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Journalism of Courage
Finding that 30-year-old Harish Rana was not being kept alive ‘mechanically’, the Delhi High Court and the Supreme Court recently rejected a plea by his parents for constituting a medical board to examine if this is a viable case for passive euthanasia.
The case has reignited the debate around the ethics and law that defines passive euthanasia — withdrawing life-supporting treatment to allow a person to die naturally.
In 2011, the Supreme Court for the first time recognised the legality of passive euthanasia in the case of Aruna Ramchandra Shanbaug v Union of India.
After being sexually assaulted by a ward attendant of Mumbai’s KEM Hospital in 1973 and suffering a brain injury in the process, nurse Aruna Shanbaug was left in a ‘persistent vegetative state’ for decades, with no possibility of recovery. Journalist and author Pinki Virani, who wrote a book on Shanbaug, filed a petition at the Supreme Court in 2009 seeking an end to the life-supporting treatment the hospital was providing to Shanbaug, arguing that she should be allowed to die peacefully.
The court, while ruling out passive euthanasia in this case, held that Shanbaug was still alive as she did not require life support. However, the court recognised the legality of passive euthanasia, though it clarified that this could only be done with the approval of a High Court.
In 2018, the Supreme Court recognised the legality of ‘passive euthanasia’ for terminally-ill patients, holding that the ‘right to die with dignity’ forms a part of the right to life under Article 21 of the Constitution of India. The court also laid down detailed guidelines for passive euthanasia, both in cases where the patient left an ‘advance directive’ or a ‘living will’ stating that life support should be withdrawn if they fall terminally ill, and in cases where no such directive was left behind.
Among the guidelines was the condition that the living will must be signed in the presence of two witnesses and signed by a Judicial Magistrate. The guidelines also called for multiple approvals before the terminally ill patient’s case is cleared – from the treating physician, a suitably qualified medical board, and another external medical board, with representation from the local administration.
In the case of patients without a living will, the family has to give their consent for withdrawal of life support. In 2019, the Indian Society of Critical Care Medicine filed an application for modifying these guidelines, stating that they were cumbersome and unworkable.
In 2023, another five-judge bench allowed the guidelines to be modified in a number of ways. This included introducing timelines for each board to make a decision, and limiting the involvement of the Judicial Magistrate.
Though the Supreme Court dismissed the plea for passive euthanasia in Harish Rana’s case on August 20, the bench was sympathetic to the plight of Rana’s parents who had spent a significant portion of their own lives and savings caring for their son who will likely never recover.
Since his fall from the fourth floor of a building in 2013, Rana has been in a ‘permanent vegetative state’, suffering from quadriplegia with “100% disability in relation to his whole body”, according to his hospital records.
According to medical experts, the financial implications are often drastic for patients in a vegetative state. Speaking of the tough decisions families are forced to make while caring for a terminally ill patient, Dr Bhavani Prasad Gudavalli, Head of the Critical Care Department at CARE Hospitals, Banjara Hills, Hyderabad, said, “It’s not as if they (the families) don’t have compassion, but when the finances come into play and you tell them that the financial implications are very high and the chance of recovery is very low, then the family will often want to withdraw treatment.”
