Passive euthanasia: After SC's historic verdict, what happens next for Harish Rana?

• Supreme Court allows passive euthanasia for Harish Rana.
• Rana to receive palliative care at AIIMS, Delhi.
• Emphasis on comfort and dignity over life extension.

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The Supreme Court’s landmark decision to allow passive euthanasia for 32-year-old Harish Rana has shifted the focus from a prolonged legal battle to the delicate medical and ethical process of ensuring a dignified natural death. Rana, a resident of Ghaziabad who has been in a persistent vegetative state for 13 years, will now be under the care of the palliative medicine unit at the All-India Institute of Medical Sciences (AIIMS), Delhi.

The court granted the petition filed by Rana’s ageing parents, who had sought permission to withdraw life-sustaining treatment, including clinically administered nutrition, after more than a decade of intensive care. While an AIIMS spokesperson was cited by The Indian Express as confirming that the institution will follow the court order, medical experts have clarified that the forthcoming process is rooted in palliative care principles, distinct from the legal concept of passive euthanasia it enables.

Passive Euthanasia vs Palliative Care

Dr Sushma Bhatnagar, former AIIMS chief and professor of onco-anaesthesia and palliative medicine, now with Max Healthcare, was cited by The Indian Express as saying that palliative care never supports any kind of euthanasia, whether active or passive. She explained that what the field supports is allowing a person to die naturally, without prolonging or hastening death.

Passive euthanasia refers to the legal and ethical withholding or withdrawal of life-sustaining treatments — such as ventilators, feeding tubes, or dialysis — from a terminally ill or comatose patient, allowing the underlying condition to take its natural course. This differs fundamentally from active euthanasia, which involves directly causing death.

13 years in a vegetative state: The parents' decade-long battle

The parents’ plea was rooted in their inability to continue providing the intensive care their son has required for over a decade. Dr Bhatnagar noted that their request was genuine given they had cared for him for more than a decade and were now ageing and unable to continue.

By seeking permission to stop or reduce his food intake, they effectively requested a form of passive euthanasia, as ceasing nutrition becomes a passive way of allowing the natural end, the report said.

The protocol at AIIMS: Allowing a natural end, not hastening death

At AIIMS, the focus will be on comfort and dignity rather than aggressive medical intervention. The protocol will involve maintaining basic care, such as pain management and hygiene, but will avoid life-prolonging measures that offer no improvement in quality of life. Dr Bhatnagar explained that if the patient stops breathing or has laboured breathing, doctors will not place him on a ventilator or in the ICU.

Rana will likely be cared for in a dedicated space within the palliative care unit, with trained staff ensuring he is clean, free from bed sores and without distressing symptoms. Routine medical investigations, including repeated blood tests and X-rays, will be avoided as they serve no purpose in his end-of-life care, according to the report.

Withdrawing life support: The role of nutrition

The handling of nutrition, a central element of the court petition, is expected to be a gradual process. Dr Bhatnagar suggested that nutrition should not stop immediately but could be withdrawn slowly, adding that the final decision rests with the treating medical team.

Predicting how long Rana might survive after the withdrawal of life support is difficult. Dr Bhatnagar observed that it depends from patient to patient, and since he is a young man, the process may take some time with no exact timeline possible.

The case draws parallels with the Aruna Shanbaug case, which previously forced India to confront the complex questions surrounding end-of-life care. Dr Bhatnagar emphasised that compassion must remain the guiding principle for the medical team, stating that doctors should extend as much humanity as possible towards the parents and family, ensuring the patient goes peacefully with a natural end.