Harish Rana v. Union of India 2026 INSC 222 - Passive Euthanasia

Summary: The Supreme Court holds that clinically assisted nutrition and hydration (CANH) delivered via a PEG tube constitutes medical treatment, not mere basic care, and that it can lawfully be withheld or withdrawn under the passive‑euthanasia framework laid down in Common Cause, provided it is in the patient’s best interests. Applying a detailed “best interests” analysis—including medical futility, irreversibility, dignity, and the views of the patient’s family and medical boards—the Court finds that continued CANH for 32‑year‑old Harish Rana, in a permanent vegetative state for 13 years with no prospect of recovery, only prolongs suffering and an undignified existence. It therefore authorised withdrawal of CANH under a robust palliative and end‑of‑life care plan at AIIMS, clarifies and streamlines the Common Cause guidelines (including duties of doctors, medical boards, CMOs and High Courts), and strongly urges Parliament to enact a comprehensive statute on end‑of‑life decision‑making.

Clinically Assisted Nutrition And Hydration (CANH) - CANH can be regarded as medical treatment, forming an integral part of a patient’s medical management, and be subject to the same ethical, legal, and clinical principles that govern the initiation, continuation, withholding, or withdrawal of other life-sustaining medical interventions - Merely because routine feeding in the form of CANH can be administered at home, by an informed lay person, it cannot be relegated to a non-medical status. (Para 125-126)

"Best interests of the patient" Principle - The principle of the “best interests of the patient” possesses an intrinsic and qualified significance in determining whether medical treatment should be withdrawn or withheld. (Para 134) When deciding whether medical treatment ought to be withdrawn or withheld, a holistic assessment of all relevant circumstances, both medical and non-medical, including but not limited to, the patient’s wishes, feelings, beliefs, values, and any other factor that would be likely to influence the patient’s decision, or which the patient himself would have taken into account, had he retained the capacity to decide. (Para 231) The principle of “best interest of the patient” may include, but not be limited to, the following considerations: 1. While deciding upon the withdrawal or withholding of medical treatment, the correct question should be whether it is in the patient’s best interests that life should be prolonged by the continuance of the particular medical treatment in question. 2. While answering such a question, the best interest principle cannot be construed in a narrow, rigid, straight-jacketed single test. The determination of the same requires due evaluation of all relevant circumstances and considerations, both medical and non-medical. 3. At the foundational level, the best interests inquiry is anchored in a strong presumption in favour of preserving life, reflecting the sanctity of life. This presumption is not absolute and may be displaced where continuation of medical treatment ceases to serve any therapeutic purpose, i.e., becomes futile, merely prolongs the suffering without the hope of recovery or causes indignity to the life of the patient. 4. The assessment of best interests must, therefore, necessarily encompass an evaluation of the futility of treatment, the absence of therapeutic purpose, the invasive and burdensome nature of continued medical intervention, and the indignity attendant upon artificially prolonging life in a state devoid of awareness, autonomy, or human interaction. 5. Further, while considering the best interests of the patient, decision-makers such as the patient’s next of kin/next friend/guardian, the treating physician, the members of the medical boards, or the courts (if involved), as the case may be, must look at the patient’s welfare in the widest sense, not just medical but also social and psychological 6. Decision-makers must try to put themselves in the place of the individual patient and ask what his wishes and attitude to the treatment is or would be likely to be; and they must consult others who are looking after him or interested in his welfare, in particular for their view of what the patient would have wanted. 7. The best interests principle shall incorporate a strong element of the substituted judgment standard, requiring the decisionmaker to place himself, so far as possible, in the position of the patient and to consider in a patient-centric manner what that patient would have wanted if he had capacity to do so. However, substituted judgment would not operate as an autonomous or overriding standard. The ultimate inquiry remains what course of action serves the patient’s best interest. 8. The decision-makers, after identifying and collating necessary and ascertainable considerations, both medical or nonmedical, must engage in the balance sheet exercise, which would involve weighing the potential benefits of continued treatment against its burdens, including physical suffering, invasiveness, indignity, psychological distress, wishes and welfare of the patient, the impact upon the patient’s lived experience and family life, and other like considerations. (Para 233)

Constitution of India - Article 21 - A competent person has the right to refuse medical treatment within their right to self-determination under Article 21 of the Constitution of India. It is also clear that the autonomy of a competent person in refusing to take or continue a medical treatment needs to be respected. This means that until the patient is competent and is in a position to exercise his right to refuse medical treatment, he may do so. (Para 212)

Euthanasia -The essential distinction between active and passive euthanasia transcends the simplistic binary of acts and omissions. Active euthanasia is characterised as “causing death” because it introduces an external, intrusive agency, such as a lethal injection, an intervention that disrupts the natural path towards death. Conversely, passive euthanasia is understood as “allowing death to occur” or “letting die”. By withdrawing or withholding medical treatment that was otherwise prolonging life, the physician allows the original harm causing event to run its natural course, returning the patient to their natural path toward death. When viewed through this lens, the role of acts and omissions also becomes clear. While the physical withdrawal of treatment may involve an ‘act’, its effect is an omission, i.e., omission to treat. By shifting the focus from the muscle movement to the conduct’s ultimate effect, there is a recognition that such interventions are, in substance, omissions. (Para 45)

Passive Euthanasia- Advanced Medical Directive - Passive euthanasia for incompetent patients, regardless of whether an AMD exists or not, is permitted only if the following conditions are met: a) The patient must be diagnosed to be suffering from a medical ailment and be classified as either terminally ill, in a PVS, or like conditions. b) The patient must be undergoing prolonged medical treatment with respect to the said ailment, indicating that the intervention has ceased to be temporary. c) The ailment must be irreversible, meaning: i. the condition is incurable; or ii. there is absolutely no hope of the patient being cured. An AMD which conveys the refusal of treatment cannot be enforced unless all the aforementioned conditions are satisfied. This applies even where the directive is explicit. For instance, consider a patient whose directive specifically states that no treatment should be administered in the event of a heart attack. If this patient is admitted with a heart attack, that instruction cannot be given effect to. The same is because the patient’s condition does not meet the requisite threshold conditions as aforesaid (e.g., terminally ill in PVS, prolonged medical treatment etc.) and therefore, the directive remains unenforceable despite its specific wording. ((Para 107-108)

Discharge against medical advice- Strongly Disapproved practice of “discharge against medical advice” (also known as “leaving against medical advice” or “discharge at own risk”) that is routinely misused in cases where the medical treatment of a patient stands discontinued. Such a course of action, when resorted to in substitution of a structured palliative and EOL care plan, risks amounting to an abdication of the doctor’s responsibility and undermines the very rationale of treatment limitation being founded on the patient’s best interest. The choice to withdraw or withhold a medical treatment cannot amount to a forfeiture of the patient’s right to a medically supervised care. We would like to clarify that it is not always mandatory that palliative and EOL care is provided in a hospital or any other institutional setting. It is permissible that the palliative care is given at home or at any place of choice of the patient or his/her family, as long as a palliative and EOL care plan has been prescribed at the time of discharge, so that the patient is not deprived of structured medical support in the most vulnerable phase of life.

Summary: The Supreme Court holds that clinically assisted nutrition and hydration (CANH) delivered via a PEG tube constitutes medical treatment, not mere basic care, and that it can lawfully be withheld or withdrawn under the passive‑euthanasia framework laid down in Common Cause, provided it is in the patient’s best interests. Applying a detailed “best interests” analysis—including medical futility, irreversibility, dignity, and the views of the patient’s family and medical boards—the Court finds that continued CANH for 32‑year‑old Harish Rana, in a permanent vegetative state for 13 years with no prospect of recovery, only prolongs suffering and an undignified existence. It therefore authorises withdrawal of CANH under a robust palliative and end‑of‑life care plan at AIIMS, clarifies and streamlines the Common Cause guidelines (including duties of doctors, medical boards, CMOs and High Courts), and strongly urges Parliament to enact a comprehensive statute on end‑of‑life decision‑making.