What does the SC verdict allowing passive euthanasia mean for India?

The ruling is expected to have a far-reaching impact on Indian patients in prolonged vegetative states and their families, said legal and medical experts, encouraging more families to seek judicial approval for this.

“Passive euthanasia” permits holding back life-saving treatment for individuals who are terminally ill or in a permanent vegetative state, allowing natural death. While passive euthanasia has been legal in India since 2018, the framework was streamlined in 2023 to ease the process.

“This ruling could encourage more families of patients in prolonged vegetative states to approach courts for withdrawal of life support. At the same time, the stringent medical board review process means courts will continue to scrutinise such pleas carefully,” said Tushar Agarwal, founder and managing partner at CLAP Juris.

Dr. Sunil Khattri, surgeon and advocate, and managing partner, Dr Sunil Khattri and Associates, said the judgment could also improve awareness about end-of-life legal rights.

“While the legal framework already existed, this judgment simplifies the procedure and could help raise greater awareness among families of patients in similar conditions,” he said.

This is different from active euthanasia, which involves causing death through medical intervention, like lethal injection. Active euthanasia is legal in pockets of the world, like in Canada, the Netherlands and Belgium, but remains illegal in most other countries, including India.

A ‘living will’, signed by an individual in advance, to be taken off life support if they are terminally ill or in a prolonged vegetative state, can ease the process. A hospital medical board ascertains if a patient can be considered for passive euthanasia, and the procedure requires the document to be signed in front of two witnesses and attested by a notary or gazetted officer.

However, in the absence of a living will, the patient’s family can approach the high court.

The Wednesday ruling may help streamline the passive euthanasia process, but it is unlikely to significantly reduce the time required. “As more cases apply the Harish Rana precedent, it will become clear whether timelines actually reduce. That said, passive euthanasia cannot be a one-step process. Given the ethical and medical complexities involved, decisions will continue to require careful deliberation and medical evaluation,” said Biplab Lenin, partner at Cyril Amarchand Mangaldas.

“Now that the legal aspect of the matter is concluded, a mention needs to be made of the love and affection with which the parents and siblings have nursed Harish for more than 12 years,” the court observed.

The Supreme Court also clarified the role of medical boards in cases involving the withdrawal of life-sustaining treatment. Such decisions must not amount to abandoning the patient and that care should shift from curative treatment to palliative and end-of-life care focused on comfort and dignity, the court said.

It stressed that withdrawal must follow a structured, medically supervised process and criticised the practice of hospitals discharging patients under “discharge against medical advice” (DAMA) in such situations.

In the present case, Rana has been in a permanent vegetative state since 2013 after suffering a severe brain injury in a fall from a building. Medical records before the court showed he had 100% disability and had been surviving only through clinically administered nutrition delivered via surgically installed feeding tubes.

Both the primary and a secondary medical board concluded that Rana’s condition was irreversible and that continuing treatment merely prolonged biological existence without any prospect of recovery.

Taking into account the medical opinion and the wish of the patient’s parents, the court held that discontinuing treatment was in the patient’s best interests.

Given the ethical concerns, the world has been divided on euthanasia. However, it appears to have wider acceptance among the medical fraternity, increasing in areas with more familiarity with the practices.

In a 2016 Delhi study published in the Indian Journal of Palliative Care, 80% of the doctors surveyed believed that a person with a terminal and painful disease should have the right to refuse/reject life‑sustaining/support treatment.

A more recent international survey published in the Journal of Medical Ethics in 2025 found that over half the physicians considered euthanasia a good option for patients with advanced cancer or alzheimers, with those working in areas with a legal option for euthanasia and physician-assisted suicide 3 times as likely to consider euthanasia a good option.