Death and dignity: SC euthanasia judgement marks significant progress

The Supreme Court's decision allowing passive euthanasia for Harish Rana highlights India's evolving right-to-die framework-while exposing gaps in state systems to implement living wills

The Supreme Court’s judgment allowing passive euthanasia for 31-year-old Harish Rana, who has been in a vegetative state since 2013, has significantly moved the needle. As the first judgment to permit the withdrawal of life-sustaining medical support since passive euthanasia was legalised, it removed anomalies that took the Rana family three years of distressing legal battles. Despite the progressive nature of this verdict, the lack of state capacity to smoothly enable passive euthanasia or execute living wills remains a significant deterrent for Indians seeking the right to death with dignity. 

Laws on passive euthanasia put India on a par with European countries, Canada, Australia, New Zealand, and Japan.  India’s apex court recognised the legal concept of passive euthanasia in a landmark 2011 case concerning Aruna Shanbaug, a nurse who had been in a vegetative state for nearly four decades following a brutal rape. Although the court did not permit euthanasia for Shanbaug on the grounds that she did not meet the criteria for being in a permanent vegetative state, the legal recognition of euthanasia under strict medical guidelines opened the door for progress. In 2018, in Common Cause versus the Union of India, a five-judge Bench upheld the right to die with dignity under Article 21. This judgment also set out guidelines for executing living wills so that individuals could make advance medical directives regarding their end-of-life care. 

Those guidelines, however, proved so bureaucratic that few citizens chose to exercise the right. The procedures involved a counter-signature by a judicial magistrate (first-class), submission to a designated local government officer, and an evaluation by a medical board if the executor became terminally ill. In 2023, the court simplified the procedure to cut out the judicial magistrate’s intervention but required the living will to be signed by two witnesses, attested by a notary or gazetted officer and handed over to a “competent officer” of the government as custodian. The problems begin here since no state barring Maharashtra has appointed a custodian for this purpose. Maharashtra appointed 147 custodians across the state only in 2024 following public interest litigation. 

For families seeking euthanasia for a terminally ill relative, the legal guidelines are complex. They require the decision of a two-tier board. A primary board comprising the physicians treating the patient and two experts (with more than five years’ experience) would determine the patient’s condition. If this board recommends withdrawing medical care, a secondary board of three experts nominated by the district chief medical officer will review the case and make a decision in 48 hours. In Mr Rana’s case, the Supreme Court also made an important change to the law. The 2018 guidelines specified the withdrawal of life support via ventilators or mechanical breathing assistance. For Mr Rana, such devices are not required because he has been on a feeding tube. Therefore, the Delhi High Court and, initially, the Supreme Court held that withdrawing the feeding tube would amount to active euthanasia, which is illegal in India. A year later, a different Bench of the Supreme Court held that clinically administered nutrition qualified as medical treatment, paving the way for Mr Rana and his family to finally find release. Beyond this individual case, if this judgment encourages states to set up robust apparatuses to deal with passive euthanasia in a timely and appropriate manner, it would prove impactful.