PASSIVE EUTHANASIA: CONSTITUTIONAL MORALITY REVAMPED

Abstract:

From the revolutionary judgement of the Supreme Court on 25 January, 1978 in the Maneka Gandhi v. Union of India (1978)[1], the ambit of one of the Fundamental Rights of the Golden Triangle, i.e., Article 21 has been widened many times to rationally include many factors that collectively makes “Right to Life and Personal Liberty” a dignified and humane one. It now includes, inter alia, many other collateral rights like Right to Education, Right to Privacy, Right to Clean Environment and many others[2]. However, one right had been at the centre of debate since the case of Aruna Shanbaug v. Union of India (2011)[3]: Right to Die with Dignity and Passive euthanasia.

There persisted a confusion among medical practitioners regarding withdrawal of life support in rare cases where recovery of the concerned patient from a permanent vegetative state was almost negligible, legality of living wills and distinction between active and passive euthanasia. Here, the Supreme Court, in the recent case of Harish Rana v. Union of India (2026)[4], delivered a revolutionary judgement that strengthened dignity jurisprudence, but exposes gaps that can only be filled legislatively.

With the allowance of passive euthanasia as a dignified right under Article 21 in exceptional cases, there has re-opened the scope of analysis and debate on the same. In this article, we will explore, in-depth, the historical, critical, and Constitutional aspects of passive euthanasia, with special reference to the Harish Rana case of this year, which makes this study a potent one under the basket of Constitutional jurisprudence.

Factual Background & Introduction of the Case:

In 2013, Harish Rana, a young engineering student, suffered a severe accident after falling from the fourth floor of his residence, sustaining a diffuse axonal brain injury. Medical officers confirmed that he was in Persistent Vegetative State (PVS) with 100% quadriplegia. As a result, for over 12 years, he survived only through Clinically Assisted Nutrition and Hydration (CANH).[5]

In 2024, Harish Rana’s parents approached the Delhi High Court seeking permission to withdraw the medical support he received, which although, was rejected by the Court which reasoned that Rana was not capable on breathing on his own, and withdrawal of CANH would amount to starvation rather than passive euthanasia. In response, the family filed a Special Leave Petition before the Supreme Court. Two medical boards (Primary and Secondary) unanimously assented that the condition which the petitioner suffered from was irreversible and that recovery was impossible.

Initially, the Court arranged a welfare package for the family. However, when the former proved to be inadequate, the matter was revived in 2025. Finally, the judgement came on 11 March 2026, with the Court holding that CANH is a form of medical treatment, not basic care and that it can be lawfully withdrawn when the continuation of the same serves no therapeutic purpose and violates the patient’s dignity.[6]

Legal Questions involved:

The judgement not only served as a precedent for future cases of passive euthanasia, but also answered several questions that remained largely unanswered till then, exposing gaps in legislature on the concerned topic. The questions, among many others, include: –

• Whether passive euthanasia is constitutionally valid under Article 21.
• Whether active euthanasia can be permitted in absence of legislation.
• Whether Advance Medical Directives (AMD) are legally enforceable.
• Scope of passive euthanasia and whether CANH constitutes “medical treatment” that can be withdrawn under it.

To understand the concepts involved in these questions, we first need to examine the two types of euthanasia and distinguish them legally and critically.

Active v. Passive Euthanasia:

Active euthanasia and passive euthanasia differ mainly in the intent and method of removal of medical support. In the former, administration of lethal substances or performance of an act is done that becomes the direct cause of death. On the other hand, in passive euthanasia, there is withdrawal or withholding of medical treatment that allows natural death in medically irrecoverable cases that allows natural death over forced ones, ideally through stopping ventilation support, or withdrawal of CANH, as the case maybe.

Another major difference in the two is their legality status. Active euthanasia is illegal in India, and even punishable under law.[7] Passive euthanasia, however, is legal under strict safeguards and scrutiny. A notable gap in this case is the absence of statutes in India, governing the same. Some countries, like the United Kingdom, have already debated regarding the practice of passive euthanasia in exceptional cases, which show the legislative intent to address the issue.[8] India, in the same way, needs to fill the vacuum, and give a definite structure to this practice.

Some notable cases in this aspect include Gian Kaur v. State of Punjab (1996)[9], which held, in early trends, that the “Right to Die” is not a part of Article 21, but opened the scope for dignified death in certain circumstances. Besides, in the case of Aruna Shanbaug v. Union of India (2011)[10], passive euthanasia got its first recognition, but only with High Court Approval. Last but not the least, in Common Cause v. Union of India (2018)[11], passive euthanasia and living wills got legalised.

Constitutional Analysis under Article 21:

Article 21 of the Indian Constitution iterates: “No person shall be deprived of his life or personal liberty except according to procedure established by law.” Here, the Supreme Court, in its revamped interpretation of “life”, has expanded it to mean living with dignity and not mere biological existence. Hence, in its ambit falls the right to make end-of-life choices under strict safeguards.[12]

The rationale behind this reasoning is that dignity extends to the final stages of life, ensuring individuals are not subjected to endure meaningless suffering. This, together read with Right to Autonomy, implies that freedom to make personal medical decisions, including refusal to treatment, is indeed a part of Right to Life.[13] In euthanasia jurisprudence, autonomy is protected through living wills or advance directives, which allows individuals to state their wishes about end-of-life care before losing capacity.

In the landmark judgement of Justice K.S. Puttaswamy v. Union of India (2017)[14], the honourable Supreme Court declared privacy as a Fundamental Right under Article 21. Here, privacy does not merely amount to liberty to control one’s personal activities, but also includes control over personal medical information and decisions. However, such decisions need to be regulated under strict Court oversight and scrutiny, which, otherwise, would leave a scope to abuse. As established in the Aruna Shanbaug case[15], medical boards (primary and secondary) became mandatory before allowing passive euthanasia. Hence, a fine balance between best interests of patient, his dignity and barrier against potential misuse must be established before arriving at any particular decision.

Advance Medical Directives (AMD):

The topic of euthanasia remains incomplete without the discussion of living wills. Advance Medical Directives are written instructions about medical treatment in the future, used when the concerned patient becomes incapable of decision making. It protects autonomy of a person even after incapacity and consequently reduces emotional and ethical burden on families. The Court agrees on this point, and as a result, AMDs are recognised as valid from the case of Common Cause v. Union of India (2018)[16], although applied with judicial oversight.

This practice, like any other debatable legal topic, does not go uncontested. It is rightfully criticised for lack of awareness in the field, including doctors and families, who remain largely unfamiliar with the concept. Execution also remains cumbersome with the formation of multiple medical boards and complex procedures. Cultural hesitation, besides, gives births to societal reluctance to discuss death and end-of-life choices. For the aforesaid reasons, in order to strengthen the institution, legal experts need effective tools like awareness campaigns, simplified procedures, institutional support and formation of statutes. This will make the act effective and practical rather than symbolic.

Critical viewpoint:

An article becomes lively when a tinge of personal opinion of the author is concocted with factual analysis. In my view, the strengths of passive euthanasia outweigh its weaknesses. Passive euthanasia not only expands dignity under Article 21, which remains largely a de jure change, but also gives a wholesome meaning to dignity. Dignity does not apply only during biological existence, but also extends beyond his death, for a person’s works are what shapes his identity. It also opens the door to patient autonomy, and respects the societal reality of how some vegetative situations make a person suffer worse than death. Clarity to doctors is another contentious issue, that will be addressed after the famous judgement. Lastly, a common framework, consistent to the Common Cause case[17] could be established that will pave the way to future legislation.

Just like a coin, with two sides, euthanasia is no exception. Despite several strengths, some weaknesses remain. Absence of legislative framework is being discussed, but no timeline for filling the gap is there till now. Over reliance on judicial interpretation would lead to legal complexities and prolonged suffering of the concerned patients. Procedural safeguards are complicated, and still remain unadopted by many families because of their complexity. This defeats the main purpose of the provision and delays the aim of dignified death.

Looking at a comparative angle, India, like the UK, follows a cautious approach. It balances dignity with prevention of misuse. Countries like the Netherlands, with a much strong and modernized medical system, follows the principle of active euthanasia[18]. However, the restrained stance does not imply that India is behind, it reflects the socio-economic reality within which the law must operate. At this stage, active euthanasia is much more prone to mala fide usage and exploitation. Hence, India’s stance is neutral, balanced and well-coordinated with the need of the Indian society. Only, the absence of legislative proactivity is what hinders the process.

Conclusion:

As we wrap up this article, the central focus must be on the dignity and interest of the affected families. It is a sine qua non addition to Article 21 of the Indian Constitution. Judicial progress has accelerated this viewpoint and catalysed the autonomy of the patients concerned. Legislative vacuum is what that is needed to be filled at this hour. The Constitution has opened the door to a dignified death, but it is now for the legislature to decide how far that door should remain open. As we navigate through the ups and downs of the largest democracy, such issues need to be addressed at the earliest convenience, so that the morale of our Constitution comes true. Passive euthanasia is hence a gateway to such legislations that need to be revamped for public good.

[1]  Maneka Gandhi v Union of India (1978) 1 SCC 248 (SC).

[2]  Mohini Jain v State of Karnataka (1992) 3 SCC 666 (SC); Justice KS Puttaswamy (Retd) v Union of India (2017) 10 SCC 1 (SC); Subhash Kumar v State of Bihar (1991) 1 SCC 598 (SC).

[3]  Aruna Ramachandra Shanbaug v Union of India (2011) 4 SCC 454 (SC).

[4]  Harish Rana v Union of India Writ Petition (Civil) No 310 of 2023 (SC, 2026).

[5]  Harish Rana v Union of India (2026), Misc Application No 2238 of 2025 in SLP (C) No 18225 of 2024 (SC, 11 March 2026) <https://api.sci.gov.in/supremecourt/2025/60980/60980_2025_7_1501_69246_Judgement_11-Mar-2026.pdf> accessed 4 May 2026.

[6]  Ibid.

[7]  Indian Penal Code 1860, ss 302, 304, 306; Aruna Ramachandra Shanbaug v Union of India (2011) 4 SCC 454 (SC).

[8]  HL Deb 22 October 2021, vol 815, cols 1955–2020 (Assisted Dying Bill).

[9]  Gian Kaur v State of Punjab (1996) 2 SCC 648 (SC).

[10]  Aruna Ramachandra Shanbaug v Union of India (2011) 4 SCC 454 (SC).

[11]  Common Cause v Union of India (2018) 5 SCC 1 (SC).

[12]  Maneka Gandhi v Union of India (1978) 1 SCC 248 (SC); Common Cause v Union of India (2018) 5 SCC 1 (SC) [197].

[13]  Suchita Srivastava v Chandigarh Administration (2009) 9 SCC 1 (SC)

[14]  Justice KS Puttaswamy (Retd) v Union of India (2017) 10 SCC 1 (SC).

[15]  Aruna Ramachandra Shanbaug v Union of India (2011) 4 SCC 454 (SC).

[16]  Common Cause v Union of India (2018) 5 SCC 1 (SC) [198] – [199].

[17]  Common Cause v Union of India (2018) 5 SCC 1 (SC).

[18]  Termination of Life on Request and Assisted Suicide (Review Procedures) Act 2002 (Netherlands) art 2.