He has required continuous medical assistance for breathing, feeding and daily care ever since.
The Supreme Court came to its decision after two medical boards looked into the case and concluded in December 2025 that the chances of recovery were negligible, with no meaningful communication or voluntary movement recorded.
Rana’s family told the court that caring for him had placed immense emotional and financial strain on them—monthly costs for medical supplies and equipment range between Rs 24,000 and Rs 30,000, and the family has had to sell their house to continue treatment.
The court, in its order, held that individuals have the right to refuse artificial life support when continuing treatment offers no realistic hope of recovery and undermines dignity.
Doctors say the questions raised by the Rana case arise regularly in critical care and palliative medicine, where treatment goals may shift from prolonging life to reducing suffering when recovery is no longer possible.
Dr Vidya Viswanathan, Associate Professor in the Department of Palliative Medicine at Homi Bhabha Cancer Hospital and Research Centre in Visakhapatnam, said the case reflects the process that the court has laid down for withdrawing life-sustaining treatment.
“As a palliative care physician, the goal of palliative care is to mitigate suffering,” she said, explaining that doctors may intervene early to provide comfort and withhold treatments that are medically inappropriate or unlikely to improve quality of life.
In Rana’s case, she said doctors are effectively withdrawing artificial nutrition and hydration because he has not been able to swallow or sustain himself without medical support for a long time.
“In palliative medicine, we prefer the term ‘allowing natural death’ rather than passive euthanasia,” Viswanathan said.
Active euthanasia—the deliberate ending of a patient’s life, typically by administering a lethal drug—remains illegal in India.
Passive euthanasia is permitted, but only under strict procedures. Central to this framework is the ‘living will’: a legal document in which a person specifies the medical treatment they want—or do not want—if they become unable to make decisions in the future.
The debate around euthanasia first gained national attention in India through the Aruna Shanbaug case. Shanbaug, a nurse at Mumbai’s King Edward Memorial Hospital, remained in a vegetative state for decades after she was assaulted in the hospital in 1973.
In a 2011 judgment, the Supreme Court allowed passive euthanasia in India for the first time, though it directed that a High Court’s approval must be sought for doing so in each case.
The court’s position was substantially expanded by the landmark Common Cause vs Union of India judgment in 2018, which recognised the legal validity of living wills and affirmed the right to refuse life-sustaining treatment as part of the right to dignity.
Before that, an attempt in 2016 to create a statutory framework through the Medical Treatment of Terminally Ill Patients Bill was not passed by Parliament.
In 2023, the Supreme Court further simplified the process for executing living wills and withdrawing life-sustaining treatment, reducing procedural hurdles for families and hospitals.
The Rana case, legal experts say, is among the first instances of these streamlined procedures being applied in practice.
Under the current guidelines, a primary medical board first examines the patient and records its opinion. A secondary board then independently reviews the case. Only after both boards agree that recovery is unlikely can the process move forward. The patient’s family or legally recognised surrogate decision-maker must also be involved.
A high court’s approval is still mandatory.
In the Rana case, the family went to the Delhi High Court, which ruled in 2024 that the patient was not suffering from a ‘terminal illness’. Only after this order did the family approach the Supreme Court.
Dr Rajat Agrawal, Director of the department of critical care medicine at Fortis Escorts Heart Institute in New Delhi, said The Indian Society of Critical Care Medicine has been advocating for nearly 15 years for clearer rules and regulations around end-of-life care.
“This judgment is a step in the right direction,” he said.
Agrawal said advances in medicine allow doctors to keep patients alive in many chronic or irreversible conditions, but such situations can place a heavy emotional and financial burden on families.
“That is why there has long been a need for clear guidelines—similar to those in the US and European countries—so, doctors and families can make decisions about passive euthanasia when treatment only prolongs suffering,” he said.
Typically, Dr Agarwal said, doctors have been cautious due to the fear of legal consequences. “Earlier, many doctors were afraid that taking such decisions could lead to legal complications or litigation. Because of that fear, the safest approach was often to continue treatment and do nothing else,” he said.
Nonetheless, there is still no specific law guiding end-of-life care; only court orders.
In September 2024, the Union Ministry of Health and Family Welfare released draft guidelines on the withdrawal of life support, seeking feedback from doctors and other stakeholders.
The proposal—intended to align hospital practice with the Supreme Court’s rulings on passive euthanasia and advance medical directives (living wills)—suggested that doctors could take a “considered decision” to discontinue life-sustaining treatment when it no longer benefitted the patient and instead prolonged suffering. It outlined applicable conditions, including brain-stem death, advanced irreversible disease, medical prognostication indicating no meaningful recovery, and documented refusal for treatment by the patient or their surrogate.
But the proposal triggered a debate within the medical community, with doctors expressing concern over legal ambiguity and the possibility of greater scrutiny over clinical decisions.
Dr Agrawal explained that a key concern was that there is no exact guideline to decide which patient is eligible for passive euthanasia.
“The draft guidelines provide some direction, but they do not fully clarify what should or should not be included,” he said.
He said that the process needs a lot of documentation, and can be exhausting. “When the procedure becomes lengthy and complex, it adds to the distress of patients and their caregivers,” he said.
Another worry, Dr Agrawal said, was that of litigation.
“There is still uncertainty about legal safeguards if healthcare professionals are taken to courts after such decisions… Until these aspects are clarified, the medical community may remain cautious about adopting the process,” he said.
Dr Niraj Tyagi, Associate Consultant in critical care medicine at Sir Ganga Ram Hospital, said the decision to withdraw life support frequently arises in cases of irreversible brain damage.
Tyagi said doctors may consider stopping treatment when it is clear that continuing life support will not alter the patient’s outcome. Yet, many clinicians approach it with caution.
“The general thinking has been that if the heart is beating, doctors must continue efforts to keep the patient alive,” he said.
The legal uncertainty around euthanasia long compounded this reluctance. “There was always a concern—if we allow a patient to go, are we doing the legally and morally correct thing under the Constitution of India, or are we simply following medical judgment?” he said.
Supreme Court allows withdrawal of medical treatment to 32-year-old Harish Rana, who has been in a vegetative state for the last 13 years with negligible hope of recovery.
Harish Rana’s father, Ashok Rana, says,” We had been fighting for this. Which parents would want this for…
— ANI (@ANI)
Laws governing euthanasia vary considerably across the world. The Netherlands, Belgium and Canada permit certain forms of assisted dying, while several US states allow physician-assisted dying for terminally ill patients.
Dr Viswanathan noted that living wills are more commonly seen in the West.
“In most Western countries, patients usually have an advance directive—what we call a living will in India — so hospitals already know a person’s preferences about life-support measures when they are admitted. These decisions are often documented beforehand and may even be linked to insurance systems. While only a few countries have legalised euthanasia, many have clearer systems of advance directives to guide end-of-life care,” she said.
India permits only passive euthanasia—the withdrawal or withholding of life-sustaining treatment—under strict medical and legal safeguards.
The Rana case, doctors say, highlights the difficult decisions that emerge when modern medicine can prolong life but cannot restore it.
(Edited by Prerna Madan)
