Passive euthanasia for Harish Rana: What will doctors do next? Ex-AIIMS palliative expert explains

“Palliative care and passive euthanasia are two different things,” explains Bhatnagar, who is now the principal director, critical care, pain management and palliative care at Max Healthcare.

What is passive euthanasia?

Passive euthanasia is the legal and ethical practice of withholding or withdrawing life-sustaining treatment (like ventilators, feeding tubes or dialysis) from a terminally ill or comatose patient, allowing them to die naturally from their underlying condition. It differs from active euthanasia by focusing on “letting die” rather than directly causing death.

Rana’s case reached the Supreme Court after his parents, who have been caring for him for more than a decade, approached the court, seeking permission to withdraw life-sustaining measures. With age catching up with them, they said they were no longer able to continue the intensive care their son requires. “Their request was genuine in the sense that they have been looking after him for many years, more than a decade. Now they are ageing and unable to look after him,” she adds.

The parents had sought permission to stop or reduce his food intake, knowing that recovery was not possible. “Stopping food is basically a kind of passive euthanasia. Doctors will not do anything actively, but it becomes a passive way of allowing the natural end,” says Dr Bhatnagar.

What could AIIMS do?

At AIIMS, the approach will remain rooted in palliative care principles. That means Rana will receive supportive care but doctors will avoid aggressive medical interventions and life support systems that only prolong life without improving quality. “They are not going to do anything to hasten his end and will not prolong his end by putting him on unnecessary support,” says Dr Bhatnagar.

In practice, the protocol will involve maintaining basic care and comfort. The patient will continue to receive routine support such as pain management and hygiene. However, if his condition worsens, for instance if breathing becomes difficult, doctors will not escalate treatment through intensive interventions. “If he stops breathing or has laboured breathing, doctors will not put this patient on a ventilator or in the ICU,” says Dr Bhatnagar. Instead, the focus will remain on comfort and dignity. Rana will likely be kept in a dedicated room or bed within the palliative care unit, where trained nurses and doctors will monitor his condition.

“There will be a lot of nursing care required,” Dr Bhatnagar says. “He should remain clean, he should not develop bed sores and he should not have pain or distressing symptoms.”

Routine medical investigations will also be avoided. “There is no role for repeated blood investigations or X-rays or chest tests. Even in palliative care we don’t do all this,” she adds.

What about nutrition?

The question of nutrition, central to the court petition, will likely be handled gradually. “As far as nutrition is concerned, I feel it should not stop immediately. It can be stopped slowly,” Dr Bhatnagar says, adding that the exact plan will depend on the treating team’s decision.

How long will the patient last in palliative care?

Predicting the timeline of such a process is difficult. “It depends from patient to patient,” she says. “He is a young boy, so it may take some time. We cannot say exactly how long.”

The case has already sparked debate on the ethics and implications of passive euthanasia in India. She points to similarities with the well-known Aruna Shanbaug case, which had also forced the country to confront difficult questions surrounding end-of-life care. “For doctors, the guiding principle must remain compassion. We should use our humanity as much as possible towards the parents as well as towards his family. He should go peacefully with a natural end.”