Abstract

Background: In 2026, the Supreme Court of India in Harish Rana v Union of India & Ors (2026 INSC 222) applied and substantially elaborated the passive euthanasia framework laid down in Common Cause (2018, 2023), in the concrete setting of a young man in a permanent vegetative state (PVS) maintained on Clinically Assisted Nutrition and Hydration (CANH) via PEG tube at home. Objective: To critically analyse the medicolegal reasoning in Harish Rana, with specific focus on: (i) Classification of CANH as “medical treatment”; (ii) Refinement of the “best interest” test; and (iii) Operationalisation and streamlining of the Common Cause guidelines, including implications for clinicians, hospitals and families. Methods: Doctrinal review of the full judgment text, read against prior Indian precedents (Aruna Shanbaug, Common Cause 2018, Common Cause 2023) and comparative jurisprudence from the UK, USA, EU and other jurisdictions expressly relied upon by the Court; thematic extraction of key medicolegal concepts (dignity, autonomy, authorised omission, futility, best interests) and their application to endoflife decisionmaking. Key findings: The Court held that CANH delivered through PEG constitutes “medical treatment” and its withdrawal, when medically futile and not in the patient’s best interests, falls within constitutionally permissible passive euthanasia rather than unlawful killing. It reaffirmed that Article 21’s right to live with dignity includes a right to die with dignity in cases of terminal illness or PVS where the process of natural death has commenced, and clarified that passive euthanasia is an “authorised omission” consistent with the physician’s duty of care. Drawing on UK and US case law (Airedale, Cruzan, Aintree, WvM and others), it adopted a nuanced “best interest” framework integrating medical futility, absence of any realistic prospect of meaningful recovery, and nonmedical factors such as prior wishes, family perspectives and dignity. The judgment also identified gaps in implementation of Common Cause guidelines, particularly for longterm homebased patients, and issued detailed directions for boards, CMOs and governments to create clearer, safer pathways for withdrawal/withholding of treatment and provision of palliative care. Conclusions: Harish Rana operationalises the abstract principles of Common Cause into a practically usable medicolegal template for withdrawing CANH in PVS, while robustly protecting dignity, autonomy and professional security. For treating doctors and forensic experts, it provides authoritative guidance on classifying CANH, documenting futility, engaging families, and navigating liability risks when discontinuing lifesustaining treatment.

• 1.   Harish Rana v Union of India & Ors, Misc. Appl. No. 2238 of 2025 in SLP (C) No. 18225 of 2024, 2026 INSC 222 (Supreme Court of India). 2026 Supreme(Online)(SC) 418.
• 2.   Withdrawal of CANH Permissible if Not in PVS Patient’s Best Interests: Supreme Court - Supreme Today AI https://supremetoday.ai/sc-permits-canh-withdrawal-pvs-bestinterests-principle-20260312008
• 3.   Harish Rana Vs UOI 2026 Supreme(Online) (SC) 418
• 4.   Common Cause v Union of India, (2018) 5 SCC 1 (Supreme Court of India).
• 5.   Common Cause v Union of India, (2023) 14 SCC 131 (Supreme Court of India).
• 6.   Aruna Ramachandra Shanbaug v Union of India, (2011) 4 SCC 454 (Supreme Court of India).
• 7.   Airedale NHS Trust v Bland, 1 All ER 821 (HL, UK).
• 8.   Cruzan v Director, Missouri Department of Health, 497 US 261 (1990) (US Supreme Court).
• 9.   Aintree University Hospitals NHS Foundation Trust v James, UKSC 67.
• 10.   W v M and Others, EWHC 2443 (COP).
• 11.   Gian Kaur v State of Punjab, (1996) 2 SCC 648 (Supreme Court of India).
• 12.   Common Cause v Union of India, (2023) 14 SCC 131 (Supreme Court of India).
• 13.   Aruna Ramachandra Shanbaug v Union of India, (2011) 4 SCC 454 (Supreme Court of India).
• 14.   Cruzan v Director, Missouri Department of Health, 497 US 261 (1990) (US Supreme Court).
• 15.   Aintree University Hospitals NHS Foundation Trust v James, UKSC 67.

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