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The Supreme Court’s judgment on Wednesday (March 11) permitting the withdrawal of life-sustaining treatment from 32-year-old Harish Rana – who has been in a permanent vegetative state since he fell from the fourth floor of his paying guest accommodation near Panjab University in Chandigarh on August 20, 2013 – has been widely and rightly described as a landmark.

It is the first time before the Supreme Court that passive euthanasia has been permitted: the withdrawal of medical treatment from a patient in an irreversible condition so as to allow a natural death. The order brings to a close a legal battle that the Rana family has fought for two and a half years – against a backdrop of 13 years of continuous care.

What is less widely noted is the strangeness of the word “first.”

India has had a legal framework for passive euthanasia since March 2018, when a constitution bench decided Common Cause v Union of India ((2018). The court held that the right to life under Article 21 – interpreted since Maneka Gandhi (1978) as encompassing the right to live with dignity – extends to the manner of dying. A person in a permanent vegetative state with no prospect of recovery cannot be compelled to remain alive by medical intervention. 

Detailed guidelines were laid down for a two-tier process: a primary medical board certifying the patient’s condition; an independent secondary medical board reviewing that finding. In January 2023, a fresh constitution bench ((2023) simplified the procedure after years of complaints that the original guidelines were unworkable.

In June 2024, the directorate general of health services released draft guidelines for public consultation intended to give the framework administrative grounding. As of today, these guidelines remain unfinished. And the framework had produced not a single case in which passive euthanasia was actually permitted before the Supreme Court. A right declared by the constitution bench, refined twice, and for eight years remained effectively a dead letter.

Advocate Manish Jain speaks to the media outside the Supreme Court after the court allowed withdrawal of life support for a man in a permanent vegetative state in New Delhi on March 11, 2026. Photo: PTI.

The Rana family’s experience illustrates with uncomfortable precision why.

Harish was initially treated at the Postgraduate Institute of Medical Education and Research in Chandigarh, where he underwent a tracheostomy and was placed on a nasogastric tube. Later in 2013, the nasogastric tube was replaced by a percutaneous endoscopic gastrostomy (PEG) tube – surgically implanted through the abdominal wall, requiring........

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