The bench held that it would be in the best interest and dignity of the patient that life-sustaining support be withdrawn in a palliative care setting.

In a first-of-its-kind judicial order in India, the Supreme Court on Wednesday allowed passive euthanasia for a 31-year-old man who has remained in a permanent vegetative state for over a decade, laying down safeguards and procedural guidelines to regulate such decisions in the future.Delivering separate but concurring opinions, a bench of justices JB Pardiwala and KV Viswanathan held that it would be in the best interest and dignity of the patient that life-sustaining support be withdrawn in a palliative care setting.

Allowing the plea by the parents of Harish Rana, the court permitted the withdrawal of clinically assisted nutrition and hydration (CANH) under strict medical supervision and directed that the process be carried out in the palliative care unit of the All India Institute of Medical Sciences (AIIMS), Delhi.

Reading out portions of the judgment in court, the bench clarified that CANH cannot be treated as a form of ordinary care. “CANH cannot be regarded as a basic means for primary care, but it is a technologically induced medical intervention that is prescribed and supervised by trained healthcare professionals, even when administered at home. Therefore, it is permissible for the primary and secondary medical boards to exercise their informed decision on withdrawing such medical support,” the bench said.

It emphasised that the guiding principle in such cases is not whether the patient should die, but whether medical intervention should continue to prolong life in circumstances where recovery is medically impossible.

“On the best interest principle, we have held that the correct inquiry would not be whether the patient should die but whether his life should be prolonged under the current circumstances and medical interventions."

Ordinarily, it would not require an intervention of this court after the medical boards’ opinion, but since it is the first such case, the court has decided to delve further into the issue,” the bench said.

The court stressed that withdrawal of life-sustaining treatment must not be equated with abandonment of the patient. “The withdrawal has to be carried out in a humane and sensitive manner. It cannot be an abandonment of a patient, but it has to be done in a structured manner that minimises pain and ensures dignity."

The court clarified that end-of-life care decisions do not necessarily have to be implemented in hospitals. “If an end-of-life care plan has been framed, it is also not essential that such a step is taken in an institutional setting; it can also be carried out at home."

The court noted that the patient’s parents and next of kin, as well as the medical boards constituted to evaluate his condition, unanimously concluded that continuation of CANH and medical treatment would serve no purpose and that withdrawal would be in his best interest.

Rana, a former Panjab University student and a resident of Ghaziabad in Uttar Pradesh, suffered head injuries in 2013 after falling from the fourth floor of his paying guest accommodation. Since then, he has remained completely unresponsive and bedridden, dependent on feeding tubes for nutrition and hydration.

Although he is not on mechanical ventilation, he requires round-the-clock care and has shown no neurological improvement for over 10 years.

After years of treatment and therapy, his parents approached the Supreme Court seeking permission to withdraw life-sustaining treatment, contending that continued medical intervention served no therapeutic purpose and merely prolonged suffering.

During the course of proceedings, the court ordered multiple medical evaluations. On December 11, it directed the constitution of a secondary medical board at AIIMS after a primary board of doctors from Ghaziabad and Meerut reported that Harish had 100% disability quadriplegia with negligible chances of recovery.

The AIIMS board, in a report dated December 16, concluded that there was little to no possibility of improvement in his condition and described the medical state as irreversible.

Before delivering its verdict, the court interacted personally with Rana's family. Recording the interaction earlier this year, the court noted the anguish expressed by his parents and younger brother, who had unanimously urged that he should not be made to suffer further if medical treatment could not improve his condition.

While permitting withdrawal of CANH, the court framed procedural safeguards intended to guide similar cases in the future. It directed that chief medical officers across districts prepare panels of medical experts to evaluate applications seeking passive euthanasia.

The bench said these panels would assist in the constitution of medical boards required to examine such requests in accordance with the framework laid down in the Supreme Court’s 2018 Common Cause judgment, which recognised the right to die with dignity.

The court waived the 30-day waiting period ordinarily required under the Common Cause framework, noting that in the present case, there was unanimous agreement among the family members and the medical boards.

The bench urged the Union government to consider enacting a law on passive euthanasia to address what it described as a legislative vacuum. “We have urged the Union of India to consider framing legislation on passive euthanasia since there is a legislative vacuum,” the bench said.