Back in 2011, while deciding the Aruna Shanbaug's euthanasia plea, the Supreme Court had invoked Mirza Ghalib's couplet: "Marte hain aarzoo mein marne ki, Maut aati hai par nahin aati" which loosely translates to "One longs to embrace death, but death is such that it comes and yet alludes".
In a judgment that opened gates for passive euthanasia in India, the court cited Ghalib to capture the inextricable dichotomy that Shanbaug and those around her had to battle for over four decades.
Sodomised and strangled with a metal dog chain at the age of 25 on November 27, 1973, in Mumbai's King Edward Memorial (KEM) Hospital, Aruna led the rest of her life in a vegetative state until her death due to pneumonia in 2015.
Her story and the plea for her mercy killing or euthanasia kick started the debate on what the Supreme Court today again dwelled upon using the Shakespeare's famous phrase "To be, or not to be".
On Wednesday, while allowing India's first passive euthanasia appeal by parents of a 31-year-old Harish Rana, who has been in a vegetative state since August 2013, Justice JB Pardiwalah began his judgment with a quote from Hamlet: "The famous Shakespearean dilemma of "to be, or not to be", which had so far remained as a literary quote, is now being used for judicial interpretation to canvass the liberty to die."
Ghaziabad native Harish Rana, who was a student of Panjab University, suffered head injuries after falling from the fourth floor of his paying guest accommodation in 2013 and has been in vegetative state for over a decade.
While allowing the plea in the case of Harish Rana, the court reiterated that protecting dignity at the end of life is intrinsic to the constitutional right to life, encompassing a death "sans pain, sans suffering and, most importantly, sans indignity".
Evolution Of Indian euthanasia jurisprudence From Shanbaug to Harish Rana - Timeline of Events
2011- Supreme Court Recognises Euthanasia
The top court for the first time recognised passive euthanasia in Aruna Shanbaug's case.
Although the case of Aruna Shanbaug first brought the issue of mercy killing into national focus, the Supreme Court did not permit passive euthanasia for her as the petition for her was moved by a journalist and not her immediate friend or relative (which the court held should be the hospital taking care of her).
2018 - Right To Die With Dignity & Detailed Guidelines from Supreme Court
A proper legal framework was evolved later in 2018, when a Constitution Bench in the Common Cause v/s Union of India case laid down detailed guidelines permitting passive euthanasia and recognising living wills.
The court distinguished between active euthanasia - a direct intervention to intentionally cause death, which remains illegal without legislation - and passive euthanasia, which involves withdrawing or withholding life-sustaining treatment.
Active euthanasia would be illegal unless there is valid legislation permitting it, the then CJI Dipak Misra had opined.
Drawing on precedents such as the US Supreme Court's Vacco v Quill and its own ruling in Gian Kaur v State of Punjab, the court held that Article 21's guarantee of life includes the right to live with dignity, which extends to a dignified end of life.
It concluded that a terminally ill patient or one in a persistent vegetative state may choose to accelerate the natural process of death by refusing life support.
2023 Modification to Guidelines
In 2023, the five-judge bench again modified the 2018 guidelines making the process less stringent by introducing timelines for medical boards and limits on the magistrate's role, making the framework more workable.
The top court held that court mandated framework primarily places responsibility on the treating physician and hospital-constituted medical boards.
The court said that Judicial intervention is envisaged only in limited situations - such as when the primary medical board refuses withdrawal of treatment or when the secondary board disagrees with the primary board's opinion.
In such cases, the patient's nominee, family member, treating doctor, or hospital staff may approach the High Courts under Article 226 of the Constitution.
The top court also reiterated that if the treating physician or hospital fails to initiate the process or constitute the required medical boards despite the patient meeting the necessary medical conditions, the patient's next of kin or guardian may similarly seek directions from the High Court to ensure the procedure under the guidelines is followed.
2026 Harish Rana Case - Court Flags "legislative inaction", Streamlines Guidelines for Passive Euthanasia
While allowing the first ever case of passive euthanasia to go through, the court today urged the Centre to bring in a law to regulate passive euthanasia.
"There are moments when legislative inaction speaks more loudly than legislative action, and the absence of regulation with regard to the issue at hand presents one such instance," the court observed.
Issuing guidelines to streamline passive euthanasia, the Supreme Court emphasised the central role of the patient's next of kin or guardian, whose written consent represents the patient's presumed wishes where the patient lacks decision-making capacity.
The court mandated that in cases where treatment is primarily being provided at home, family members have to admit the patient to a hospital of their choice or approach a hospital to designate a treating physician who can initiate the process of passive euthanasia.
The court said that to avoid delays, Chief Medical Officers of districts must maintain a panel of registered doctors and nominate a member for the secondary medical board, preferably within 48 hours of a hospital's request.
If the hospital or treating doctor fails to begin the process despite the patient meeting the medical criteria, the family may approach the relevant High Courts.
Even after both medical boards agree to withdraw or withhold life-sustaining treatment, the decision will take effect only after a 30-day reconsideration period, allowing any aggrieved person to challenge the decision in court, while emphasising that courts should exercise restraint in disturbing a carefully concluded medical process.
Need For Timely Legal Recourse For Family
Acknowledging the painful dilemma of the family of such patients, the Supreme Court's intervention over the years has reflected an endeavour to lessen the sufferings of the family.
"To love someone is to care for them not just in times of joy, but in their saddest and darkest hours. It is to care for them even when the horizon is devoid of hope. It is to stand by them as they prepare to cross the threshold into the beyond. Ultimately, to love is nothing but to care deeply, softly, and endlessly. Our decision today does not neatly fit within logic and reason alone. It sits in a space between love, loss, medicine and mercy. This decision is not about choosing death, but is rather one of not artificially prolonging life," the court said while concluding judgment.
