‘Right To Die With Dignity’: In A First, SC Allows Passive Euthanasia For Man In Coma For 13 Years

New Delhi: In a significant ruling on the right to die with dignity, the Supreme Court on Wednesday permitted the withdrawal of life-sustaining medical treatment for 32-year-old Harish Rana, who has remained in a persistent vegetative state for the past 13 years following a severe brain injury.

A Bench of Justices JB Pardiwala and KV Viswanathan allowed Rana’s parents to discontinue the Clinically Administered Nutrition (CAN) that has been sustaining his life through surgically installed PEG feeding tubes.

Rana, a former student of Panjab University, suffered catastrophic brain injuries in 2013 after falling from the fourth floor of his paying-guest accommodation. Since the accident, he has been in a persistent vegetative state with 100 per cent quadriplegia and has remained confined to bed, dependent on a tracheostomy tube for respiration and feeding tubes for nutrition.

The court noted that medical records over the past 13 years showed no improvement in his neurological condition and that the treatment being administered merely prolonged his biological existence without any therapeutic benefit.

“Harish Rana, currently aged 32 years, was once a young, bright boy. His brain injury left him in a condition of Persistent Vegetative State with 100% quadriplegia,” the Bench observed, adding that he had survived solely on clinically administered nutrition.

Medical Boards Supported Withdrawal

The Bench said the decision to withdraw treatment was supported by both the primary and secondary medical boards constituted to assess Rana’s condition. These boards concluded that the continuation of clinically administered nutrition was not in the best interest of the patient.

The court held that CAN qualifies as medical treatment and can be withdrawn based on the considered judgment of the medical boards.

Noting that both boards and the patient’s parents had unanimously recommended withdrawal of life support, the court said judicial intervention is ordinarily unnecessary in such circumstances. However, since this was the first such instance being considered, the matter was placed before the apex court.

Court Lays Down Directions

While permitting the withdrawal of treatment, the court issued a series of directions to ensure that the process is carried out with dignity and proper safeguards.

It ordered that:

• The medical treatment, including clinically administered nutrition, be withdrawn, waiving the usual 30-day reconsideration period.
• All India Institute of Medical Sciences (AIIMS) must admit Rana to its palliative care centre and facilitate his transfer from his residence.
• The withdrawal of life support be implemented through a carefully designed plan to maintain dignity and comfort.
• High Courts across the country must direct judicial magistrates to receive intimations from hospitals when primary and secondary medical boards unanimously decide to withdraw or withhold life support.
• The Central Government must ensure that Chief Medical Officers in all districts maintain panels of registered medical practitioners for constituting secondary medical boards.
• The court also recommended that the Centre consider enacting comprehensive legislation governing passive euthanasia.

Court Praises Parents’ Devotion

Justice Pardiwala, who authored the main judgment, recorded the court’s appreciation for the patient’s parents, noting their unwavering care and devotion for their son over the past decade.

“His family never left his side… to love someone is to care for them even in the darkest times,” the judgment observed.

Justice Viswanathan delivered a concurring opinion.

During the proceedings, Justice Pardiwala reflected on the philosophical complexity of the issue, quoting American minister Henry Ward Beecher’s words: “God asks no man whether he will accept life, you must take it,” and invoking the famous line from William Shakespeare’s Hamlet: “To be or not to be” to underline the moral dilemma courts face when deciding cases involving the right to die.

Passive Euthanasia In India

Passive euthanasia, where life-sustaining treatment is withdrawn or withheld, was first recognised under limited circumstances by the Supreme Court in the landmark judgment in Aruna Shanbaug vs Union of India.

The case involved nurse Aruna Shanbaug, who remained in a vegetative state for more than four decades after a brutal sexual assault that left her paralysed and severely brain-damaged. Although the court rejected the plea to withdraw her life support, it laid down guidelines permitting passive euthanasia in exceptional circumstances.

Later, in 2018, the Supreme Court further strengthened the right to die with dignity through the ruling in Common Cause vs Union of India, which recognised advance directives or “living wills” and established procedures involving medical boards.

The Harish Rana ruling is seen as an important step in operationalising these principles and clarifying procedures for hospitals and authorities when families and medical experts conclude that continued treatment offers no medical benefit.