New Delhi: In a landmark verdict addressing the profound ethical and legal complexities of end-of-life care, the Supreme Court Wednesday authorised withdrawal of Clinically Assisted Nutrition and Hydration (CANH) for 32-year-old Ghaziabad resident Harish Rana.
Noting that this decision would be in the “best interests” of Rana, who has been in a Persistent Vegetative State (PVS) for over 13 years, the top court also brought back into focus the right to die with dignity. The watershed verdict marked the first ever implementation of the Supreme Court’s 2018 guidelines on withdrawal of life support.
The bench of Justices J.B. Pardiwala and K.V. Viswanathan wrote concurring judgments, agreeing in outcome but not in reasoning.
Justice Pardiwala, writing the leading opinion, opened the judgment with the poignant words of American preacher Henry Ward Beecher: “God asks no man whether he will accept life. That is not the choice. You must take it. The only choice is how”.
Agreeing with the outcome, Justice Viswanathan penned a separate judgment emphasising the “infinite variety of the human condition”.
While the law provides the framework, it would be “naive to ignore the harsh reality” of the family’s 12-year vigil, he noted. Quoting a Sanskrit subhashita (prose), he wrote “mental worry” is often more devastating than the “funeral fire”, as it “burns the living one”.
Expressing concern over “legislative inaction” and “need for legislation” despite multiple Law Commission reports (the 196th and 241st) recommending a formal law on passive euthanasia, the top court said it has over the years issued guidelines using its powers under Article 142, but these are only a “temporary constitutional bridge”.
It urged the Centre to enact comprehensive legislation to provide clarity and prevent end-of-life decisions from being shaped by “financial distress” or “socio-economic vulnerability”.
The case dates back to 20 August 2013, when Harish Rana, then a 20-year-old B.Tech student at Panjab University, fell from the fourth floor of his paying guest accommodation, sustaining a blunt injury to the brain.
Since the incident, Rana has existed in a “continued vegetative existence”. Medical records indicate he has no awareness of his surroundings, can’t interact with others, and doesn’t respond to pain or touch.
For over 12 years, he has been bedridden, dependent on a tracheostomy tube for breathing and Percutaneous Endoscopic Gastrostomy (PEG) tube for feeding.
Also Read: SC allows passive euthanasia in Harish Rana case: What it means for end-of-life care in India
From Delhi HC to apex court
The legal battle for Rana’s “right to die with dignity” began in early 2024.
His parents initially approached the Delhi High Court seeking approval for passive euthanasia. In July 2024, the high court rejected the plea, reasoning that Rana was not “terminally ill” and was able to sustain himself without being “kept alive mechanically”.
Aggrieved, the parents then moved the Supreme Court.
In August 2024, the top court initially declined the plea for passive euthanasia but directed the Uttar Pradesh government to cover Rana’s medical expenses and provide home-based care.
However, by 2025, Rana’s health deteriorated further, necessitating hospitalisation for severe bedsores and a fresh tracheostomy.
His parents then filed a miscellaneous application, stating there was no possibility of recovery and seeking a formal evaluation by medical boards.
The medical verdict: ‘Negligible’ chances of recovery
The Supreme Court constituted two independent medical boards to assess Rana’s condition, in accordance with its Common Cause v. Union of India judgment (2018).
The Primary Medical Board, comprising specialists from Ghaziabad, visited Rana’s residence and concluded that while his brainstem function was intact, his condition was emaciated with permanent contractures in all limbs. “The chances of his recovery from this state is negligible,” they said.
The Secondary Medical Board had specialists from AIIMS, New Delhi, who confirmed that Rana fulfills the diagnostic criteria for Persistent Vegetative State (PVS). They noted that while CANH was required for his survival, it would “not aid in improving his medical condition or repairing his underlying brain damage”.
During an emotional interaction with the Supreme Court, Rana’s parents and two siblings made a fervent appeal to let nature take its course. His father stated that after 13 years of exhaustive effort, the family believed continuing treatment only “prolongs the agony”.
A significant factor for the ageing parents was the “visible concern” over who would care for Harish after their passing. His mother said watching him suffer daily was more painful than the prospect of his death, clarifying that their decision was not born out of despair but out of a desire for his dignity.
The central government, represented by Additional Solicitor General (ASG) Aishwarya Bhati, initially focused on providing Rana with palliative care and medical assistance. However, after the medical boards delivered their findings, the ASG submitted that the doctors unanimously agreed that continuing treatment was not in the patient’s “best interests” in accordance with the landmark Common Cause judgment of 2018.
Also Read: What is ‘living will’ and what are the Supreme Court’s hearings on passive euthanasia about
SC’s view of CANH, passive euthanasia
A critical legal question was whether Clinically Assisted Nutrition and Hydration (CANH) administered via a percutaneous endoscopic gastrostomy (PEG) tube constitutes “medical treatment”. The top court ruled that it does, distinguishing it from basic care like bottle- or spoon- feeding.
The bench held that because CANH involves medical protocols, surgical installation, and specialised liquid nutrition, it is a “technologically mediated medical intervention” subject to the same withdrawal principles as a ventilator.
The Supreme Court corrected what it saw as Delhi HC’s narrow interpretation. It clarified that for withdrawal of life support, a patient need not necessarily be terminally ill if they are in a PVS or similar condition where the ailment is irreversible and treatment is futile.
The top court further addressed the procedural gap for patients receiving “stay-at-home” care. It ruled that families in such settings have the right to admit the patient to a hospital specifically to trigger the evaluation process by medical boards under the Common Cause guidelines.
The Supreme Court bench of Justices Pardiwala and Viswanathan concluded that the legal requirements for withholding medical treatment were “unequivocally” met in Rana’s case since it was conclusively determined that continued administration was no longer in his “best interests”.
It noted: “In light of the unanimous consensus arrived at by the parents/next of kin and the constituted medical boards… we are of the opinion that the medical treatment ought not to be prolonged any further.”
Twin legal requirements
The Supreme Court directed Rana’s admission to the AIIMS Palliative Care department to ensure withdrawal of CANH is carried out through a humane, medically supervised plan that minimises pain and distress.
Justice Pardiwala concluded that the decision was not about choosing death, but about “not artificially prolonging life… when medicine can only delay the inevitable”.
The bench noted that in the facts and circumstances of the present case, they are satisfied that the twin legal requirements for the withdrawal and withholding of medical treatment have been “unequivocally” met.
First, it is established that the CANH currently being administered to the applicant constitutes “medical treatment”.
Second, it has been conclusively determined that continued administration of the same is no longer in the “best interests” of the applicant.
Underlining the legislative vacuum over the issue, the bench wrote: “Due to this legislative vacuum, this Court has, from time to time, been constrained to step in and 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.”
The bench also directed high courts of all states to issue appropriate directions to all Judicial Magistrates of First Class (JMFC) within their jurisdiction to receive intimation from the hospital, in accordance with the guidelines as laid down in Common Cause, in the event the primary medical board and secondary medical board are unanimous in their decision to withdraw and/or withhold the medical treatment of any patient.
Additionally, it asked the central government in coordination with health secretaries of all States/UTs to ensure that the CMOs of all concerned districts forthwith prepare and maintain a panel consisting of registered medical practitioners possessing qualifications in accordance with the guidelines as laid down in Common Cause judgment for the purpose of nomination to the secondary medical board.
(Edited by Amrtansh Arora)