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 for 13 years, thereby taking a massive step towards upholding the right to die with dignity.
The Court touched upon several aspects concerning euthanasia and emphasised on structured 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.
Also Read: Passive Euthanasia in India: Key Takeaways from Supreme Court’s Landmark Verdict
Streamlining and contextualising the Common Cause guidelines
Taking note that the instant case presented first substantive application of the Common Cause Guidelines, the Court pointed out that this case also illustrates the practical complexities, difficulties, and dilemmas encountered by all stakeholders in their implementation, most acutely by the patient’s next of kin/next friend/guardian and by treating physicians or medical practitioners. Even when requisite threshold conditions/medical parameters, are fulfilled, the Court observed that the initiation of the process contemplated under the Common Cause Guidelines remains fraught with hesitation and apprehension amongst doctors.
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Acknowledging the aforestated practical complexities, the Court pointed out that the Constitution Bench in Common Cause, 2018 consciously embedded multiple safeguarding checkpoints in the Guidelines to address the hesitation and apprehension amongst doctors in initiating the envisaged process.
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The role of the patient’s next of kin/next friend/guardian remains integral, as their written consent embodies, as far as possible, the patient’s own wishes had he possessed decision-making capacity, without which consent the process may be stalled.
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Where medical care is predominantly provided at home, the patient’s next of kin/next friend/guardian may admit the patient to a hospital of their choice, or alternatively approach a hospital for the limited purpose of designating a primary treating physician, who shall thereafter initiate the process in accordance with the Common Cause Guidelines.
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To prevent administrative delays in constituting the secondary medical board, CMOs of all concerned districts would be required to maintain a panel of qualified registered medical practitioners and nominate one, preferably within 48 hours of a hospital’s request, on a case-to-case basis.
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Where the treating physician or hospital fails to commence the process despite satisfaction of the threshold conditions/medical parameters, the patient’s next of kin/next friend/guardian may seek appropriate directions from the High Court under Article 226 of the Constitution.
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Once both the medical boards have concurred in their decision to withdraw or withhold medical treatment, such decision shall be implemented only after a reconsideration period of 30 days, during which an aggrieved person may approach the appropriate court of law, subject to establishing locus, for the purpose of challenging the concurring opinions of the medical boards. It is to be borne in mind that courts must exercise restraint and due caution in unsettling the process that has already culminated after a due and careful consideration of the patient’s best interests.
Legislative Inaction and Need for Legislation
Highlighting that legislative gaps vis-a-vis passive euthanasia and end-of-life and palliative care, it was pointed out that the Supreme Court had to step in to frame guidelines, not as a matter of institutional preference, but as a matter of constitutional necessity, in order to safeguard the sanctity of fundamental rights, more particularly the right to life with dignity. “We underscore that judicial intervention in this domain has never been intended to supplant legislative wisdom, but only to operate as a temporary constitutional bridge until Parliament discharges its role”.
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The Court highlighted that the 196th Law Commission Report in 2006 concluded that a terminally ill patient’s decision to discontinue medical treatment does not attract criminal liability and that such withdrawal ought to be permissible when it accords with the patient’s best interests. Law Commission specifically traced the legislative competence of the Parliament to enact a law on the subject under Entry 26 of List III of the Seventh Schedule to the Constitution.
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It was stated that during Aruna Ramachandra Shanbaug v. Union of India, (2011) 15 SCC 480, the Court was compelled to deal with issues raised in the case in an acute legislative vacuum. Thereafter, 241st Law Commission found no reason to differ from the view by the earlier 196th Law Commission Report.
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In 2016, the MoHFW published a draft bill, namely, the Medical Treatment of Terminally-Ill Patients (Protection of Patients and Medical Practitioners Bill, 2016, inviting public comments. However, following the consultative stage, no further steps were taken. The bill was neither finalised nor introduced for deliberation before the Parliament.
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The Court pointed out that need to lay down Guidelines in Common Cause, 2018 arose solely because there was no law in place. However, the Court therein expressed a “pious hope” that the legislature would intervene and enact an appropriate law to establish a coherent and comprehensive regulatory framework governing the subject.
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After Common Cause, 2023, which modified the 2018 guidelines, Directorate General of Health Services, MoHFW, released Draft Guidelines (Guidelines for Withdrawal of Life Support in Terminally Ill Patients, 2024) for public consultation in June 2024. However, no fruitful conclusion has been reached to date, even on these guidelines.
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The Court highlighted that cumulative effect of prolonged legislative inaction is leaving citizens, particularly those situated at the most vulnerable threshold of life, exposed to serious and systemic risk. In the absence of a clear and comprehensive legislation, end-of-life decisions stand imperilled by the possibility that considerations wholly extraneous to medical science or the patient’s autonomy, most notably financial distress, lack of insurance coverage, or socio-economic vulnerability, may imperceptibly shape outcomes.
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Such vacuum creates the danger that decisions ostensibly grounded in compassion or clinical futility may, in reality, be driven by the inability of families to sustain prolonged and expensive medical intervention, thereby blurring the line between a genuine best-interest determination and an act compelled by economic exhaustion.
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The Court explained that guidelines framed by constitutional courts only bridge a temporary legislative vacuum arising out of imminent necessity. They are not designed to operate as a permanent substitute for legislative enactment.
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Henceforth, the Court urged the Central Government to consider enacting a comprehensive legislation on the subject in line with the Common Cause guidelines. Such legislation would provide clarity, coherence, and certainty in matters that are deeply practical and emotionally sensitive.
With this landmark judgment, the Supreme Court has laid the first step towards a hopeful future of a robust jurisprudence focussing on another aspect of Article 21 of the Constitution, i.e., the right to die with dignity. The Court’s efforts in streamlining the Common Cause guidelines for even implementation across India with an equally strong appeal to fill the legislative gaps vis-a-vis passive euthanasia and end-of-life care, will hopefully ensure a workable, humane, and secure process for terminally ill patients.
[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