1. Legal application by parents for withdrawal of clinically assisted nutrition and hydration (CANH) in a patient diagnosed with an irreversible permanent vegetative state. (Para 2 , 4 , 6 , 7 , 8 , 11 , 12 )
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2026 Supreme(SC) 244
SUPREME COURT OF INDIA
J.B. Pardiwala, K.V. Viswanathan, JJ.
Harish Rana – Applicant
Versus
Union of India & Ors. – Respondents
Miscellaneous Application No. 2238 of 2025 In Special Leave Petition (Civil) No. 18225 of 2024
Decided On : 11-03-2026
Advocates appeared:
For the Petitioner(s): Ms. Rashmi Nandakumar, AOR Ms. Dhvani Mehta, Adv. Ms. Anindita Mitra, Adv. Ms. Yashmita Pandey, Adv. Mr. Manish Jain, Adv. Mr. Vikash Kumar Verma, Adv. Mr. Jugul Kishore Gupta, Adv.
For the Respondent(s): Ms. Aishwarya Bhati, A.S.G. Ms. Shivika Mehra,Adv. Ms Riddhi Jad, Adv. Mr Sudarshan Lamba, AOR Mr. Amrish Kumar, AOR Ms. Sushma Verma, Adv. Ms. Shreya Jain, Adv. Mr. B. L. Narasmma Shivani, Adv. Mr. Arun Kanwa, Adv. Mr. Raj Bahadur Yadav - Aor, Adv.
For the Petitioner(s): Ms. Rashmi Nandakumar, AOR Ms. Dhvani Mehta, Adv. Ms. Anindita Mitra, Adv. Ms. Yashmita Pandey, Adv. Mr. Manish Jain, Adv. Mr. Vikash Kumar Verma, Adv. Mr. Jugul Kishore Gupta, Adv.
For the Respondent(s): Ms. Aishwarya Bhati, A.S.G. Ms. Shivika Mehra,Adv. Ms Riddhi Jad, Adv. Mr Sudarshan Lamba, AOR Mr. Amrish Kumar, AOR Ms. Sushma Verma, Adv. Ms. Shreya Jain, Adv. Mr. B. L. Narasmma Shivani, Adv. Mr. Arun Kanwa, Adv. Mr. Raj Bahadur Yadav - Aor, Adv.
The court affirmed that Clinically Assisted Nutrition and Hydration (CANH) constitutes "medical treatment" and may be lawfully withdrawn if a holistic "best interest" assessment—incorporating medical futility and substituted judgment—determines that continuing such treatment is not in the patient's best interest and violates their right to dignity.
Headnote:(A) Constitution of India - Article 21 - Right to Life and Dignity - Passive Euthanasia - Withdrawal of Medical Treatment - Clinically Assisted Nutrition and Hydration (CANH) - Best Interest Principle - The "right to live with dignity" inherently encompasses the "right to die with dignity," allowing for the withdrawal or withholding of medical treatment when such intervention is futile and merely prolongs the dying process (Paras 52, 55). A clear distinction exists between active euthanasia, which involves a positive act to cause death and remains impermissible, and passive euthanasia, which involves the omission of life-sustaining treatment to allow nature to take its course (Paras 35, 40, 91).
(B) Medical Law - Clinically Assisted Nutrition and Hydration (CANH) - Whether CANH constitutes "medical treatment" - Administration of nutrition and hydration through medical devices (such as PEG tubes) is a technologically mediated medical intervention, not mere basic primary care, and is therefore amenable to the legal framework governing the withdrawal of life-sustaining treatment (Paras 118, 128).
(C) Best Interest Principle - Scope and Application - In cases of incompetent patients, the decision to withdraw treatment must be based on the "best interests of the patient," which requires a holistic assessment of both medical considerations (futility, irreversibility, and indignity) and non-medical considerations (patient's values, beliefs, and substituted judgment) (Paras 219, 231, 233). The substituted judgment standard, which seeks to determine what the patient would have wanted if competent, is a component of the overarching best interest test (Paras 211, 231).
Facts of the case:
An applicant in a permanent vegetative state (PVS) for 13 years following a severe traumatic brain injury is sustained by Clinically Assisted Nutrition and Hydration (CANH) via a PEG tube. The applicant's parents and two independent medical boards (Primary and Secondary) concluded that the condition is irreversible, the treatment is futile, and continuing the artificial prolongation of life is not in the applicant's best interest.
Findings of Court:
The court found that the administration of CANH constitutes medical treatment. Based on the unanimous medical opinion and the family's testimony regarding the applicant's prior values, the court determined that continuing the treatment serves no therapeutic purpose and violates the applicant's right to die with dignity.
Issues: (1) Whether the administration of CANH is to be regarded as "medical treatment"; (2) The meaning and scope of the "best interest of the patient" principle; and (3) Whether it is in the best interest of the applicant that his life be prolonged by continuation of medical treatment.
Ratio Decidendi: The court ruled that CANH is a medical procedure involving clinical judgment and risks, thus qualifying as medical treatment. Under Article 21, the right to a dignified death justifies the withdrawal of such treatment when it is medically futile and does not serve the patient's overall welfare, as determined by a balance sheet approach weighing the burdens of treatment against any potential benefits.
Result: Miscellaneous Application allowed; medical treatment, including CANH, to be withdrawn under a structured palliative and end-of-life care plan.
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Table of Contents
2. Parties disputed whether CANH qualifies as medical treatment amenable to withdrawal under passive euthanasia guidelines, vs. being essential care not subject to such withdrawal. (Para 23 , 25 )
3. Withdrawal of life-sustaining medical treatment in PVS cases is permissible under Article 21 if it serves the best interests of the patient without violating duty of care. (Para 47 , 55 )
JUDGMENT
J.B. PARDIWALA, J.:
For the convenience of exposition, this judgment is divided into the following parts:
| INDEX | |
| (A). | FACTUAL MATRIX |
| (B). | SUBMISSIONS ON BEHALF OF THE APPLICANT |
| (C). | SUBMISSIONS ON BEHALF OF THE UNION OF INDIA |
| (D). | CORE CONCEPTS UNDERLYING THE DECISION IN COMMON CAUSE 2018 |
| I. | The Essential Distinction: Active and Passive Euthanasia |
| II. | Permissibility of Passive Euthanasia under Article 21 of the Constitution of India |
| (a) | The unifying and omnipresent force of ‘dignity’ in the discourse on ‘right to die with dignity’ |
| (b) | Viewing the “right to die with dignity” through the prism of self-determination, individual autonomy and privacy. |
| (c) | Recognising non-voluntary passive euthanasia within the framework of Article 21 |
| (i) | ‘Dignity’ as the standalone basis for the recognition of non-voluntary passive euthanasia |
| (ii) | Unconscious or incompetent patients and their right to bodily integrity. |
| (iii) | ‘Authorized omission’ in consonance with the duty of care of doctors |
| III. | Impermissibility of Active Euthanasia under Article 21 of the Constitution of India |
| IV. | Establishing the Permissibility of Advanced Medical Directives |
| V. | Procedural Framework for Passive Euthanasia |
| (E). | ISSUES FOR DETERMINATION |
| (F). | ANALYSIS |
| (1) | Whether the administration of CANH is to be regarded as “medical treatment”? |
| (2) | What is the meaning, scope, and contours of the principle of “best interest of the patient” in determining whether medical treatment should be withdrawn or withheld? |
| (a) | Best interest of the patient in United States of America (USA). |
| (b) | Best interest of the patient in United Kingdom (UK) |
| (c) | Best interest of the patient in Ireland |
| (d) | Best interest of the patient in Italy |
| (e) | Best interest of the patient in Australia |
| (f) | Best interest of the patient in New Zealand |
| (g) | Best interest of the patient in European Union (EU) |
| (h) | Best interest of the patient in India |
| (i) | Medical considerations under the best interest principle |
| (ii) | Non-medical considerations under the best interest principle |
| (i) | Application of the best interest principle |
| (3) | Whether it is in the best interest of the applicant that his life be prolonged by continuation of medical treatment? |
| (4) | What are the further steps to be undertaken in the event that a decision to withdraw or withhold medical treatment is arrived at? |
| (5) | Streamlining and contextualising the Common Cause Guidelines |
| I. | Safeguarding Checkpoints that remove any hesitation amongst doctors |
| II. | Role of the patient’s next of kin/next friend/guardian |
| III. | Bridging the procedural gap for patients who are undertaking medical treatment in a home-setting |
| IV. | Nomination of registered medical practitioner by CMO |
| V. | Reconsideration Period |
| VI. | Court Intervention |
| (6) | Legislative inaction and the need for legislation |
| I. | The 196th Law Commission Report |
| II. | The decision of Aruna Shanbaug |
| III. | The 241st Law Commission Report |
| IV. | The decision of Common Cause 2018 |
| V. | Draft Guidelines of 2024 |
| (G). | CONCLUSION |
| I. | Summary of our discussion |
| (a) | Understanding Common Cause 2018 |
| (b) | CANH is a medical treatment |
| (c) | Best Interest Principle |
| (d) | Palliative and EOL Care |
| (e) | Streamlining of the Common Cause Guidelines |
| (f) | Need for a comprehensive statutory framework |
| II. | The Final Order |
“God asks no man whether he will accept life.
That is not the choice.
You must take it.
The only choice is how.”
1. The above words of Henry Ward Beecher assume great significance in the present case, more particularly when the courts are asked to give their
