From Aruna Shanbaug to Harish Rana, India’s long reckoning with the right to die with dignity

On a grey afternoon in August 2013, Harish Rana, an engineering student, slipped from the fourth floor of his paying guest accommodation in Chandigarh. The accident left him in a permanent vegetative state, dependent on life supporting equipment. That split-second event gave rise to a 13-year legal battle.

On March 11, 2026, the Supreme Court of India delivered a landmark judgment, allowing Harish Rana’s family’s plea to withdraw the feeding tubes keeping him alive, giving effect for the first time to the constitutional right to die with dignity recognised way back in 2018.

A bench of Justice JB Pardiwala and Justice KV Viswanathan directed that Rana be shifted to the palliative care ward of AIIMS New Delhi, where a medical board would oversee the withdrawal of his clinically administered nutrition with the care owed to any human being in their final passage.

It was a culmination of a process that began with the Aruna Ramchandra Shanbaug case, which first prompted India to confront what it means to prolong a life that has, in every meaningful sense, already ended.

That case began with a sexual assault in November 1973. Aruna Shanbaug, a young nurse at King Edward Memorial Hospital, Mumbai, just weeks away from her wedding, was attacked by a ward boy named Sohanlal Walmiki. He wrapped a dog chain around her neck and attacked her.

The strangulation cut off the oxygen supply to her brain. The assault left her in a state of irreversible neurological devastation from which she would never emerge. In 2009, journalist and activist Pinki Virani filed a writ petition before the Supreme Court seeking permission to withdraw her nutrition.

The nurses of KEM Hospital opposed the plea. The 2011 ruling, declined withdrawal in her specific case but it did something more consequential. It laid down, for the first time, that passive euthanasia was not inherently impermissible in India.

The bench, led by Justice Markandey Katju, which starts on a rather poetic note, encapsulates a victim’s ordeal by quoting a Mirza Ghalib couplet:

“Marte hain aarzoo mein marne ki
Maut aati hai par nahin aati.”

One dies in the longing for death
Death arrives, but death does not come.

The judgment drew a line between active euthanasia (administering a lethal substance) and passive euthanasia (withdrawing life-sustaining treatment). The former remained illegal. The latter could be permitted in an irreversible vegetative state, could be permitted with High Court sanction and after consulting a medical board).

This followed the reasoning of the House of Lords in the English case of Airedale NHS Trust v Bland in 1993. Aruna Shanbaug died in May 2015, of pneumonia, never having regained consciousness.

Common Cause judgments

The Aruna Shanbaug case laid down a mechanism for the exercise of passive euthanasia. However, crucial questions were left unattended. Firstly, does a person have the right to record, in advance, their wishes about end-of-life care? Secondly, could someone, while being healthy and cognisant, determine what should happen to them if they fell into a state such as Aruna’s?

The Common Cause Society had been pursuing these questions since 2005, seeking recognition of the right to execute a “living will” – a document through which a person could specify, in advance, their refusal of artificial life support. The petition sat in court for over a decade.

In March 2018, a five-judge Constitution Bench of the Supreme Court, led by the then Chief Justice Dipak Misra, delivered its landmark judgment in Common Cause v. Union of India, holding that the right to die with dignity was a fundamental right under Article 21 of the Constitution.

A life stripped of all agency, all consciousness, and all human experience was not a life the Constitution could compel a person to continue against their will, the court said. It recognised advance directives, replaced the need for a sanction from the High Court with a two-tier medical board system, and anchored the entire framework within Part III of the Constitution that lists fundamental rights, thus greatly increasing its significance.

However, the conditions for registering a valid living will – getting it notarised in front of two witnesses and a Judicial Magistrate First Class – proved cumbersome. Disability rights advocates raised the harder question: who decides what constitutes a life worth living? Fear mounted that the framework could create subtle pressure on families and institutions to withdraw care from patients with severe disabilities who were not in vegetative states at all.

Moreover, on a global scale, religious groups, particularly from Christian and Islamic traditions, had opposed it on doctrinal grounds, arguing that the sanctity of life could not be subject to judicial calibration.

In 2023, the Supreme Court, in Common Cause v. Union of India, while deciding an application seeking clarification of its earlier 2018 judgment, made significant changes to the process.

Primarily, it dispensed with the requirement of the living will being executed in the presence of a Judicial Magistrate First Class. The magistrate was no longer required to either retain a copy of the document or to forward it to the District Registry, family members and physician.

However, the government, for its part, has remained ambivalent. Despite repeated concerns from the Supreme Court, in both 2018 and 2023 Common Cause rulings, no comprehensive legislation on passive euthanasia or advance directives has been enacted yet.

While Harish Rana could breathe unaided, what kept him alive was a PEG tube, a surgically inserted feeding apparatus delivering nutrition directly to his stomach. After 11 years, his parents approached the Delhi High Court in 2024, seeking administration of passive euthanasia. The High Court dismissed the petition, held that removing the feeding tube would amount to active, not passive, since Rana was not dependent on a ventilator, A distinction was drawn between ventilator support, classified as artificial life support, and nutritional support, held to be more fundamental.

His parents had filed a Special Leave Petition before the Supreme Court, which in November 2024 directed the Union government to provide adequate care – including providing home care. Liberty was granted to return if necessary.

After this, in view of Rana’s continued vegetative state, his parents again approached the Supreme Court.

The Supreme Court, in the present judgment, rejected the distinction carved out by the Delhi High Court. The court was of the view that clinically assisted nutrition and hydration ought to be recognised as medical treatment. The very survival of the patient in a permanent vegetative state “is resting on an invasive form of artificial support”, so denying this recognition “would reduce the patient to being a passive subject of medical technology”, it said.

While deciding on withdrawing treatment, it held that “the correct question should be whether it is in the patient’s best interests that life should be prolonged…” The presumption in favour of preserving life may be “displaced where continuation of medical treatment ceases to serve any therapeutic purpose, i.e., becomes futile, merely prolongs the suffering without the hope of recovery or causes indignity to the life of the patient,” the court said.

As a result, while allowing the exercise of passive euthanasia, the court directed the withdrawal of all treatment, including clinically assisted nutrition and hydration.

The Harish Rana judgment does not represent a new doctrine but reiterates principles from 2011, 2018, and 2023, now given effect for the first time. Once again, the Supreme Court, this time definite terms, urged the Union government to enact comprehensive legislation on end-of-life care.

A statutory framework would spare families the cost and rigour of protracted litigation. But the complex socio-political and religious sensitivities surrounding end-of-life care in India cannot be wished away and any legislation, when it comes, will have to reckon with them honestly.

Aman Alam is a student barrister at University of London, and an advocate at the Supreme Court of India.

Ramisha Fatima is a second-year law student at Aligarh Muslim University.