The Right to Die with Dignity in India: The Law After Harish Rana

The right to die with dignity in India is not a general right to end one’s life. It is the legally protected right of a competent person to refuse unwanted medical treatment and, in narrowly defined circumstances, to permit the withdrawal or withholding of life-sustaining treatment when recovery is no longer possible. The law has taken more than a decade—and four important Supreme Court decisions—to reach its present form.

Guest post by Kaustubh Pratap Singh, Law Student, Himachal Pradesh University

What does “passive euthanasia” mean?

Indian judgments use the expression “passive euthanasia” for the withdrawal or withholding of medical treatment that sustains life. The immediate cause of death remains the patient’s underlying illness or injury; treatment is no longer used to postpone the natural course of that condition.

Active euthanasia is different. It involves a positive act intended to cause death, such as administering a lethal substance. The Supreme Court has repeatedly said that active euthanasia remains unlawful unless Parliament enacts legislation permitting it.

The distinction is therefore between causing death through a new external agency and allowing death to occur after life-prolonging treatment is withdrawn. Even where switching off a machine requires a physical act, the legal character of the decision is an omission to continue treatment.

Aruna Shanbaug (2011): the first judicial framework

Aruna Ramachandra Shanbaug was a nurse who suffered catastrophic injuries after an assault in 1973 and remained in a persistent vegetative state for decades. In Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454, the Supreme Court held that passive euthanasia could be permissible in exceptional cases, while active euthanasia remained unlawful.

Because there was no governing statute, the Court created an interim procedure. A decision by parents, a spouse, close relatives or a “next friend” required approval from the High Court, which would obtain an opinion from a committee of medical experts.

The Court did not permit withdrawal of treatment in Aruna Shanbaug’s own case. It accepted that the KEM Hospital staff who had cared for her were her appropriate next friends and noted their opposition to withdrawal. The decision opened a legal route, but the High Court-centred process was demanding and difficult to use.

Common Cause (2018): dignity, autonomy and living wills

The constitutional foundation was clarified in Common Cause (A Registered Society) v. Union of India, (2018) 5 SCC 1. A Constitution Bench recognised that the right to live with dignity under Article 21 includes dignity during the process of dying. It also affirmed the right of a competent adult to refuse medical treatment as an aspect of autonomy, privacy, bodily integrity and self-determination.

The Court held that Advance Medical Directives—commonly called living wills—are legally valid. An adult with decision-making capacity may record, in advance, the circumstances in which life-sustaining treatment should not be continued if that person later loses the ability to communicate.

For patients who cannot decide for themselves, treatment may be withdrawn only when the prescribed medical conditions and procedural safeguards are satisfied, and the decision serves the patient’s best interests. The Court laid down separate procedures for cases with and without an Advance Medical Directive.

The 2023 modification: a more workable process

In 2023, the Supreme Court modified the Common Cause directions after acknowledging practical difficulties in their implementation. The principal changes included:

an Advance Medical Directive may be signed in the presence of two independent witnesses and attested before a notary or gazetted officer, instead of requiring execution before a Judicial Magistrate First Class;
medical boards may include doctors with at least five years’ experience in the relevant specialties;
the Primary and Secondary Medical Boards should ordinarily give their opinions within 48 hours of referral; and
the document should be made available to the family physician, relevant local authority and, where available, the person’s digital health record.

These changes reduced procedural obstacles without abandoning the central safeguards of medical scrutiny, informed decision-making and protection against abuse.

Harish Rana (2026): applying the framework in practice

In Harish Rana v. Union of India, 2026 INSC 222, the Supreme Court considered the case of a man who had remained in a permanent vegetative state for more than twelve years after a severe traumatic brain injury. He was cared for at home with a tracheostomy, urinary catheter and clinically assisted nutrition and hydration (CANH) delivered through a surgically placed percutaneous endoscopic gastrostomy, or PEG, tube.

The case raised two decisive questions: whether CANH delivered through a PEG tube is “medical treatment”, and whether continuing it was in Harish Rana’s best interests.

The Court held that CANH is medical treatment. Its prescription and delivery require clinical assessment, a medical device, ongoing supervision and management of risks such as infection, aspiration and metabolic instability. The fact that trained family members may administer feeds at home does not convert the intervention into ordinary food and water.

Both medical boards and the family agreed that the treatment offered no therapeutic benefit and should be discontinued. Applying the best-interests principle, the Court held that the proper question was not whether death was in the patient’s interests, but whether it was in the patient’s interests to have life artificially prolonged by continued treatment.

The Court directed withdrawal or withholding of the treatment, including CANH, and required AIIMS to admit Harish Rana to its palliative-care department. It stressed that withdrawal must occur under a structured end-of-life plan that manages symptoms, minimises suffering and preserves dignity.

What the judgment clarified for future cases

The importance of Harish Rana extends beyond one family. The Court clarified that:

where the Primary and Secondary Medical Boards concur, a further court order is ordinarily unnecessary;
the patient’s best interests must include both medical considerations and, so far as they can be ascertained, the patient’s own values, wishes and likely choice;
patients receiving long-term care at home may be admitted to a hospital, or linked with a treating physician, so that the Common Cause process can begin;
where a hospital or treating physician fails to initiate the process despite the threshold conditions being met, the family or next friend may approach the High Court under Article 226;
after concurring board opinions, implementation ordinarily follows a 30-day reconsideration period during which an aggrieved person with standing may approach a court; and
Chief Medical Officers must maintain panels of eligible doctors so that Secondary Medical Boards can be constituted without avoidable delay.

The Court described this as the first case to reach it in which the Common Cause guidelines were applied in their full measure. It also urged the Union Government to consider comprehensive legislation, observing that judicial guidelines were not intended to remain a permanent substitute for a statute.

How the law operates today

A competent adult: A person capable of making an informed decision may refuse medical treatment. That decision belongs to the patient and does not require the State to agree with the patient’s reasons.

A patient with an Advance Medical Directive: The directive identifies the circumstances in which treatment may be withheld or withdrawn and normally names a guardian or close relative authorised to participate when the patient loses capacity. The medical-board procedure must still be followed.

A patient without an Advance Medical Directive: The treating physician and medical boards must evaluate whether the statutory and judicially prescribed medical thresholds are met and whether continued treatment serves the patient’s best interests. The patient’s next of kin, next friend or guardian remains central to the process.

Withdrawal of life-sustaining treatment does not mean abandonment. Doctors retain a duty to provide palliative and end-of-life care, including pain relief, symptom management and respect for the patient’s dignity.

Living wills and digital health records

The 2023 directions contemplated keeping Advance Medical Directives in digital form and incorporating them into digital health records where available. That could make a person’s wishes accessible during an emergency away from home.

The Digital Health Records (Mandatory Use) Bill, 2025 was introduced in the Rajya Sabha as a private member’s bill. It proposed wider use of digital health identifiers and records in specified public-health settings. It is a proposal, not enacted law, and it does not itself establish a binding nationwide system for storing living wills.

Accordingly, people should not assume that creating an ABHA number automatically places an Advance Medical Directive in a national record. A directive should be executed in accordance with the Supreme Court’s requirements and copies should be made available to the persons and authorities identified in the applicable procedure.

Practical takeaway

Active euthanasia remains unlawful in India.
A competent adult may refuse unwanted medical treatment.
Withdrawal or withholding of life-sustaining medical treatment is constitutionally permissible when the governing safeguards are satisfied.
A living will is legally valid, but its execution and implementation must follow the Supreme Court’s procedure.
For an incompetent patient, the controlling question is whether continuing treatment is in that patient’s best interests.
CANH administered through a PEG tube can constitute medical treatment and may be considered for withdrawal under the same framework.
Palliative and end-of-life care must continue after life-sustaining treatment is withdrawn.

India’s right-to-die jurisprudence is therefore not a licence to cause death. It is a framework for respecting autonomy and dignity when medicine can no longer heal and can only prolong biological existence. The next step is comprehensive legislation that makes this sensitive process clear, accessible and consistent across the country.