In a historic decision, the Supreme Court of India has permitted passive euthanasia for Harish Rana, a 32-year-old man who has been in a coma for the past 13 years. The ruling marks the first time a court in India has directly allowed passive euthanasia for a patient under the legal framework established by the court in its 2018 Common Cause judgment, which was later updated in 2023.

The order was delivered by a bench comprising Justices JB Pardiwala and KV Viswanathan while hearing a plea filed by Rana’s father. The family had approached the court seeking permission to withdraw life-sustaining medical support for Rana, who has remained in an irreversible vegetative state since 2013.

Harish Rana was a student when the tragic incident occurred in August 2013 in Chandigarh. According to the case details, he suffered a devastating fall from a building that left him in a critical condition. Since the accident, he has been in a coma and dependent on artificial life support for survival. Over the years, his medical condition has shown no signs of recovery, and he has continued to remain in a permanent vegetative state.

While considering the plea filed by his father, the Supreme Court examined the provisions related to passive euthanasia laid down in its earlier judgment. The 2018 ruling by a five-judge bench had recognised the legality of passive euthanasia for terminally ill patients and also provided guidelines for the process.

After reviewing the circumstances of the case, the bench acceded to the family’s request. In its order, the court directed that the life-sustaining treatment being provided to Rana be withdrawn in accordance with the legal guidelines.

The bench clearly stated that “the medical treatment, including Clinically Assisted Nutrition (CAN) being administered to the applicant, shall be withdrawn/ withheld”. The judges also emphasised that the process must be handled carefully and respectfully. According to a report by The Indian Express, the court said that the process “must be carried out in a humane manner”.

The Supreme Court also issued directions regarding the medical arrangements required for carrying out the withdrawal of treatment. It asked the All India Institute of Medical Sciences to admit Harish Rana to its palliative care department.

The bench said that this step was necessary “so that the withdrawal and or withholding of the applicant’s medical treatment, including CAN, can be given effect to.” It further directed that AIIMS should make all necessary arrangements for transferring Rana from his residence to the hospital’s palliative care unit.

The court specifically instructed the hospital authorities to ensure that the process is conducted with proper medical supervision and care. In its order, the bench said, “AIIMS must ensure that such withdrawal and or withholding is carried out through a robust, palliative, and end-of-life care plan which is specifically tailored to manage symptoms without causing any discomfort to the applicant and ensuring that his dignity is preserved to the highest degree.”

The ruling also highlighted the legal principles established in the Supreme Court’s earlier judgment on passive euthanasia. The 2018 verdict had recognised a patient’s right to refuse life-sustaining treatment in certain circumstances. It had also laid down detailed guidelines regarding the procedure to be followed.

These guidelines apply to two types of situations. One is when a patient has left behind an “advance directive” or a “living will” stating that life support should be withdrawn if they enter a terminal medical condition. The second situation applies when no such directive exists and family members approach the court seeking permission to withdraw life-sustaining treatment.

In Rana’s case, the family filed the plea as he had not left behind any advance directive or living will. After examining the facts and medical condition of the patient, the Supreme Court decided to allow the withdrawal of treatment under the framework of passive euthanasia.

The judgment is significant because it represents the first instance where the Supreme Court has directly permitted passive euthanasia for an individual patient following the guidelines set out in its earlier rulings.