Mint Explainer | The gaps in India's withdrawal of life support protocols

Medical experts note that the Supreme Court’s 2023 order in the Common Cause miscellaneous application established a refined legal framework for both withholding and withdrawing life-sustaining treatment by simplifying the 2018 guidelines.

However, there is a perceived gap in its application, largely due to a lack of awareness among the people. Experts say clearer protocols and wider awareness are needed to ensure such decisions are handled ethically and consistently.

A bench comprising Justices J.B. Pardiwala and K.V. Viswanathan directed that Rana be shifted to the palliative care department at All India Institute of Medical Sciences in New Delhi to ensure the withdrawal process is carried out humanely.

The court waived the mandatory 30-day "reconsideration period," usually required by the 2023 guidelines, noting that the patient's family, medical boards, and the state were in unanimous agreement.

Passive euthanasia involves withholding or withdrawing medical treatment (like ventilators or feeding tubes) that artificially prolongs life, allowing the patient to die naturally. This is what the court has permitted under strict safeguards. Countries that recognize this include the UK, Germany, Japan, and France.

Notably, Canada’s model is one of the most effective frameworks globally. Unlike India's current reliance on court-monitored guidelines, Canada’s Medical Assistance in Dying (MAID) legislation provides clear statutory timelines and specific legal immunity for healthcare providers. This removes the "grey areas" that often lead to the prolonged legal battles seen in the Indian context.

Naresh Trehan, chairman and managing director at Medanta hospital suggested a rigorous testing protocol. Trehan said to ensure accuracy and prevent errors, at least two or three sets of testing must be performed by a multi-speciality group of experts.

The decision must be based strictly on the patient’s medical condition and the lack of hope of recovery, never for the convenience of doctors or to ease the burden on hospital infrastructure.

"This is a very important humanitarian judgment. The central government needs to establish a 'foolproof methodology' involving not just medical professionals, but also psychologists and philosophers, he said. Ultimately, the goal is dignity in life and dignity in death,” Trehan said.

As the Court noted, life for Rana had been "defined by pain and suffering." The ruling ensures that the state’s duty to preserve life does not become a mandate to prolong a vegetative state.

Senior advocate Ajay Verma views the recent decision as a progressive step that balances legal rights with ethical medical practices. “It’s a very positive move. It recognizes and reinforces passive euthanasia, i.e., permitting a person to die with dignity.”

Advance Medical Directives (AMDs) are legal documents that allow individuals to refuse specific life-sustaining treatments in advance if they lose the capacity to make medical decisions. In 2023, the Supreme Court simplified its 2018 guidelines by removing the requirement of a judge’s signature and streamlining the medical board approval process, making the execution of these “living wills” faster and more accessible.

The legal framework evolved through three landmark stages: in the Aruna Shanbaug case (2011), the Court first recognised the legality of passive euthanasia in exceptional circumstances; later, in Common Cause (2018 and 2023), it upheld the right to die with dignity as part of the fundamental right to life and laid down procedures for implementing AMDs.

The latest, Harish Rana (2026) case— the first verdict to apply these principles to a patient in a Permanent Vegetative State (PVS) who had not left a "living will," confirming that withdrawal of treatment can be authorized based on the patient's best interests.

Under the Supreme Court’s 2023 verdict on Advanced Medical Directives, there is already a clear legal procedure involving primary and secondary boards for withholding and withdrawing support. "The perceived gap in practice is actually a lack of awareness, as the living will and advanced medical directives are now a legal document, yet it remains underutilized because people are often reluctant to discuss death,” said Bhatnagar, who is presently principal director, oncology (looking after onco-anesthesia, onco-critical care, and palliative care) at Max Hospital, Saket.

"A significant clarification in recent rulings is that clinically assisted nutrition and hydration are officially classified as 'medical treatment,' making them subject to withdrawal under passive euthanasia guidelines," he added.