CANH can be withdrawn under passive euthanasia framework: Supreme Court

The Supreme Court on Wednesday declared that clinically assisted nutrition and hydration (CANH) delivered via a PEG tube constituted medical treatment, not mere basic care, and that it can lawfully be withheld or withdrawn under the passive euthanasia framework laid down in 2018 Common Cause judgment, provided it is in the patient’s best interests.

A bench of Justices J B Pardiwala and K V Vishwanathan said, CANH can be regarded as medical treatment, forming an integral part of a patient’s medical management, and can be subject to the same ethical, legal, and clinical principles that govern the initiation, continuation, withholding, or withdrawal of other life-sustaining medical interventions.

"Merely because routine feeding in the form of CANH can be administered at home, by an informed lay person, it cannot be relegated to a non-medical status,'' the bench said.

The court also emphasized, a competent person has the right to refuse medical treatment within their right to self-determination under Article 21 of the Constitution. It is also clear that the autonomy of a competent person in refusing to take or continue a medical treatment needs to be respected. This means that until the patient is competent and is in a position to exercise his right to refuse medical treatment, he may do so, it added.

Applying a detailed “best interests” analysis, including medical futility, irreversibility, dignity, and the views of the patient’s family and medical boards, the bench held that the continued CANH for 32‑year‑old Harish Rana, lying in a permanent vegetative state for 13 years with no prospect of recovery, only prolonged his suffering and an undignified existence.