INTRODUCTION: THE CONSTITUTIONAL TUG-OF-WAR
“The right to life is not a right to mere animal existence; it is a right to live with dignity. If that dignity is lost to a vegetative state, the right to die becomes the final expression of that life.”[1] This profound observation from the landmark Harish Rana v Union of India decision highlights a major shift in Indian jurisprudence. While the constitution of India guarantees the “Right to Life” (Article 21),[2] there has been a big debate on whether this right to life means that life must be saved at all costs or if it should also mean the right to end one’s life with dignity when there is extreme suffering in one’s life.
The range of this argument active euthanasia which is the positive action of death ending life versus passive euthanasia as the omission or withdrawal of life-sustaining treatment. The latter was previously a legal grey area, the Harish Rana case of 2026 has now moved the law away from the abstract conceptualization and into the realm of clinical reality, with sanctioning the withdrawal of Clinically Assisted Nutrition and Hydration (CANH).[3] However, an important question still prevails: is the current judicial framework a real protection of patient autonomy or is it perhaps one cautious legal compromise that stops short of true dignity?
THE JURIS-TRIAL PROCESS: THE CRIMINALIZATION TO COMPASSION
The euthanasia jurisprudence, India had its origin: The Inconsistency Era. In P Rathinam v Union of India, the Supreme Court in the beginning reflected the “right to die” rather than the right to live.[4] However, it was soon overruled in the case of Gian Kaur v State of Punjab which stated that though there was no consistency of thought that there is a right to end life under Article 21 yet it necessarily includes the right to a “dignified exit” from it.[5]
The “Landmark Shift” came in the case of Aruna Shanbaug vs Union of India, when the Courts approved passive euthanasia to patients who were in a Permanent Vegetative State (PVS) under the strict judicial oversight.[6] This “Landmark Shift” was further developed in the Common Cause Judicial judgement, where Advance Medical Directives were legalized, making the “Living Will” an exercise of individual autonomy.[7]
The Milestone of 2026 Harish Rana vs Union of India- changed these theories into reality. In this, one man was found in PVS for thirteen years and the Court critically classified Clinically Assisted Nutrition and Hydration (CANH) as ‘medical treatment’ and not as ‘basic care’ which permitted its withdrawal to take place.[8] This was the first practical application of passive euthanasia changed the legal orientation from judicial discourse to clinical practice.
THE DOCTRINE IN ACTION: TESTS & THRESHOLDS
The implementation of passive euthanasia in India is governed by stringent “Tests and Thresholds” that are intended to balance the two sides-striking the right balance from misuse and from banking on autonomy. Central to this is the need for incurable illness, wherein the patient should be in a Permanent Vegetative State (PVS) or has a terminal condition.[9] Patient autonomy is practiced mainly by way of granting informed consent through Advance Medical Directives (Living Wills), which has been made considerably easier through efforts initiated by the Supreme Court in 2023 to overhaul the process of living wills.[10]
In case of incompetent patients, the judiciary applies the “Best Interest” Principle. In Harish Rana, the case of the patient, the Court went beyond clinical parameters and considered the quality of life of the patient and the family suffering over a long period of time vis-a-vis the futility of continuing the treatment.[11] This process is protected by the Medical Board Approval by both primary and secondary medical authorities, followed by Judicial Oversight by a Magistrate. Finally, the Palliative Mandate guarantees that the withdrawal of Clinically Assisted Nutrition and Hydration (CANH) is not an act of abandonment at all, but with structured end of life care to minimize pain.[12]
DOES PASSIVE EUTHANASIA TRULY UPHOLD DIGNITY? (THE DEBATE)
Proponents suggest passive euthanasia is a guarantee of dignity because there is no prolong agony and it secures bodily autonomy – in essence, ‘right to be left alone’.[13] But this raises the ‘Passive Paradox’. Is pulling out a feeding tube, as approved in Harish Rana, really any more dignified that a quick lethal injection? Critics claim this makes the law a “cruel compromise,” in which the use of starvation is legally permissible, but not actively painless killing.[14]
This distinction requires a re-examination of Article 21: is the right to refuse treatment only a negative right to be left alone or should it include a positive right to be helped to die?[15] For, in practice, there exists an “Autonomy Gap.” For incompetent patients, decision-making power shifts heavily to the doctors and the families, running the risk of “forced” euthanasia against the backdrop of the glaring socio-economic realities in India and exorbitant long-term care costs.[16] Finally, there continues to be severe implementation hurdles; lofty rhetoric of “dignified death” by the Supreme Court too often clashes with the bureaucratic nightmare of treading through cumbersome Medical Boards, presentably delaying peace for the dying.[17]
JUDICIAL RESPONSE & PRACTICAL CHALLENGES
Despite the Supreme Court’s progressive steps, there are practical implementation issues with huge procedural hurdles. The current “Living Will” guidelines, although streamlined in 2023, are being criticized as being too cumbersome for use in medical emergencies in the field.[18] The bureaucratic maze of meetings to convene Medical Boards and get Judicial Magistrate approval often delays critical end of life decisions, inadvertently prolonging the grief and trauma for the suffering families.
For incompetent patients without Advance Directives the State has to step in using the doctrine of parens patriae, where it acts as the ultimate guardian to safeguard the vulnerable.[19] This mechanism of protection however, is being strained by a glaring gap in the legislation. The judiciary is still reluctantly performing a “legislative role” in the absence of a dedicated Euthanasia Act. In the Harish Rana Verdict of 2026, the Supreme Court explicitly begged the Indian Parliament to enact a comprehensive law for end-of-life care and reiterated that complex bioethical issues not only require robust democratic debate, but require proper guidance from robust legislatures rather than ad-hoc and potentially unaccountable judicial decision-making.[20]
CONCLUSION
The journey from Aruna Shanbaug to the 2026 Harish Rana verdict goes a long way in the context of the growth of the Indian legal system.[21] Although the legalization of passive euthanasia is a giant leap towards the maintenance of patient autonomy, the current legal framework is a unstable “work in progress.”[22] Until the withdrawal of life support is accessible, painless, and entirely free of socio-economic coercion, passive euthanasia risks playing the role of a mere “legal fiction” for most of the citizens.
True dignity in dying transcends the legal right to die; it implies in itself a quality of dying. Although the Harish Rana case gave room to necessary closure, it unintentionally opened a more profound ethical dialogue on the issue of whether or not India is ready for the next step: Active Euthanasia. A dignified death is not only a constitutional fact but also a moral necessity that needs a radical shift in culture and laws.[23]
Ultimately, as we approach this murky bioethical border, there is a crucial question that arises before lawmakers and non-lawmakers alike, is India truly poised to adopt the ‘Right to Assisted Dying,’ or do we first need to master our country’s national network of Palliative Care?
Author(s) Name: Zoya Siddiqui (Central Law College)
References:
[1] Harish Rana v Union of India [2026] INSC 142. See also Sucheta, ‘In a Historic First, Supreme Court Permits Passive Euthanasia for man living in persistent vegetative state for 13 years’ (SCC OnLine Blog, 11 March 2026) [https://www.scconline.com/blog/post/2026/03/11/supreme-court-india-first-ever-passive-euthanasia/] accessed 27 March 2026.
[2] Constitution of India 1950, art 21.
[3] Harish Rana (n 1)
[4] P Rathinam v Union of India (1994) 3 SCC 394.
[5] Gian Kaur v State of Punjab (1996) 2 SCC 648.
[6] Aruna Ramchandra Shanbaug v Union of India (2011) 4 SCC 454.
[7] Common Cause (A Regd Society) v Union of India (2018) 5 SCC 1.
[8] Harish Rana (n 1).
[9] Aruna Ramchandra Shanbaug (n 6).
[10] Common Cause v Union of India (2023) SCC OnLine SC 99. For a detailed analysis of the procedural changes, see Editor, ‘Supreme Court simplifies procedure to withhold life support of a terminally ill patient’ (SCC OnLine Blog, 25 January 2023) [https://www.scconline.com/blog/post/2023/01/25/supreme-court-simplifies-procedure-to-withhold-life-support-of-a-terminally-ill-patient-modifies-guidelines-given-in-2018-euthanasia-judgment-legal-research-legal-news-updates/] accessed 28 March 2026.
[11] Harish Rana (n 1).
[12] Ibid.
[13] Common Cause (2018) (n 7).
[14] Harish Rana (n 1). See further Sucheta, ‘Passive Euthanasia in India: Key Takeaways from Supreme Court’s Landmark Verdict’ (SCC OnLine Blog, 12 March 2026) [https://www.scconline.com/blog/post/2026/03/12/supreme-court-india-verdict-allows-passive-euthanasia-key-takeaways/] accessed 28 March 2026.
[15] Constitution of India 1950, art 21.
[16] Aruna Ramchandra Shanbaug (n 6).
[17] Common Cause (2023) (n 10). See also Krishnadas Rajagopal, ‘Supreme Court modifies guidelines for living wills, passive euthanasia’ (The Hindu, 24 January 2023) [https://www.google.com/search?q=https://www.thehindu.com/news/national/supreme-court-modifies-guidelines-for-living-wills-passive-euthanasia/article66428751.ece] accessed 28 March 2026.
[18] Ibid.
[19] Aruna Ramchandra Shanbaug (n 6).
[20] Harish Rana (n 1).
[21] Aruna Ramchandra Shanbaug (n 6); Harish Rana (n 1).
[22] Common Cause (2023) (n 10).
[23] Constitution of India 1950, art 21.