Why Supreme Court’s Latest Verdict On Euthanasia Is A Landmark One

In what will be considered a landmark case in the country’s legal framework around euthanasia, the Supreme Court earlier today allowed for the withdrawal of life support for a 31-year-old male who had been in a vegetative state for over 13 years.

Open had first reported about this case involving Harish Rana, who as a young engineering student had tragically fallen from the fourth floor of his paying guest accommodation, leading to brain injuries and complete paralysis, with only a feeding tube keeping him alive, when his family first approached the Delhi High Court seeking to have the tube disconnected a few years ago.

Rana’s family members had cared for him for over 13 years entirely on their own, first at various hospitals in the early years of his treatment, and thereafter entirely at home. They had approached the court once they realised that he was never going to recover. “The parents are both old now, and finding it increasingly difficult. They are looking for solutions. Also, all of this has been a big financial strain,” Dr Ishita Gandhi, the director of palliative support at CanSupport, an organisation that provides free palliative care which had begun to support Rana when the case first hit the news, had told this reporter back in 2024. Rana’s father Ashok, who is retired, made a living selling sandwiches, and a younger brother had only begun working recently. Caring for Rana was not just emotionally draining but also exhausting for his aged parents. Apart from the feeding tube, also known as a PEG (percutaneous endoscopic gastrostomy) tube, which needed to be changed in a hospital every month, Rana also relied on a catheter and a tracheostomy tube, which is a tube that is surgically inserted through the neck and into the trachea to allow air to fill the lungs. “They have all [Rana and his family] been living a very hard life. And they have been doing it for years,” Gandhi told this reporter.

The case however took its own twists and turns. The Delhi High Court turned down the family’s request to disconnect the feeding tube, and when they appealed to the Supreme Court, it appeared to be initially agreeing with the Delhi High Court, with a bench headed by the then Chief Justice of India DY Chandrachud making oral comments where it expressed its sympathies to the parents, but claimed the case did not satisfy the parameters of passive euthanasia. “This is a very, very hard case,” the bench was quoted as saying back then. “In this case, it would amount to active euthanasia, which is not legal… The High Court was right. No doctor would agree to do that.”

Since there are no laws passed by the Parliament that addresses this issue of euthanasia, it is the judicial system that has had to step into the vaccum. The Supreme Court first came up with a distinction between the concept of active and passive euthanasia in 2011 in the Aruna Shanbaug case, with the court permitting passive euthanasia where life support in individuals with terminal illnesses and no scope of recovery could be withdrawn or withheld (provided medical boards approved it), but active euthanasia or the active assistance in the death of an individual was to remain illegal.

Rana’s case challenged this distinction between active and passive euthanasia. Disconnecting a feeding tube, the judges earlier seemed to be suggesting, would not be akin to withdrawing life support for an individual with no hope of recovery, but actively assisting in his death.

The line between active and passive euthanasia can be both ethically and legally confusing. Why should disconnecting a PEG tube, which is a surgically-placed tube that passes nutrition via the abdomen and into the stomach, and which many medical specialists consider a form of life support, be considered active euthanasia and hence illegal, when switching off a ventilator will be regarded as passive euthanasia? Those who believe that no such distinction between active and passive euthanasia should exist in fact argue that switching off a respirator is as deliberate an act as injecting a lethal cocktail of drugs.

The Supreme Court has now allowed for passive euthanasia in Rana’s case, ruling that clinically-assisted nutrition should also qualify as medical treatment that can be withdrawn if medical boards recommend it. As the bench of Justices JB Pardiwala and KV Viswanathan delivered their verdict, a visibly emotional Justice Pardiwala, according to reports, said, “The issues in this matter have brought to the fore the fragility and transience of the life we live… Our decision today is not only logic, it sits in a space of love, medicine and science. And then addressing Rana’s parents, Justice Pardiwala said “This is an act of profound compassion and courage. You are not abandoning your son. You are allowing him to leave with dignity.”