There is a kind of grief that has no public language. It lives in hospital corridors at 2 am, in the steady beep of monitors, in the peculiar silence of a room where someone you love is present in body but absent in every meaningful sense. Most families carrying this grief have never heard of Article 21. They only know the question that haunts every morning: Is this still living, or have we confused the act of breathing with the fact of being alive?
In January 2026, the parents of Harish Rana walked into the Supreme Court carrying that question in legal form. Their son had been in a Persistent Vegetative State (PVS) for 13 years, since a fall at 19 left him with irreversible brain damage. He breathed, and his eyes opened, but he had no awareness of himself or his surroundings and could not recognise the mother who had stayed beside him for 13 years. He was fed through a tube surgically inserted into his stomach. Two specialist boards, including one from AIIMS New Delhi, were unanimous: Permanent, irreversible, no recovery possible. The family’s prayer was simple and devastating: Let the treatment stop. In Harish Rana vs Union of India, the Supreme Court said yes.
The significance of this judgment lies far beyond the tragic circumstances of a single case. It forces our law to confront a moral paradox created by modern medicine: The same technologies that save lives can also prolong biological existence long after the person who once inhabited that body has irreversibly disappeared.
Constitutional Dignity
The Court’s reasoning builds on one of the most philosophically ambitious decisions in Indian constitutional history. In Common Cause vs Union of India (2018), a five-judge Constitution Bench recognised that the right to live with dignity under Article 21 includes the right to die with dignity. The judgment did not recognise a right to death. Rather, it acknowledged a more modest but profound principle: Individuals have the autonomy to refuse medical treatment that merely prolongs the process of dying.
Justice D Y Chandrachud, in his concurring opinion, posed the question that sits at the centre of this jurisprudence: When bodily and mental functions irreversibly deteriorate, and consciousness disappears, does the continued preservation of biological life truly protect dignity? His answer was clear. A person condemned to a state of biological survival without awareness, agency, or experience does not have their dignity protected by the continuation of that condition. In certain circumstances, dignity may require the law to step back and allow nature to take its course.
This reasoning reflects a deeper shift in constitutional thinking. For decades, legal systems treated life as an absolute value whose preservation justified almost any intervention. But dignity, the Court recognised, cannot be reduced to the mere continuation of physiological processes. The Constitution protects not simply life as a biological fact but as a meaningful human experience grounded in autonomy and personhood. When medicine can no longer restore that experience, the insistence on indefinite intervention risks transforming protection into coercion.
Active and Passive Euthanasia
The most delicate issue in this area concerns the distinction between active and passive euthanasia. Indian law continues to prohibit active euthanasia, which involves the deliberate administration of a substance intended to cause death. Passive euthanasia, on the other hand, involves withdrawing or withholding medical intervention that artificially prolongs life.
The Supreme Court has repeatedly affirmed that the difference between the two lies not in a simplistic contrast between acts and omissions but in the source of causation. Active euthanasia introduces a new agent of death. Passive euthanasia removes an artificial barrier to a natural process already underway. The law, therefore, treats them differently because the moral and legal responsibility involved is fundamentally distinct.
Courts across the common law world have recognised this distinction. In Airedale NHS Trust vs Bland (1993), the House of Lords observed that a doctor who withdraws life-sustaining treatment does not kill the patient but simply ceases to prevent the underlying illness from taking its course. The disease remains the cause of death. The physician merely acknowledges the limits of medical intervention.
The Supreme Court’s recent judgment clarifies another important aspect of this principle by recognising that clinically assisted nutrition and hydration delivered through a PEG tube constitute medical treatment rather than ordinary care. A feeding tube inserted surgically and replaced periodically in a hospital is not equivalent to offering a patient a glass of water. It is a clinical intervention made necessary by the patient’s medical condition. Once understood in those terms, its continuation must be governed by the same principles that apply to all medical treatment: Patient autonomy, informed consent, and medical futility.
Institutional Failure
Yet for all the Court has accomplished, there is one problem it cannot resolve on its own. In Common Cause, the Supreme Court explicitly called upon Parliament to enact comprehensive legislation governing end-of-life care. It repeated that request in subsequent proceedings and has now done so again. Eight years later, Parliament has not acted.
Justice Dipak Misra wrote in Common Cause that “life measured by artificial heartbeats while the patient is not even aware that he is breathing” is an imposition of indignity, not its protection. Parliament has had eight years to respond to that insight and has chosen silence. The consequences are visible across hospitals. Doctors frequently pressure families into signing “Discharge Against Medical Advice” forms because few have been trained to implement the legal framework governing withdrawal of treatment. Palliative care remains catastrophically underfunded. Fundamental questions about proxy consent and legal protection for physicians acting in good faith remain unanswered. This is not a policy gap. It is a failure of institutional seriousness about how citizens die.
Legislation could address issues that courts cannot resolve through constitutional interpretation alone. It could establish clear procedures for implementing living wills, provide legal protection for doctors who withdraw treatment in accordance with established protocols, clarify decision-making authority when families disagree, and integrate palliative care into public health policy. Courts can articulate rights, but legislatures must build the institutions that make those rights meaningful.
A Right Beyond Courts
The brother of Harish Rana told the Court’s appointed counsels something that deserves to be read slowly. He said the family had reached its decision “with great difficulty and on firm belief that the continuation of medical treatment no longer serves any meaningful purpose and only prolongs the agony of the applicant”. He remembered playing football with his brother, full of life at 19. Thirteen years had only deepened the family’s certainty that the person they remembered was no longer inside the body they were tending.
Across India, thousands of families live in that same dilemma today. Many will never approach the Supreme Court. They will confront these decisions quietly in hospitals and homes, often without legal guidance, medical counselling, or palliative care support. For them, the importance of the Court’s jurisprudence lies in its recognition that dignity cannot be measured solely in heartbeats.
Justice Chandrachud wrote that dignity at the end of life reflects “the central expectation of a fading life: Control over pain and suffering and the ability to determine the treatment which the individual should receive.” For Harish Rana’s parents, that control came only after 13 years of waiting.
They did not want their son dead. They wanted him free. The Supreme Court has finally found the constitutional language to recognise that difference. The question now is whether Parliament, and the rest of us, are prepared to confront what that recognition demands.
The writer is a lawyer and public policy consultant
