The Supreme Court on Thursday reserved judgment on a petition seeking judicial authorisation for the withdrawal of life-sustaining treatment in the case of a 32-year-old man who has remained in an irreversible permanent vegetative state for more than 12 years following a fall from a building.
The Bench of Justice JB Pardiwala and Justice KV Viswanathan was hearing a miscellaneous application filed by the patient’s father, invoking the settled constitutional jurisprudence on passive euthanasia and the right to die with dignity as an intrinsic facet of the right to life guaranteed under Article 21 of the Constitution. The application sought permission to discontinue all life-prolonging medical interventions presently sustaining the patient.
The adjudication was situated within the legal framework laid down by the Constitution Bench in Common Cause (A Regd.) v. Union of India (2018) 5 SCC 1, as subsequently refined through procedural directions issued in January 2023. These guidelines prescribe a calibrated, multi-layered decision-making process requiring evaluation by duly constituted Primary and Secondary Medical Boards before a court may consider permitting withdrawal of life support in cases involving terminal illness or permanent vegetative states. It was submitted that the prescribed protocol had been fully complied with in the present matter.
The Court was informed that both medical boards, constituted pursuant to its directions, had returned concurrent findings that the patient’s neurological condition was irreversible and that there existed no realistic prospect of recovery.
The Counsel for the petitioner traced the doctrinal evolution of Indian end-of-life jurisprudence, commencing with Gian Kaur v. State of Punjab (1996) 2 SCC 648, proceeding through Aruna Ramachandra Shanbaug v. Union of India (2011) 4 SCC 454, and culminating in Common Cause, wherein the Supreme Court conclusively recognised that the right to life encompasses the right to die with dignity and affirmed the permissibility of passive euthanasia subject to stringent procedural safeguards.
Reliance was placed on the common cause directives to submit that where the opinions of the Primary and Secondary Medical Boards are concurrent, the process ordinarily attains finality, barring exceptional circumstances of divergence necessitating reference to the High Court and constitution of a further expert panel.
The petitioner also pressed for systemic institutional reforms, advocating the creation of standing panels or rosters of medical specialists in government hospitals to facilitate the timely constitution of medical boards, given the humanitarian urgency and clinical sensitivity inherent in such cases. Reference was made to measures undertaken by Goa, Maharashtra and Karnataka in this regard. The substantive relief sought was the withdrawal of clinically assisted nutrition and hydration, to be implemented in accordance with recognised palliative care protocols and under strict medical supervision at the Institute of Human Behaviour and Allied Sciences, Government of NCT of Delhi.
During the hearing, the Bench examined earlier observations of the Delhi High Court suggesting that the patient was not being mechanically sustained and was capable of independent physiological survival. It was contended for the petitioner that such observations were made in the absence of a definitive medical assessment and did not accurately reflect the patient’s clinical condition.
The Counsel appearing for the Union of India broadly concurred with the medical assessment that the patient was in a permanent vegetative state with no possibility of recovery. It was further pointed out that, notwithstanding the authoritative pronouncement in Common Cause, there appeared to be no reported instance of its directions having been fully applied in judicial practice, underscoring the precedential importance of the present case. The Centre emphasised that the informed and considered views of caregivers and family members must be accorded substantial weight, consistent with the doctrine of best interests.
On the issue of legal permissibility, it was reiterated that passive euthanasia, characterised by omission rather than commission, was constitutionally and legally sustainable, provided that death results from the underlying medical condition and not from any affirmative act attributable to medical intervention. A comparative reference was made to Aruna Shanbaug, noting that in that case the caregiving nursing staff opposed withdrawal of life support, and that the patient demonstrated limited responses to external stimuli—features absent in the present case.
In compliance with earlier directions of the Court, the Primary Medical Board reported that the patient was bedridden, dependent on a tracheostomy for respiration and a gastrostomy for nutrition, and had developed extensive pressure sores, with recovery assessed as clinically implausible. A Secondary Medical Board constituted by the All India Institute of Medical Sciences arrived at a similar conclusion. Upon consideration of these findings, the Bench underscored the gravity of the situation and indicated its intention to interact personally with the patient’s parents before rendering a final decision.
The present application arose in the context of earlier proceedings in which the petitioner had approached the Supreme Court in 2024 after the Delhi High Court declined to direct the constitution of a medical board. While substantive relief was initially declined, the State of Uttar Pradesh had undertaken to bear the cost of continued medical treatment. The instant application was subsequently filed, citing further deterioration in the patient’s condition and the absence of any therapeutic response.
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