On March 11, 2026, the Supreme Court of India, in Harish Rana v. Union of India, allowed the withdrawal of clinically assisted nutrition and hydration (CANH) from a man who had been in a permanent vegetative state (PVS) since 2013. This judgment is the first time that the end-of-life framework outlined in Common Cause v. Union of India (as modified in 2023) has been applied in full, and it also resolves certain questions that were left unanswered.

What does it mean to die with dignity? In India, this question has a constitutional history. The right to life under Article 21 of the Indian Constitution has, over time, been read to encompass the quality and character of that existence, and has been interpreted to include the right to die with dignity.

The journey began in Gian Kaur v. State of Punjab, wherein the Court, while rejecting any general right to die under Article 21, recognised that for patients who were terminally ill or in PVS, the right to die with dignity would be a part of the right to live with dignity. In Aruna Shanbaug v. Union of India, this right was given substance by recognising the legality of withholding or withdrawing life-sustaining treatment, when the decision to withdraw was in the patient’s best interests. However, the approval for the same had to be granted by a High Court. In Common Cause, a five-judge constitution bench grounded the right firmly in Article 21, displaced the courts from the centre of decision-making and laid down a framework for withholding or withdrawing treatment.

Under this framework, where there is no Advance Medical Directive, a treating physician, after determining that a patient is in an irreversible condition, may inform the hospital, which will constitute a primary medical board (PMB). The PMB, after discussing with the patient’s next of kin, gives an opinion on whether withdrawal of medical treatment is in the best interests of the patient. If it certifies withdrawal, a secondary medical board is constituted. Where both boards are unanimous, the hospital can proceed with withdrawal after informing the judicial magistrate. When there is a disagreement at any stage, the matter may be taken to the High Court, which must decide, keeping in mind the best interests of the patient. In Harish Rana, the Court, while applying this framework, also clarifies what a best interest assessment involves, resolves whether CANH constitutes medical treatment, and strengthens the institutional framework through which the right operates.

Best Interests Standards

While Common Cause established that any decision to withdraw treatment from incompetent patients was to be taken only when it was in their best interests, it did not expand on what this principle entailed. Harish Rana fills that gap by conducting a cross-jurisdictional analysis across seven legal systems and drawing from them a set of considerations that should be taken into account while determining the best interests of the patient.

The Court clarifies that a best interests analysis cannot merely include a clinical assessment of medical futility, which is necessary but not sufficient. The inquiry must also examine the patient’s own wishes and values, reconstructed through the evidence of those who knew them. Neither clinical judgment nor family preference alone is determinative; the constitutional obligation requires the assessment of the patient as an individual (para 233).

Resolving the CANH Classification 

Under Common Cause, only an intervention that qualifies as ‘medical treatment’ could be considered for withdrawal. Earlier, there was a lack of clarity on whether CANH fell within the definition of ‘medical treatment’ or whether it was basic primary care. The Court, in Harish Rana, clarifies this by recognising CANH as ‘medical treatment,’ thus making it subject to the procedure laid down in Common Cause. Without this classification, the withdrawal framework could not be triggered for a significant category of patients, including Harish Rana himself.

Strengthening the Framework

Beyond clarifying doctrine, the judgment also strengthens the infrastructure through which the right must operate. The Court directed states to ensure that a panel of registered medical practitioners is established without delay, who will be available to serve on medical boards. It further directed High Courts to issue directions to judicial magistrates to receive intimation from hospitals where medical boards are unanimous in their decision to withdraw or withhold treatment. These directions serve to ensure that the right can be realised not only in principle, but also in practice.

The Legislative Gap

While the decision in Harish Rana is a significant advance, the right to die with dignity still rests on judge-made guidelines with no statutory backing. The path to realising this right, as demonstrated by the case itself, has been spearheaded by the judiciary. This is not a sustainable model for accessing a right. The right to die with dignity cannot only be a right for those who can litigate it. A constitutional guarantee of this significance must be embedded in statute, with clear procedures and trained institutional actors.

The Court notes that, despite explicit judicial direction since 2018 and Law Commission recommendations dating back to 2006, the Parliament has still not acted. The Harish Rana case has illustrated what operationalising a right can look like; what remains is to see what accessing such a right will look like.