The recent judgment of the Supreme Court in the case of Harish Rana v. Union of India (2026) has raised questions about the ethical, legal and social implications (ELSI) of passive euthanasia. Euthanasia is related to the right to die with dignity, as recognized by the Supreme Court in Common Cause v. Union of India (2018). The court ruled that the right to a dignified death is inseparable from the right to quality palliative care. Thus, in Harish Rana’s case, for the first time, the court allowed withdrawal of the applicant’s Clinically Assisted Nutrition and Hydration (CANH).
The Common Cause Court held that the right to die with dignity is an integral part of the right to life under Article 21 of the Constitution. Permitting passive euthanasia and recognizing Advance Medical Directive (living Willing) for terminally ill patients to refuse life-prolonging treatment was established in Aruna Shanbaug v Union of India (2011). Following this, in Common Cause versus Union of India (2023), the court streamlined the process of passive euthanasia and made it easier to perform.
In the new guidelines, the court changed the requirement for two medical boards, a hospital board and a district board, refined it to make the process smoother, and removed the mandatory immediate judicial review in each case. In dealing with advance directives (living wills), the court emphasized patient autonomy, which allows individuals to refuse life-sustaining treatment and die naturally with dignity.
In view of the above, several questions arise regarding euthanasia and its importance in India. First, whether granting passive euthanasia is ethical. It is logically perceived that birth and death are natural processes; so nature should decide when a person will die and how the body will react to the disease. In this context, any interference with natural rules can be considered unethical.
But it is also a fact that life is the period between birth and death and is lived in a society where dignity is of the utmost importance. Thus, life can be considered sociological rather than biological. Both birth and death should be dignified. In this context, the right to die with dignity becomes more important.
Ethical aspects of euthanasia
The ethical principles enshrined in this act of granting passive euthanasia further clarify this issue. The primary and probably the most important aspect is the principle of autonomy, which gives the patient – or in the case of an incurable disease, their next of kin – the right to make decisions. The second is the principle of beneficence, which is related to the benefit of the patient, which should be considered by treating physicians. The third is the principle of non-maleficence, which suggests that the decision to allow passive euthanasia should not cause harm. Finally, the principle of justice must be protected to ensure that no injustice is done to the patient.
If we leave these principles aside, we can look at the decision from the point of view of the Double Effect Theory proposed by St. Thomas Aquinas. According to this theory, every action produces two effects, and the one that is less harmful or beneficial should be considered ethical. In the case of passive euthanasia, the action — withdrawal of life support, or CANH in the case of Harish Rana — has two effects. First, the death of the patient, and second, relief from suffering. If the decision is made without malice, the act can be considered ethical because the patient has been relieved of pain.
Social implications
The right to die with dignity or passive euthanasia in India reflects a progressive but cautious approach, especially due to the transition in societal values. This transition is from rigid moral traditions to a more compassionate rights-based approach. While it promotes dignity, autonomy, and relief from suffering, it also raises concerns about abuse, ethical conflicts, and social inequality. There has also been a shift from a societal attitude of protecting life at all costs to one where quality of life is more important than length of life.
Another significant consequence is economic in nature, as long-term life-sustaining treatment with no hope of recovery would put the family under severe economic stress, especially in the middle and lower income groups. In this context, the right to die with dignity appears justified.
The social implications can further include its potential misuse and particularly vulnerable people, such as the elderly, disabled and the poor, may face coercion. This can create a situation where the decision can be driven by financial constraints, social neglect and family pressure. Critics may therefore point out that this would amount to a hidden abandonment.
The court took the utmost care in delivering its judgment, stating that “passive euthanasia is an outdated and incorrect term and should not be used either in common usage or in legal writing and discussion”. This unnecessarily confuses the legal position on the issue, as the debate cannot be neatly divided into “acts” and “omissions”. Furthermore, the court also ruled that the patient is not abandoned by the withdrawal or denial of medical treatment. Palliative and end-of-life care must continue for these patients.
(CBP Srivastava is President, Center for Applied Research in Governance, Delhi)
Published – 30 March 2026 22:14 IST
