise), precise assessment of the patient’s nutritional requirements, patient’s underlying clinical condition, gastrointestinal tolerance, potential metabolic instability, assessment of the anticipated duration of CANH support, and the potential risks of complications that are associated with CANH.
⮚ Administration of CANH also requires a periodic medical review of its indications, route of administration, risks, benefits and therapeutic goals.
⮚ The clinical and procedural characteristics of CANH, therefore, indicate that CANH cannot be regarded as a mere means of basic sustenance or primary care, but should be recognised as a technologically mediated medical intervention that is prescribed, supervised and periodically reviewed by trained healthcare professionals in accordance with established medical standards.
⮚ When comparing CANH with normal feeding, it is incorrect to direct exclusive attention on the aspect that nourishment is being provided. Rather, regard should be had for the whole regime of artificial feeding, which involves the use of catheters and enemas and the constant combating of potentially deadly infections.
⮚ CANH, even when administered at home, remains a medical procedure because such administration of nutrition and hydration must necessarily be performed under regular medical and nursing supervision, involving skills and protocols which the lay person would need to specifically obtain by drawing upon medical knowledge.
⮚ CANH constitutes medical treatment, it is permissible for the primary medical board and secondary medical board to exercise their clinical judgment with regard to the continuation or withdrawal or withholding of the CANH, like any other form of medical treatment, in accordance with Common Cause Guidelines.
Best Interest Principle- Application of
⮚ The best interest principle comes into play when the withdrawal or withholding of medical treatment is contemplated for an incompetent patient who is unable to make an informed decision for himself.
⮚ There is a need to adhere to the best interest principle at every stage while determining whether withdrawal or withholding of medical treatment must be undertaken, by all stakeholders and decision-makers, including the medical boards, the patient’s next of kin/next friend/guardian, and the courts (if involved).
⮚ On the issue that why best interest principle is applied, the Court explained that where the patient is diagnosed with a terminal illness or is in PVS, with no hope of recovery, and the continuation of treatment merely prolongs his biological existence without any therapeutic benefit, that duty no longer mandates continuing with the medical treatment. In determining whether or not such a stage has been reached, the best interests principle is to be applied.
Contours of Best Interests Principle
⮚ Correct inquiry is whether it is in the best interests of the patient that his life should be prolonged by the continuance of such forms of medical treatment.
⮚ Best interest principle cannot be construed as a narrow, rigid, formulaic and straight-jacketed single test. A true and holistic application of this principle would require the evaluation of all relevant circumstances and considerations, both medical and non-medical.
⮚ Best interest of any patient would be anchored upon a strong presumption in favour of preserving his life. However, this presumption is not absolute, and it may be displaced where both medical and non-medical considerations warrant the discontinuation of a particular medical treatment.
⮚ Medical considerations may entail a determination of whether a particular treatment has become futile, merely prolongs the suffering without the hope of recovery or causes indignity to the life of the patient.
⮚ Non-medical considerations may entail a determination of what the patient would have wanted for himself had he possessed the decision-making capacity. This involves the application of the substituted judgment standard wherein the determination is based upon what decision the patient himself would have made had he possessed the competence to do so.
⮚ Best interests principle must incorporate a strong element of the non-medical considerations under the substituted judgment standard requiring the decision-maker to consider, in a patient-centric manner, what that patient would have wanted if he possessed the requisite capacity. However, this substituted judgment standard would not operate autonomously or in an overriding manner. The ultimate governing test or question would, nevertheless, be – what course of action serves the patient’s best interest.
⮚ After ascertaining both medical and non-medical considerations, the decision-makers must draw a balance sheet which would involve weighing the potential benefits of continued treatment against its burdens. The decision-makers must make entries of medical and non-medical considerations on such a balance sheet.
Palliative and End of Life (EOL) Care
⮚ Once a decision to withdraw or withhold medical treatment is taken, its implementation must be humane and reflective of a responsible and sensitive discharge of the doctor’s continuing duty of care towards the patient. The withdrawal or withholding of treatment must not, in effect or execution, result in the abandonment of the patient.
⮚ The palliative and EOL care plan must ensure that a decision taken in the patient’s best interests are translated into clinical practice in a manner that minimises suffering and upholds dignity.
⮚ In this regard, the Court disapproved of the routine practice of “discharge against medical advice” (leaving against medical advice or discharge at own risk) which is misused in situations where medical treatment stands discontinued. The choice to withdraw or withhold treatment does not entail a forfeiture of the patient’s right to medically supervised care.
⮚ Court clarified that it is legally permissible for hospitals to admit patients who are undergoing treatment in home settings, where a reassessment of the patient’s best interests is sought. Upon admission, the treating physician is authorised to initiate the structured evaluative process to determine whether the continuation, withholding, or withdrawal of treatment serves the patient’s best interests.
Streamlining of the Common Cause Guidelines
⮚ In view of the practical uncertainty, difficulties, and dilemmas faced by all stakeholders, the Court endeavoured to explain and streamline the Common Cause Guidelines so that the constitutional principles recognised in Common Cause 2018 are translated into a workable, humane, and practically secure process.
Need for a comprehensive statutory framework
⮚ The Court urged the Central Government to consider enacting a comprehensive legislation on end-of-life care in consonance with Common Cause 2018. Such a legislation would provide more clarity, coherence, and certainty to these pertinent, practical and emotionally charged issues.
The judgment marks a significant development in India’s euthanasia jurisprudence, reaffirming that the right to life under Article 21 of the Constitution includes the right to die with dignity in certain circumstances. By clarifying the application of the Common Cause guidelines, the Supreme Court has sought to ensure a humane, patient-centric approach to end-of-life decision-making while also urging the Government to enact a comprehensive statutory framework governing passive euthanasia and end-of-life care in India.
[Harish Rana v. Union of India, MISCELLANEOUS APPLICATION NO. 2238 OF 2025, decided on 11-3-2026]
*Judgment by Justice J.B. Pardiwala
**Supplementing opinion by Justice K.V. Viswanathan
Advocates who appeared in this case:
For Petitioner(s): Ms. Rashmi Nandakumar, AOR Ms. Dhvani Mehta, Adv. Ms. Shivani Mody, Adv. Ms. Anindita Mitra, Adv. Ms. Yashmita Pandey, Adv. Mr. Manish Jain, Adv. Mr. Vikash Kumar Verma, Adv. Mr. Jugul Kishore Gupta, Adv.
For Respondent(s): Ms. Aishwarya Bhati, A.S.G. Ms. Sushma Verma, Adv. Ms. Shreya Jain, Adv. Ms. Shivika Mehra,Adv. Mr. B. L. Narasmma Shivani, Adv. Mr. Arun Kanwa, Adv. Mr. Sudarshan Lamba, AOR Mr. Amrish Kumar, AOR