All you need to know about: passive euthanasia

The Supreme Court on Wednesday (March 11, 2026) allowed the withdrawal of life support to 32-year-old Harish Rana. Mr. Rana had sustained severe head injuries and 100% quadriplegic disability after a fall in 2013. He has been bed-ridden for over 13 years now. The judgment came after the Bench conducted long, measured and multi-tiered consultations with Mr. Rana’s family, medical boards and counsel appearing for both the family members, and the Centre.

With this, the principles of passive euthanasia have been practically applied by the apex court for the first time.

Active vs. passive euthanasia?

Euthanesia is the practice of physician-assisted ending a patient’s life to relieve them from incurable suffering.

Passive euthanasia permits the withdrawal of life-sustaining treatment in terminally ill patients, in situations where the treatment only prolongs suffering, allowing for death to take its natural course. Active euthanasia, on the other hand, is a direct act to cause death in order to relieve suffering.

India’s stance

Judgments from Supreme Court have acknowedged the case for withdrawal of life support in terminally ill patients. A series of draft guidelines were also issued by the Union Health Ministry in this regard. India, however, does not allow for active euthanasia.

In 2018, a Constitution Bench of the apex court had upheld passive euthanasia and the right to give advance medical directives or ‘Living Wills’ to smooth the dying process as part of the fundamental right to live with dignity. The court had ruled that the fundamental right to life and dignity under Article 21 of the Constitution included the “right to die with dignity”.

Experts had noted, however, that implementation continued to remain slow and uneven, procedural requirements were cumbersome and for patients and their families, delays, added to suffering.

In 2024, the Union Ministry of Health released a set of draft guidelines that laid out four conditions for passive euthanasia. It defined terminal illness as an irreversible or incurable condition from which death is inevitable in the foreseeable future. Severe devastating traumatic brain injury which shows no recovery after 72 hours or more is also included, it said. Withdrawal was defined as a considered decision in a patient’s best interests, to stop or discontinue ongoing life support in a terminally ill disease that is no longer likely to benefit the patient or is likely to harm in terms of causing suffering and loss of dignity.

These conditions were: Any individual declared to be brainstem dead as per The Transplantation of Human Organs and Tissues Act, 1994; medical prognostication and considered opinion that patient’s disease condition is advanced and not likely to benefit from aggressive therapeutic interventions; patient/surrogate documented informed refusal, following prognostic awareness, to continue life support and compliance with procedure prescribed by the Supreme Court.

Vegetative state

In the current case, the Supreme Court had noted that: “The doctors are of the opinion that Harish would remain in this permanent vegetative state for years to come… He would never be able to recover and live a normal life.”

A vegetative state is when a patient is in a state of ‘continuing wakefulness without awareness’.

A special article in The New England Journal of Medicine in 1994 defines it as: “The vegetative state is a clinical condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles, with either complete or partial preservation of hypothalamic and brain-stem autonomic functions. In addition, patients in a vegetative state show no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; show no evidence of language comprehension or expression; have bowel and bladder incontinence; and have variably preserved cranial-nerve and spinal reflexes.”

In general, after one month of being in a vegetative state, a patient is classified as being in a ‘persistent vegetative state’. When this state lasts longer, several months or more (different durations in different countries), some authorities classify it as a permanent vegetative state.

The first intance of a judicial application of euthanesia was in 1996. In the Gian Kaur verdict, the Supreme Court had indicated that passive euthanasia would only “accelerate the process of dying”.

In the tragic case of Aruna Shanbaug — the nurse who was bed-ridden for over three decades — the apex court  laid down procedural guidelines for passive euthanasia. However, Shanbaug died in 2015 of natural causes.