New Delhi, March 11 The Supreme Court on Wednesday allowed the withdrawal of artificial life support from a 32-year-old man who has been in a coma for more than 13 years, stating that the government should consider enacting comprehensive legislation on passive euthanasia.
In the top court's first-ever order on this sensitive issue, a bench of Justices JB Pardiwala and KV Viswanathan directed AIIMS-Delhi to ensure that life support is withdrawn in a way that maintains the patient's dignity. Passive euthanasia refers to the intentional act of allowing a patient to die by withholding or withdrawing life support or treatment necessary to keep him alive.
The patient, Harish Rana, a BTech student at Panjab University and a sports-loving young man, suffered head injuries after falling from the fourth floor of his accommodation in 2013 and has been in a coma since.
"In the facts and circumstances of this case, we are satisfied that the twin legal requirements for the withdrawal and withholding of medical treatment have been unequivocally met. First, it has been established that the clinically assisted nutrition and hydration currently being administered to the applicant constitutes 'medical treatment'.
"Secondly, it has been conclusively determined that the continued administration of the same is no longer in the 'best interests' of the applicant. In light of the unanimous consensus arrived at by the parents/next of kin and the constituted medical boards respectively, we are of the opinion that the medical treatment ought not to be prolonged any further," the bench said in a 338-page judgment.
"The right to die with dignity is inseparable from the right to receive quality palliative and End of Life care. It is imperative to ensure that the withdrawal process is not marred by pain, agony, or suffering," it added.
The top court noted that Rana survived only through clinically administered nutrition via percutaneous endoscopic gastrostomy tubes, and medical boards had unanimously concluded that continuation of treatment merely prolonged biological existence without any possibility of recovery.
When primary and secondary boards had certified withdrawal of life support, there was no need for judicial intervention, the apex court said. The court made a special mention of Rana's parents, expressing its appreciation to them for showing immense love and care for their son. "His family never left his side," it said.
"The issues in this matter have once again brought to the fore the fragility and transient nature of life, and how swiftly things can turn for the worse. For the past thirteen years, the applicant has lived a life defined by pain and suffering. This suffering has been made all the more cruel by the fact that, unlike most of us, he was stripped of the ability to even give voice to his anguish."
However, while this case highlights how unforgiving life can be, it is easy to lose sight of another vital fact. We note with immense respect that the applicant's parents and siblings have stood as unyielding pillars of support. They have exhausted every effort to care for him and continue to do so with unwavering dedication. We can only place on record our deepest appreciation for their boundless love, endurance, and kindness in the face of such adversity," the bench said.
Rana's family had said that allowing withdrawal of artificial life support would restore his dignity after years of irreversible suffering. Shortly after the Supreme Court pronounced its judgment, a crowd gathered outside the Brahm Raj Empire society in Ghaziabad, where the family now lives.
Rashmi Nandakumar, the lawyer who represented the Ranas in the Supreme Court, told
Local residents spoke about how the family had gone out of their way to get their son treated. Ashok Rana and his wife Nirmala Rana had sold their house in Delhi to meet the medical expenses of their son, neighbours told the media.
The order allowing passive euthanasia is in line with the court's 2018 Common Cause judgment, which was modified in 2023 and recognised the fundamental right to die with dignity.
In the 2018 judgment, a constitution bench had recognised passive euthanasia and the right to die with dignity as a fundamental right under Article 21. The court had held that passive euthanasia could be carried out using "Advance Medical Directives".
On January 24, 2023, a five-judge Constitution bench modified the 2018 guidelines to ease the process of granting passive euthanasia to terminally ill patients. A primary and a secondary medical board must be formed for an expert opinion on the withdrawal of artificial life support for a patient in a vegetative state, the guidelines stated.
Hearing the Rana family's writ petition, the top court had earlier expressed its desire to meet the parents. It examined a report on Rana's medical history filed by a secondary medical board of doctors from AIIMS-Delhi and remarked that it was a "sad" report.
The primary medical board, upon examining the patient's condition, had stressed that there was negligible chance of his recovery.
"What they tried to convey, in their own way, was that the medical treatment imparted over a period of almost two years be discontinued and nature be allowed to take its own course.
"According to them, if the medical treatment is not making any difference, there is no point in continuing with such treatment and making Harish suffer for no good reason. They believe that Harish is suffering like anything, and he should be relieved of all further pain and suffering," the bench noted in its order.
In 2011, the top court rejected a euthanasia plea on behalf of Aruna Shanbaug, bedridden in a permanent vegetative state in a Mumbai hospital for 38 years after a brutal sexual assault in November 1973. The court, however, said that passive euthanasia could be considered under certain conditions, including cases where the patient was in a permanent vegetative state.