Published On: August 18, 2026
Authored By: Ayan Maji
Department of Law, University of Calcutta
Part I: From the Right to Life to the Right to Refuse Treatment
Medicine has long been associated with the preservation of life. Courts, too, have traditionally viewed the sanctity of life as a constitutional imperative. Yet a difficult question arises when medical intervention no longer restores health but merely prolongs suffering. Can the State compel the continuation of life-sustaining treatment against the interests of a patient who cannot recover? More fundamentally, does the constitutional guarantee of life include the freedom to reject medical intervention?
These questions, once regarded as matters of ethics rather than law, have increasingly entered constitutional adjudication across the world. Indian jurisprudence has also evolved from treating life as an inviolable value to recognising that dignity, autonomy and bodily integrity are equally indispensable components of the right to life. The recent decision in Harish Rana v Union of India has brought these principles into sharp focus, both by permitting the withdrawal of life-sustaining treatment for a patient in a Persistent Vegetative State and by reaffirming, more broadly, that an adult of sound mind possesses the legal authority to refuse or discontinue medical treatment.[1]
The significance of the Harish Rana case extends beyond its immediate facts. It represents another step in the judiciary’s gradual shift from a paternalistic model of healthcare—where doctors and the State determine what is best for the patient—to a rights-based framework in which individual autonomy and dignity occupy the centre of constitutional protection. Rather than creating a “right to die,” the Court applied and clarified a framework in which the Constitution protects a competent person’s freedom to decide what may or may not be done to their own body, and protects a dignified withdrawal of futile treatment for those who cannot decide for themselves.
This article examines the constitutional foundations of the right to stop medical treatment through the prism of the Harish Rana case. It argues that the decision is not an isolated judicial innovation but the logical culmination of decades of constitutional development concerning privacy, dignity, informed consent and personal autonomy under Article 21 of the Constitution.
The Harish Rana Case: A New Chapter in End-of-Life Jurisprudence
The proceedings in Harish Rana emerged from an intensely difficult family tragedy rather than a personal choice made by the patient himself. Rana suffered a severe brain injury after falling from a building in 2013 and remained in a Persistent Vegetative State for more than thirteen years, sustained by Clinically Assisted Nutrition and Hydration (CANH) through a feeding tube, with no capacity to communicate any wishes of his own. His parents approached the courts seeking permission to withdraw this treatment, on the ground that his condition was irreversible and that continued intervention offered no realistic prospect of recovery.
The matter eventually reached the Supreme Court after the Delhi High Court declined to intervene, and after an earlier Supreme Court order had instead directed the State to fund home-based care. Indian criminal law has historically imposed liability where an act or omission contributes to another’s death, leading many medical practitioners and lower courts to adopt an overly cautious approach even where continued treatment served no therapeutic purpose.
In resolving the matter, the Supreme Court applied the “best interests” framework it had earlier laid down for incompetent patients—obtaining the opinions of two independent medical boards and consulting the family—before permitting withdrawal of CANH. In the course of doing so, the Court also reiterated, as a general constitutional principle applicable to competent patients, that medical treatment rests upon consent, and that consent necessarily includes the freedom to withdraw it.[2] A competent adult cannot ordinarily be compelled to undergo invasive medical procedures merely because doctors believe that continued treatment would extend life; an incompetent patient, correspondingly, cannot be kept on treatment that serves no therapeutic purpose once a properly conducted best-interests assessment concludes that withdrawal is appropriate.
The proceedings reinforce an increasingly accepted constitutional proposition—that bodily integrity belongs to the individual rather than the State or the medical profession. The law protects life, but it does not authorise forced medical intervention upon a competent adult who has made an informed refusal, nor does it require the indefinite continuation of futile treatment for a patient who cannot decide for themselves, provided the prescribed medical and procedural safeguards are followed.
The Harish Rana proceedings therefore stand as an important reaffirmation of patient autonomy and dignity rather than an endorsement of euthanasia. The distinction is constitutionally significant. The withdrawal of unwanted or futile treatment allows the underlying illness to take its natural course; it does not involve the deliberate administration of a lethal substance to end life.[3]
From Medical Paternalism to Patient Autonomy
For much of legal history, healthcare operated under a paternalistic model. Physicians were regarded as the ultimate decision-makers, and patients were often expected to comply with medical advice without meaningful participation in the decision-making process.
Modern constitutional democracies have steadily abandoned this approach. The contemporary understanding of medical ethics recognises four foundational principles: autonomy, beneficence, non-maleficence and justice. Among these, autonomy has assumed increasing prominence because every medical intervention necessarily implicates bodily integrity and personal liberty.
Legal scholar Ronald Dworkin famously argued that respect for autonomy requires allowing individuals to shape the course of their own lives according to their deeply held convictions, particularly in matters involving death and dying.[4] Likewise, Professor Tom L. Beauchamp and Professor James F. Childress identify respect for patient autonomy as one of the central principles of biomedical ethics, emphasising that competent patients possess the moral and legal authority to accept or reject medical treatment after receiving adequate information.[5]
Indian constitutional jurisprudence increasingly reflects these ethical developments. Courts have recognised that healthcare decisions are not merely clinical judgments; they are profoundly personal choices touching upon dignity, identity and self-determination.
Article 21 and the Constitutional Protection of Bodily Integrity
The constitutional foundation of the right to refuse medical treatment lies within the expansive interpretation of Article 21, which guarantees that no person shall be deprived of life or personal liberty except according to procedure established by law.
Initially interpreted narrowly in A.K. Gopalan v State of Madras, Article 21 underwent a transformative expansion following Maneka Gandhi v Union of India, where the Supreme Court held that any restriction upon personal liberty must satisfy the standards of fairness, reasonableness and non-arbitrariness.[6] This marked the beginning of a constitutional philosophy in which liberty became inseparable from human dignity.
Over subsequent decades, Article 21 evolved into a repository of numerous unenumerated rights, including privacy, bodily integrity, reproductive choice, healthcare and decisional autonomy. These developments laid the intellectual groundwork for recognising an individual’s authority over medical treatment.
Perhaps the most influential articulation of bodily autonomy appears in Justice K.S. Puttaswamy (Retd.) v Union of India, where the nine-judge Bench unanimously recognised privacy as a fundamental right. Justice D.Y. Chandrachud observed that privacy protects “the preservation of personal intimacies, the sanctity of family life, marriage, procreation, the home and sexual orientation.”[7] The judgment further emphasised that decisional autonomy constitutes an essential element of dignity and personal liberty.
The recognition of privacy carries profound implications for medical law. Decisions concerning surgery, life support, organ donation or refusal of treatment involve intensely private assessments of bodily integrity. If privacy protects personal decision-making, it necessarily protects informed medical choices as well.
The Court’s reasoning also echoes the famous principle articulated by Justice Benjamin Cardozo in the American decision Schloendorff v Society of New York Hospital:
“Every human being of adult years and sound mind has a right to determine what shall be done with his own body.”[8]
Although originating in American jurisprudence, this principle has acquired universal significance and resonates strongly with India’s evolving constitutional doctrine under Article 21.
The Harish Rana proceedings demonstrate that this constitutional understanding is no longer confined to abstract discussions of privacy. Instead, it has begun to influence concrete questions concerning life-sustaining medical treatment, where respect for individual autonomy and dignity often collides with the instinct to preserve life at all costs.
The Judicial Journey Towards the Right to Refuse Treatment
The constitutional recognition of a patient’s right to discontinue medical treatment did not emerge overnight. Rather, it is the product of a gradual judicial evolution in which the Supreme Court carefully distinguished between the impermissible act of intentionally causing death and the constitutionally protected right of a competent individual to decline unwanted medical intervention—a distinction later extended to incompetent patients through the best-interests standard.
The debate initially centred on the controversial relationship between the right to life and the right to die. In P. Rathinam v Union of India, the Supreme Court observed that Article 21 could, in certain circumstances, encompass a “right not to live.”[9] However, this interpretation proved short-lived. A Constitution Bench in Gian Kaur v State of Punjab emphatically overruled P. Rathinam, holding that Article 21 does not include a general right to die because the Constitution seeks to protect life rather than extinguish it.[10]
Yet Gian Kaur contained an important constitutional insight that would later reshape end-of-life jurisprudence. Justice J.S. Verma observed that the process of dying with dignity in the context of a terminal illness occupies a different constitutional space from suicide. The Court recognised that while the Constitution does not sanction the deliberate termination of life, it may protect a dignified natural death where life has reached its inevitable conclusion.[11] This observation laid the intellectual foundation for later decisions recognising passive euthanasia and the withdrawal of life-sustaining treatment.
Aruna Shanbaug: Opening the Constitutional Conversation
The Supreme Court addressed these issues directly in Aruna Ramachandra Shanbaug v Union of India, one of the most significant decisions in Indian medical jurisprudence.[12]
Aruna Shanbaug had remained in a persistent vegetative state for more than four decades after suffering a brutal assault while working as a nurse. The case compelled the Court to confront the ethical and legal dilemma of whether life-sustaining treatment could ever be withdrawn.
Although the Court declined permission in Aruna Shanbaug’s particular circumstances—largely because the hospital staff caring for her wished to continue treatment—it recognised passive euthanasia as legally permissible under judicial supervision. The Court distinguished between active euthanasia, involving a deliberate act to end life, and passive euthanasia, where extraordinary medical interventions are withheld or withdrawn, allowing the underlying illness to take its natural course.[13]
Justice Markandey Katju observed that courts must strike a careful balance between preserving life and respecting human dignity. Importantly, the judgment emphasised that withdrawal of treatment does not constitute an act of killing; rather, it represents a decision not to artificially prolong biological existence when meaningful recovery has become impossible.
Although criticised for imposing cumbersome procedural safeguards requiring High Court approval, Aruna Shanbaug marked India’s first judicial recognition that constitutional values may, in exceptional circumstances, favour the discontinuation of life-sustaining treatment.
Common Cause: Dignity Beyond Mere Survival
The constitutional position was decisively clarified by the Constitution Bench in Common Cause (A Regd Society) v Union of India.[14]
The Court unanimously held that the right to die with dignity forms an integral component of Article 21, particularly where an individual suffers from an incurable or terminal illness. More importantly, the Bench recognised that a competent person possesses the right to refuse life-prolonging medical treatment and may also execute an Advance Medical Directive (Living Will) specifying treatment preferences in the event of future incapacity.
Chief Justice Dipak Misra observed:
“Life and death are inseparable. Every moment our bodies undergo change, and life ultimately reaches its natural conclusion. The Constitution protects not merely life, but a life lived with dignity.”[15]
Justice D.Y. Chandrachud similarly stressed that autonomy is central to constitutional liberty:
“The ability of an individual to make decisions about the course of his or her life is an essential aspect of human dignity.”[16]
These observations fundamentally altered the legal landscape. The constitutional inquiry was no longer confined to preserving biological existence at all costs. Instead, the Court recognised that forced medical treatment may itself violate dignity where it disregards the informed wishes of a competent patient, or the best interests of one who cannot express any.
This principle directly resonates with the Harish Rana proceedings. If autonomy includes the freedom to determine the course of one’s medical treatment, and if dignity requires that futile treatment not be forced upon a patient who cannot decide for themselves, then the withdrawal of consent, or a properly conducted best-interests determination, may permit the discontinuation of life-sustaining interventions.
The Simplification of Advance Directives
Despite its progressive reasoning, the elaborate procedural safeguards prescribed in Common Cause (2018) proved difficult to implement in practice. Hospitals frequently found the process cumbersome, resulting in uncertainty for patients and medical professionals alike.
Recognising these practical difficulties, the Supreme Court revisited the issue in Common Cause v Union of India (2023), simplifying the procedure for constituting medical boards and executing Advance Medical Directives.
Informed Consent: The Cornerstone of Medical Freedom
The right to discontinue treatment cannot exist without the broader doctrine of informed consent. Indian law firmly establishes that every competent patient has the right to receive adequate information regarding diagnosis, available treatment options, foreseeable risks and likely outcomes before consenting to or refusing medical intervention.
The Supreme Court’s decision in Samira Kohli v Dr Prabha Manchanda remains the leading authority on this subject.[17]
Justice R.V. Raveendran held that valid consent requires more than mere acquiescence. A patient must possess sufficient information to make an independent and informed decision. Consent obtained through misunderstanding, inadequate disclosure or coercion cannot satisfy constitutional standards.
The Court observed that “the patient has the right to choose whether or not to undergo treatment after being adequately informed.”
This principle extends beyond the commencement of treatment. If consent legitimises medical intervention, then the withdrawal of consent ordinarily removes its legal foundation. Continuing invasive treatment despite an informed refusal may therefore constitute an unlawful interference with bodily integrity.
The Harish Rana proceedings reaffirm precisely this proposition for competent patients. Respect for patient autonomy requires recognising not only the freedom to consent but also the equally important freedom to say “no.”
Comparative Perspectives: A Global Shift Towards Patient Autonomy
Indian constitutional developments are consistent with an international movement recognising personal autonomy and dignity at the end of life.
In the United Kingdom, the House of Lords in Airedale NHS Trust v Bland authorised the withdrawal of artificial nutrition and hydration from a patient in a persistent vegetative state, holding that treatment lacking therapeutic benefit need not be continued indefinitely.[18] Lord Goff emphasised that the withdrawal of futile treatment does not amount to an unlawful act causing death but rather allows the patient’s underlying condition to take its natural course.
Similarly, the celebrated American case Cruzan v Director, Missouri Department of Health recognised that competent adults possess a constitutionally protected liberty interest in refusing life-sustaining treatment.[19] Although states may require clear evidence of an incompetent patient’s wishes, the Supreme Court accepted that bodily integrity includes the freedom to reject unwanted medical intervention.
More recently, the Supreme Court of Canada in Carter v Canada recognised that personal autonomy and dignity occupy a central place in constitutional adjudication concerning end-of-life choices.[20] While the Canadian decision addressed physician-assisted dying rather than treatment refusal, its broader emphasis on autonomy reflects a growing international consensus that medical decisions belong primarily to the individual, or to those safeguarding that individual’s interests, rather than the State.
These comparative developments reinforce the constitutional trajectory visible in India. The Harish Rana proceedings, which the Court itself situated within a comparative survey of several jurisdictions, are therefore best understood as part of a broader global recognition that respect for life includes respect for personal agency and dignity.
The Constitutional Significance of the Harish Rana Proceedings
The significance of the Harish Rana proceedings lies not in the creation of a novel constitutional right but in the reaffirmation and, for the first time, the practical application of principles that had gradually emerged through Indian constitutional jurisprudence. The Supreme Court’s observations strengthen the proposition that the right to life under Article 21 is fundamentally a right to live with dignity, autonomy and bodily integrity, rather than a mere guarantee of biological survival.
The decision is particularly important because it addresses a long-standing concern among medical professionals. Despite the recognition of passive euthanasia in Common Cause, many hospitals remained reluctant to authorise withdrawal of life-sustaining treatment due to fears of criminal liability under the Indian Penal Code. By actually applying the best-interests framework to an individual patient for the first time, and by reiterating that a competent patient’s informed refusal must ordinarily be respected, the Court provides greater legal certainty to both healthcare institutions and treating physicians.
The proceedings also reaffirm an important constitutional distinction. The withdrawal of unwanted or futile medical treatment is not an act intended to cause death; rather, it respects the patient’s dignity by allowing the underlying illness to take its natural course. In this sense, the Constitution protects personal autonomy and dignity without transforming Article 21 into a general right to end one’s life.
As Justice D.Y. Chandrachud observed in Common Cause:
“Autonomy is an individual’s freedom to take decisions about her own life. These are intrinsic to dignity.”
The Harish Rana proceedings demonstrate how this constitutional understanding operates in clinical settings where decisions concerning life-support systems often involve profound ethical and emotional consequences, particularly where the patient can no longer speak for themselves.
Autonomy versus the Sanctity of Life: An Enduring Constitutional Debate
Notwithstanding the progressive trajectory of Indian jurisprudence, the recognition of a right to discontinue treatment continues to generate constitutional and ethical debate.
One school of thought argues that the State bears a positive obligation to preserve life wherever possible. Since Article 21 guarantees the protection of life, it is contended that public authorities should discourage any decision likely to accelerate death, even if motivated by personal autonomy or a considered best-interests assessment.
However, this approach risks reducing constitutional rights to a purely biological conception of existence. As legal philosopher Ronald Dworkin argued, respect for life includes respect for the values and convictions through which individuals define the meaning of their own existence. Compelling unwanted medical intervention may preserve physiological functioning while simultaneously undermining dignity, bodily integrity and personal agency.
Indian constitutional jurisprudence increasingly reflects this latter understanding. The Constitution protects life, but it also protects the individual’s authority to make deeply personal decisions concerning medical treatment—whether exercised directly by a competent adult, or, where that is not possible, through a rigorous best-interests process.
Professor Upendra Baxi has similarly argued that constitutional rights derive their legitimacy from the protection of human dignity rather than the unquestioning exercise of State power. This perspective supports the proposition that personal autonomy and dignity are not subordinate to medical paternalism but constitute an essential dimension of constitutional liberty.
Challenges That Continue to Persist
Despite considerable judicial progress, the practical implementation of end-of-life rights in India remains fraught with challenges.
First, public awareness of Advance Medical Directives (Living Wills) remains limited. Many individuals are unaware that the Supreme Court has recognised their legal validity or that they can record treatment preferences for future medical situations involving incapacity—a gap that the Harish Rana case illustrates starkly, since the absence of any such directive was precisely what required his family to seek judicial intervention.
Secondly, institutional hesitation persists among healthcare providers. Doctors frequently confront uncertainty regarding documentation requirements, assessment of patient competence and potential exposure to criminal or civil liability. Even after the procedural simplifications introduced by the Supreme Court in 2023, inconsistent implementation across hospitals continues to impede the effective exercise of patient autonomy.
Thirdly, India still lacks a comprehensive legislative framework governing end-of-life decision-making. The current legal regime is primarily judge-made, relying upon constitutional interpretation and judicial guidelines. While these decisions carry binding authority under Article 141 of the Constitution, statutory legislation would provide greater clarity regarding procedural safeguards, professional responsibilities and institutional accountability—a need the Supreme Court itself underscored in the Harish Rana judgment by urging Parliament to legislate.
Another unresolved concern involves the assessment of decision-making capacity. Determining whether a patient possesses the mental ability to make an informed refusal, and how to construct a reliable best-interests assessment where they do not, often presents complex medical and ethical questions. Future legal reforms may therefore need to establish uniform standards for evaluating competence while safeguarding vulnerable individuals from coercion or undue influence.
The Way Forward
The Harish Rana proceedings should be viewed as part of India’s continuing constitutional journey towards recognising patient-centred, dignity-focused healthcare. Nevertheless, judicial pronouncements alone cannot transform medical practice.
Meaningful implementation requires several complementary reforms.
1. Comprehensive legislation: Parliament should consider enacting a comprehensive End-of-Life Care Act incorporating the principles articulated in Common Cause and reaffirmed and applied in the Harish Rana proceedings. Such legislation could establish uniform procedures for Advance Medical Directives, clarify the legal responsibilities of healthcare professionals and provide safeguards against abuse.
2. Institutional protocols: Hospitals should formulate standardised institutional protocols concerning treatment refusal, informed consent and withdrawal of life-sustaining interventions. Consistent procedures would reduce uncertainty for both patients and medical practitioners.
3. Medical ethics education: Healthcare professionals must receive specialised training regarding constitutional rights, informed consent and end-of-life decision-making. Respect for patient autonomy and dignity should become an integral component of clinical practice rather than an exceptional legal obligation.
4. Public legal awareness: Public legal awareness campaigns are equally necessary. Constitutional rights are meaningful only when individuals understand and are capable of exercising them—including the right to record an Advance Medical Directive before incapacity arises.
Conclusion
The Harish Rana proceedings represent a significant milestone in the constitutional evolution of patient autonomy and dignity in India. Rather than diminishing the sanctity of life, the decision affirms a more profound constitutional ideal—that life derives its value from dignity, choice and individual self-determination, and that this value survives even when a patient can no longer voice it themselves.
From Maneka Gandhi to Puttaswamy, from Samira Kohli to Common Cause, Indian constitutional jurisprudence has steadily expanded the meaning of Article 21 beyond mere survival. The Harish Rana proceedings demonstrate that this evolution naturally extends to decisions concerning life-sustaining medical treatment, whether made directly by a competent patient or, in appropriate cases, on their behalf through a rigorous best-interests process. A patient cannot ordinarily be kept on invasive medical intervention simply because others believe continued treatment is desirable.
The constitutional promise of dignity would ring hollow if it ended precisely when individuals confront the most intimate decisions of their lives—or, as in Rana’s case, when illness has taken that choice away from them entirely. Respecting an informed refusal of treatment, or a carefully reached best-interests determination, does not amount to abandoning the value of life; instead, it acknowledges that the Constitution protects not only life itself but also the freedom to determine how that life is lived—and, when nature has made recovery impossible, how its final chapter unfolds.
Ultimately, the Harish Rana proceedings reinforce a constitutional principle that is both legally sound and morally compelling: the right to life under Article 21 includes the right of every person to a dignified course of medical treatment, whether that is exercised through their own informed decision or, where they cannot decide for themselves, through a properly conducted assessment of their best interests.
References
[1] Harish Rana v Union of India, Supreme Court of India, 11 March 2026, 2026 SCC OnLine SC 358.
[2] Samira Kohli v Dr Prabha Manchanda (2008) 2 SCC 1.
[3] Common Cause (A Regd Society) v Union of India (2018) 5 SCC 1.
[4] Ronald Dworkin, Life’s Dominion: An Argument About Abortion, Euthanasia and Individual Freedom (Alfred A Knopf 1993).
[5] Tom L Beauchamp and James F Childress, Principles of Biomedical Ethics (8th edn, Oxford University Press 2019).
[6] Maneka Gandhi v Union of India (1978) 1 SCC 248.
[7] Justice K.S. Puttaswamy (Retd.) v Union of India (2017) 10 SCC 1, [298] (per Chandrachud J).
[8] Schloendorff v Society of New York Hospital 211 NY 125 (1914), 129 (Cardozo J).
[9] P Rathinam v Union of India (1994) 3 SCC 394.
[10] Gian Kaur v State of Punjab (1996) 2 SCC 648.
[11] ibid [24]–[25].
[12] Aruna Ramachandra Shanbaug v Union of India (2011) 4 SCC 454.
[13] ibid [101]–[124].
[14] Common Cause (A Regd Society) v Union of India (2018) 5 SCC 1.
[15] ibid [196].
[16] ibid (per Chandrachud J) [597].
[17] Samira Kohli v Dr Prabha Manchanda (2008) 2 SCC 1.
[18] Airedale NHS Trust v Bland [1993] AC 789 (HL).
[19] Cruzan v Director, Missouri Department of Health 497 US 261 (1990).
[20] Carter v Canada (Attorney General) 2015 SCC 5, [2015] 1 SCR 331.
Further Reading
Baxi U, The Future of Human Rights (3rd edn, Oxford University Press 2008).
George J Annas, ‘The Rights of Patients’ (New York University Press).
John Keown, ‘Euthanasia, Ethics and Public Policy: An Argument against Legalisation’ (Cambridge University Press 2018).
Rajeev Dhavan, ‘The Right to Life and Personal Liberty under Article 21’ (various law review publications).
