Court's humane judgment, Parliament's inhuman silence

Harish Rana’s case shows that judicial compassion cannot substitute for legislative courage

On March 11, the Supreme Court of India permitted the withdrawal of life support from Harish Rana, a 32-year-old man who has been in a persistent vegetative state since a fall in 2013. The judgment has been called landmark, humane, and long overdue. All true. But, there is a more uncomfortable angle, one about democratic failure, judicial improvisation, and the quietly unequal way dignity is distributed at the end of life in India.

The bridge that became a building

Justice J B Pardiwala's opinion contains a confession that deserves to be read alongside its compassionate conclusion. In paragraph 279, the court acknowledges that its intervention in end-of-life matters has "never been intended to supplant legislative wisdom, but only to operate as a temporary constitutional bridge until Parliament discharges its role." A bridge is a crossing, not a destination.

This one was first laid in 2006. The law commission submitted its 196th report recommending legislation on terminal care. Parliament ignored it. In 2011, the Supreme Court in Aruna Shanbaug v Union of India was forced to frame its own guidelines, and explicitly asked Parliament to step in. Parliament did not.

In 2012, a revised 241st law commission report came with a new draft bill attached. Nothing moved. Four private member bills, introduced in 2002, 2007, 2014, and 2019, died without sustained deliberation. In 2016, the Ministry of Health published a draft bill for public comment; after the consultations, no further steps followed.

Then came Common Cause v Union of India (2018), another constitution bench judgment that framed another set of guidelines, expressed a ‘pious hope’ that the legislature would act, and handed the responsibility back once more. When a Rajya Sabha member asked what the government intended to do, the Health Minister replied that the Supreme Court's judgment "should be followed as law."

The Harish Rana judgment arrives eight years after that ‘pious hope’. The bridge is now 20 years old. Parliament has not built the building.

When feeding became medicine

The legal pivot on which the Harish Rana judgment turns has been largely missed in commentary: the court's holding that Clinically Assisted Nutrition and Hydration, tube feeding through a surgically installed gastric tube, is ‘medical treatment’ rather than basic care. This sounds like a technical reclassification. It is not.

The distinction matters enormously. If tube feeding is merely feeding, then withdrawing it is morally proximate to starvation. If it is a medically constructed intervention, prescribed, monitored, periodically reviewed, attended by risks of aspiration pneumonia and systemic infection, then withdrawing it is no different from withdrawing a ventilator or stopping chemotherapy. The apex court chose the latter, drawing on jurisprudence from the UK's House of Lords in Airedale NHS Trust v Bland (1993) to California's Barber v Superior Court (1983).

In doing so, the court has quietly redrawn a boundary that extends well beyond euthanasia. It has articulated something philosophically significant in procedural language: that the body kept alive by sophisticated clinical machinery is not simply a living body. It is a body in a medically constructed state. Constructed states can be deconstructed. The implications for future cases involving dementia, locked-in syndrome, and minimally conscious states have barely been examined.

India joins a global consensus, through the back door

One of the most striking features of the judgment is its sweeping comparative survey. The court examined how courts in the United States, the United Kingdom, Ireland, Italy, Australia, New Zealand, and the European Union have approached the withdrawal of life support. What it found was a convergence that has been building for decades. The US ‘substituted judgment’ standard, what would the patient have wanted?, and the British ‘best interests’ standard, what serves the patient's welfare?, are no longer truly distinct tests.

The court describes the two as converging ‘at twilight where subjective autonomy and objective welfare intersect.’ The US Supreme Court's 1990 Cruzan v Director decision, the European Court of Human Rights' 2015 Lambert v France ruling, and India's own Common Cause 2018 framework are now part of the same evolving global constitutional grammar: that dignity and medical futility together create a right not merely to life, but to death that is not artificially prolonged.

India is formally part of this consensus. But it arrived there through 20 years of judicial bridge-building, not democratic deliberation. Every other major democracy that has developed this jurisprudence has eventually put it in statute: the UK's Mental Capacity Act 2005, Australia's state-level advance care planning legislation, and New Zealand's End of Life Choice Act 2019. India remains the outlier: a country where constitutional rights in this domain are protected only by guidelines framed under Article 142 of the Constitution, which grants the Supreme Court extraordinary powers to do ‘complete justice’. Complete justice should not have to stand in for a law.

Who gets to die with dignity

There is a paragraph in the Harish Rana judgment that deserves far more attention than it has received, wherein, the court issues a warning about the absence of legislation: that end-of-life decisions, ostensibly grounded in compassion or clinical futility, ‘may, in reality, be driven by the inability of families to sustain prolonged and expensive medical intervention, thereby blurring the line between a genuine best-interest determination and an act compelled by economic exhaustion.’

The court is acknowledging, with unusual candour, the class politics of dying in India. Over 60% of healthcare expenditure in India is out-of-pocket. Families bankrupted by years of ICU care are making financial decisions dressed as medical ones. A statutory framework that mandates independent oversight, builds out palliative care infrastructure, and protects against coercion is the only way to ensure that the right to die with dignity is not available exclusively to the economically exhausted or the legally resourceful.

The Harish Rana family spent 13 years fighting for their son. They eventually won. But the dignified death they sought for Rana should require a doctor, a medical board, and a clear law. The first two now exist, in the form of a guideline. The third does not.

What must come next

The Supreme Court has done its constitutional work. It classified tube feeding as medical treatment. It confirmed that the ‘best interests’ standard governs decisions for patients who cannot speak for themselves. It streamlined the procedural framework: primary and secondary medical boards, a 30-day reconsideration window, a CMO obligation to maintain panels of qualified practitioners. It directed AIIMS to admit Harish Rana to its palliative care department and to withdraw treatment humanely.

What it cannot do is legislate. That task belongs to Parliament, and Parliament's continued silence is not a neutral act. When the health minister tells the Rajya Sabha that court guidelines ‘should be followed as law’, he is not describing a legal reality. He is describing a political abdication. The executive has outsourced its duty, and the judiciary has accepted the burden because leaving citizens without protection would be worse.

India needs a comprehensive end-of-life care law. A law would shield doctors from the criminal liability that currently shadows withdrawal decisions. It would create advance directive registries that families can access, instead of being left to petition the highest court to reconstruct a loved one's presumed wishes. It would mandate palliative care infrastructure across districts, and not only in AIIMS. It would mean that the right to die with dignity is no longer a privilege that takes 13 years and a Supreme Court petition to exercise.

The judgment is genuinely humane. But its humanity should prompt a harder question: how many families, without the knowledge or the means to reach the Supreme Court, are living through in silence the same 13 years right now?

The bridge has held. It is time to build the building.

Julian Seal Pasari is Assistant Professor of Law, and Avinash Verma is research assistant, National University of Study and Research in Law (NUSRL), Ranchi. X: @JulianSPasari and @iavinashwrite.

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.