On March 11 2026, a Division Bench of the Supreme Court delivered a 338-page judgment sanctioning the withdrawal of life-sustaining treatment to Harish Rana, a 32-year-old man who has been in a persistent vegetative state for 13 years after a road accident. This is the first time a court has permitted passive euthanasia in India. It was the culmination of two rounds of protracted litigation by Mr Rana’s family, but it was also a landmark decision that clarified several important legal questions. The right to passive euthanasia had technically existed since the Supreme Court recognised it in Common Cause v. Union of India (2018), which stated that the right to die with dignity was part of Article 21 of the Constitution.[1]
Specifically, the Bench in Harish Rana (2026) concluded that clinically assisted nutrition and hydration constitute “medical treatment” capable of withdrawal. Further, it expands the “best interests” standard for patients without advance directives to incorporate documented prior statements and known personal values, and exercises Article 142 discretion to waive Common Cause‘s mandatory 30-day reconsideration period where a prolonged vegetative state renders procedural delay purposeless.[2] The judgment, however, equally reveals how thoroughly every question in this area remains judicially unsettled due to the absence of a statute.
THE STRUCTURAL DEFICIENCIES OF THE CURRENT FRAMEWORK
The foundational failure is legislative absence. The Law Commission recommended legislation on passive euthanasia back in 2006,[3] and even the Supreme Court in Common Cause asked Parliament to step in.[4] But eight years later, hospitals and doctors still rely on court guidelines instead of a clear statute. Moreover, relying on a court judgment rather than a statute can create confusion. It is hard to imagine a doctor in a district hospital reading, let alone fully understanding, a 338-page Supreme Court judgment before making an urgent end-of-life decision.
Another major challenge is that doctors still fear criminal prosecution. Sections 100, 101, 105, and 108 of the Bharatiya Nyaya Sanhita, 2023 broadly define culpable homicide, murder, and abetment of suicide.[5] There is no safe-harbour provision for a physician who withdraws treatment causing death, even with consent, court approval, and a medical board’s clearance. Exception 5 to Section 101 carves out consent[6], but its application to euthanasia is legally untested. This causes doctors, particularly outside major urban centres, to be reluctant to withdraw treatment. Often, this hesitation stems from fear of legal consequences.
The medical board infrastructure compounds the problem. Most district hospitals have no Hospital Ethics Committee and lack the specialist composition that the Common Cause guidelines require. The Secondary Board process is slow and heavily bureaucratic. For terminally ill patients, these delays can make the entire system meaningless.
The living will framework illustrates another huge failure. Advance Medical Directives require notarised execution before two witnesses and registration with the jurisdictional sub-divisional magistrate. There is no national registry or Aadhaar-linked retrieval system, and there is no hospital admission system that routinely raises the option with terminal patients. If few people can realistically exercise a legal right, its practical value becomes questionable. Beneath all of this runs a structural inequality, where most Indian families make end-of-life decisions informally, in hospital corridors, without legal protection, invisible to any accountability mechanism the law provides.
ACTIVE EUTHANASIA AND THE QUESTION INDIA REFUSES TO CONFRONT
Consider a 58-year-old schoolteacher diagnosed two years ago with ALS. She knows that she is now going to experience progressive paralysis, loss of speech, and ultimately dependence on mechanical ventilation. She retains full decision-making capacity and has made it clear in writing to her doctor and family that she does not wish to progress with ventilator dependence. She wants to die on her own terms, while she is still physically capable of meaningful interaction with her family. Under Indian law, she can make a living will refusing a ventilator, operative only once she has already lost the capacity for the life she is trying to preserve. She cannot ask her physician to help her die now, peacefully. The law offers her a right to die, but only once her disease has sufficiently advanced that the manner of dying is no longer meaningfully her choice.
The entire legal resistance to active euthanasia rests on one idea: that there is a meaningful moral difference between doing something that causes death and failing to prevent it.[7] Law calls withdrawing a ventilator passive, since a doctor merely stops treatment, allowing nature to take its course.[8] Administering a lethal medication, on the other hand, is called active euthanasia or deliberate killing. These categories might sound clean until examined more closely. Consider what actually happens when a doctor withdraws a ventilator. She walks to the machine and turns it off. The patient dies at that moment, not later, because of that act. It seems that the critical difference lies not in the action itself but rather in the manner in which it is described by the law.
The Supreme Court in Common Cause has already accepted that prolonged undignified suffering violates Article 21, and autonomy over one’s death is a fundamental right. Now the question is how to end that suffering legally. Right now, Indian law allows some forms of ending treatment, but rejects others, even when the outcome is essentially the same. Interestingly, Indian law permits terminally ill patients to refuse chemotherapy, execute do-not-resuscitate orders, and self-discharge against medical advice without systematic scrutiny of their decision-making capacity.[9] That scrutiny appears only when the request is for euthanasia, triggered not by any clinical finding but by society’s discomfort with the decision itself, which is not a principled legal distinction.
Before moving forward, it becomes imperative to discuss the inherent risks associated with active euthanasia. The most significant is economic coercion. In a country with deep inequalities and cultural expectations around elder care, the pressure on a terminally ill person to perceive their continued existence as a burden is not hypothetical. Legislation must therefore mandate independent psychiatric assessment by a government-empanelled psychiatrist with no prior relationship to the patient. It must explicitly exclude financial hardship and family burden from the statutory definition of qualifying suffering.
The slippery slope objection deserves equal seriousness. The Netherlands has seen proposals to extend eligibility to those over 75 who consider their lives ‘completed’, independent of any medical condition[10], and has prosecuted, but later acquitted, a physician who sedated a dementia patient before administering a lethal injection when the patient showed signs of resistance.[11] These are not cautionary hypotheticals, but consequences of an expanding eligibility criteria and review mechanisms with no teeth. A possible response would be to adopt narrow statutory criteria that Parliament alone can amend, alongside periodic legislative review through a sunset clause, requiring review rather than automatic continuation. At the same time, India’s weak healthcare infrastructure means such a system cannot be introduced everywhere at once. In the beginning, it should be allowed only in NABH-accredited hospitals that already have proper palliative care units. Expansion to other hospitals or regions should happen only after independent reviews show that the first phase is working safely and properly.
THE BLUEPRINT FOR AN INTEGRATED STATUTORY ARCHITECTURE
Parliament must first convert the Common Cause guidelines into statute. A Dying with Dignity Act must mandate a timeline for application-to-clearance with named criminal liability for institutional delay, require Hospital Ethics Committees in every institution above 50 beds,[12] and establish a digital Aadhaar-linked National Advance Medical Directive Registry integrated with the Ayushman Bharat Digital Mission. Most critically, it must provide explicit physician immunity from BNS liability for acts performed in documented compliance with its provisions.
We also require a National Palliative Care Act mandating palliative care as an insured service under PM-JAY, setting a nationally enforceable expansion target for palliative care within five years, and requiring 40 hours of end-of-life training in all MBBS programmes.[13] Fewer than 4% of Indians requiring palliative care currently receive it.[14] A right to die with dignity without a systematic pain management infrastructure is outright abandonment.
On active euthanasia, Parliament should enact a separate Physician-Assisted Dying Act, operational for five years in Phase 1 designated facilities only, requiring a terminal prognosis under six months, verified decision-making capacity, refractory suffering certified by a palliative specialist, and three written requests across a mandatory 15-day interval.[15] Each case must be reviewed within 30 days[16] by a Regional Euthanasia Review Committee comprising a retired High Court judge, an independent senior physician, and an accredited bioethicist, with mandatory annual reports submitted to Parliament. Cases outside the eligibility criteria must be referred for criminal prosecution.
Ultimately, thirteen years after Harish Rana’s accident, he has finally received what the law had supposedly guaranteed him since 2018. His case will be remembered as a landmark, but it also shows how inaccessible the present framework really is. No fundamental right should require years of court proceedings, repeated medical evaluations, and hundreds of pages of judicial reasoning before it can be exercised by a single family. The judiciary has already provided the parameters, and now the onus rests entirely on Parliament to construct the statutory architecture.
Author: Inaaya Waqar
References:
[1] Common Cause (A Registered Society) v Union of India (2018) 5 SCC 1, [243] (Chandrachud J).
[2] Harish Rana v Union of India Miscellaneous Application No 2238 of 2025 in Special Leave Petition (Civil) No 18225 of 2024 (Supreme Court of India, 11 March 2026) 2026 SCC OnLine SC 358 (Pardiwala and Viswanathan JJ).
[3] Law Commission of India, Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) (Report No 196, 2006).
[4] Common Cause (A Registered Society) v Union of India (2018) 5 SCC 1, [246] (Chandrachud J).
[5] Bharatiya Nyaya Sanhita (Act No 45 of 2023), ss 100, 101, 105, 108.
[6] Bharatiya Nyaya Sanhita (Act No 45 of 2023), s 101, Exception 5.
[7] M Tooley, ‘An Irrelevant Consideration: Killing Versus Letting Die’ in Bonnie Steinbock (ed), Killing and Letting Die (Prentice-Hall 1980) 56.
[8] R Gillon, ‘Euthanasia, Withholding Life-Prolonging Treatment, and Moral Differences between Killing and Letting Die’ (1988) 14 Journal of Medical Ethics 115.
[9] Common Cause (n 1) [119]–[121] (right to refuse treatment as dimension of Article 21, including chemotherapy and life-sustaining intervention); Samira Kohli v Dr Prabha Manchanda (2008) 2 SCC 1 [16]–[19] (Raveendran J) (patient’s right to refuse specific treatment is absolute absent a life-threatening emergency; consent must be procedure-specific); Suchita Srivastava v Chandigarh Administration (2009) 9 SCC 1, [11] (Balakrishnan CJI) (bodily integrity and right to refuse unwanted medical intervention as dimension of personal liberty under Article 21); Justice KS Puttaswamy (Retd) v Union of India (2017) 10 SCC 1 [115]–[116] (Chelameswar J) (right to refuse medical treatment including right against forced feeding as incident of right to privacy under Article 21).
[10] Judith AC Rietjens and others, ‘Two Decades of Research on Euthanasia from the Netherlands: What Have We Learnt and What Questions Remain?’ (2009) 6(3) Journal of Bioethical Inquiry 271.
[11] Eva Constance Alida Asscher and Suzanne van de Vathorst, ‘First Prosecution of a Dutch Doctor since the Euthanasia Act of 2002: What Does the Verdict Mean?’ (2020) 46(2) Journal of Medical Ethics 71.
[12] National Accreditation Board for Hospitals and Healthcare Providers, Guidebook to NABH Certification Standards for Entry Level Hospitals (2nd edn, Quality Council of India 2025) s 1 (classifying hospitals with 1–50 beds as Small Healthcare Organisations and those with 51 beds and above as hospitals subject to full accreditation standards).
[13] The 40-hour proposal draws on the National Medical Commission, Competency Based Medical Education Curriculum for MBBS (NMC 2019), which allocates no dedicated end-of-life care module; for comparison, Canadian undergraduate palliative care education requires a minimum of 40 hours across the MBBS equivalent: S Kavalieratos and others, ‘Palliative Care Education in Undergraduate Medical Training’ (2022) 20 Journal of Pain and Symptom Management 432.
[14] P Sharma and others, ‘Access to Palliative Care in India: Situational Analysis and Modelling of Access from Public Healthcare Centers’ (2025) 19 ecancermedicalscience 1886 <https://doi.org/10.3332/ecancer.2025.1886> accessed 25 May 2026.
[15] The 15-day minimum interval between oral requests adapts Or Rev Stat § 127.840 (Oregon Death with Dignity Act 1997), which requires two oral requests separated by at least 15 days and one written request before a prescription may be issued; the three-request structure mirrors the same provision. For comparison, the Belgian Act on Euthanasia of 28 May 2002 (Belgisch Staatsblad/Moniteur belge, 22 June 2002) s 3(2) requires a written request and consultation with a second independent physician, but imposes a one-month waiting period only where the patient is not terminally ill.
[16] The 30-day review window is proposed as a broader adaptation of the Belgian Federal Control and Evaluation Commission’s mandatory reporting framework: Belgian Act on Euthanasia of 28 May 2002 (Belgisch Staatsblad/Moniteur belge, 22 June 2002) arts 5 and 8, which require each performing physician to submit a registration document to the Commission within four working days of the act, with the Commission reviewing for legal compliance and referring non-compliant cases to the Public Prosecutor; the proposed 30-day window accommodates India’s administrative constraints while preserving mandatory ex-post scrutiny.
