Some court judgments resolve legal disputes. Others expose the limits of law itself. A recent ruling of the Karnataka High Court in H vs Chief Secretary to Government & Anr (2026:KHC:29765) belongs firmly in the latter category.
Faced with an emotionally fraught petition, Justice Suraj Govindaraj was called upon to weigh competing constitutional values that rarely sit comfortably together—bodily autonomy, reproductive rights, medical necessity, dignity and the overwhelming realities of lifelong caregiving.
At the centre of the case was a 23-year-old woman living with profound intellectual and developmental disabilities. Diagnosed with Global Developmental Delay, moderate intellectual disability, cerebral palsy and a seizure disorder, she was found by a medical board to lack the cognitive capacity to understand the nature or consequences of a Total Abdominal Hysterectomy. In legal terms, informed consent was impossible.
Her ageing parents, who had cared for her throughout her life, approached the court seeking permission for the procedure after repeated infections, recurrent fevers and serious health complications linked to her inability to manage menstrual hygiene independently.
The High Court granted permission. But far from treating the matter as routine, it rooted its decision in a carefully constructed “best interests” analysis, relying on expert medical opinion and focusing squarely on the woman’s dignity, health and long-term welfare.
The judgment does not dilute the constitutional importance of bodily autonomy. Rather, it recognises that autonomy itself becomes difficult to apply where a person lacks the ability to exercise informed choice. In such exceptional situations, courts are left to navigate the uneasy territory between protecting rights and preventing harm.
That tension has long occupied Indian constitutional jurisprudence.
In Suchita Srivastava vs Chandigarh Administration (2009), the Supreme Court unequivocally recognised reproductive choice as an integral component of personal liberty under Article 21. Crucially, it held that women with intellectual disabilities are not excluded from this guarantee. But it also acknowledged that where decision-making capacity is impaired, the exercise of those rights demands a more nuanced and protective framework.
The Court strengthened that principle in Devika Biswas vs Union of India (2016), condemning coercive sterilisation and emphasising that reproductive decisions must always be voluntary and informed.
Yet, cases like the present one reveal the limitations of an autonomy-centred approach when consent itself is structurally unattainable.
The challenge, then, is not whether autonomy matters—it unquestionably does—but how the law protects dignity when autonomy cannot be meaningfully exercised.
The Supreme Court offered further guidance in Dr Narendra Gupta vs Union of India (2023), cautioning that invasive medical procedures cannot be justified merely for convenience or administrative ease. Medical necessity, it said, must be clearly established.
That principle echoes the landmark Aruna Ramachandra Shanbaug judgment of 2011, where the Supreme Court evolved the “best interests” doctrine for incapacitated patients. In the absence of consent, judicial scrutiny, independent medical expertise and strict procedural safeguards become indispensable.
The Karnataka High Court appears to have followed precisely that path. Rather than substituting convenience for consent, it anchored its reasoning in medical evidence, expert opinion and the patient’s welfare. Yet, the judgment also exposes significant gaps in India’s disability law.
The Rights of Persons with Disabilities Act, 2016, recognises the legal capacity of persons with disabilities and strongly endorses supported decision-making over substituted consent. What it does not provide, however, is a clear statutory framework governing irreversible medical procedures such as hysterectomies or sterilisation. As a result, judges are frequently required to create safeguards through judicial interpretation instead of applying comprehensive legislation.
Courts have repeatedly warned against normalising such interventions. The Madras High Court, in V Krishnan vs State of Tamil Nadu (2019), cautioned against routine hysterectomies for women with intellectual disabilities, insisting that every case must undergo rigorous scrutiny. Likewise, in a series of decisions in X vs Union of India, the Supreme Court has consistently prioritised dignity, health and individual circumstances over administrative convenience. The result is a body of jurisprudence that is principled but fragmented—guided more by case law than by comprehensive legislation.
The legal questions become even more difficult when women with intellectual disabilities become pregnant following sexual assault.
Indian criminal law treats such pregnancies as consequences of a grave offence, while the Medical Termination of Pregnancy Act permits termination in appropriate circumstances, including guardian consent where the woman lacks decision-making capacity. In decisions such as X vs Union of India (2016) and Meera Santosh Pal vs Union of India (2017), the Supreme Court has even permitted medical termination beyond statutory limits where continuation of pregnancy would seriously endanger the woman’s physical or mental health.
Across these diverse cases, one principle consistently emerges: the woman’s best interests—not social convenience or institutional efficiency—must remain paramount.
Perhaps the most overlooked dimension of the Karnataka judgment, however, lies beyond the courtroom altogether. Behind every legal debate on disability stands an invisible network of caregivers—most often ageing parents—who shoulder extraordinary physical, emotional and financial burdens with minimal institutional support. While constitutional rights are extensively articulated, far less attention has been paid to the State’s continuing responsibility once families are no longer able to provide care.
The Constitution itself points in that direction. The Directive Principles urge the State to promote welfare, protect vulnerable citizens and provide assistance in cases of disability. Existing legislation, including the National Trust Act, offers guardianship mechanisms and schemes such as Gharaunda and Niramaya, while the Deendayal Disabled Rehabilitation Scheme supports organisations working in this space. State governments also provide pensions and rehabilitation programmes.
Yet, these initiatives remain uneven, fragmented and often inadequate for ensuring lifelong care.
The Supreme Court underscored this broader obligation in Jeeja Ghosh vs Union of India (2016), affirming that dignity is not merely aspirational, but an enforceable constitutional right requiring active State intervention. The Karnataka case illustrates why that principle now demands far greater institutional expression.
India urgently needs a comprehensive care architecture—assisted living facilities, long-term residential support, monitored guardianship systems and sustained public investment that does not leave families to shoulder the burden alone. Without such structures, courts will continue to confront impossible choices that legislation should already have anticipated.
The judgment also highlights the need for statutory reform. Clear legal safeguards for irreversible procedures could include mandatory certification by independent medical boards, judicial or quasi-judicial oversight, objective standards for establishing medical necessity and documented consideration of less invasive alternatives. Equally important is formally recognising caregivers as stakeholders entitled to meaningful State support rather than treating their sacrifices as an unspoken social expectation.
Ultimately, the Karnataka High Court’s ruling is not an endorsement of unrestricted medical intervention. It is an acknowledgement of the law’s limitations when confronted with profound vulnerability and impossible choices.
More importantly, it shifts the debate beyond a single medical procedure. The real question is not whether this one decision was justified. It is whether India can move beyond case-by-case judicial intervention and build a legal and social framework that protects both autonomy and dependency with equal seriousness.
Because when consent is impossible and care is lifelong, justice cannot end with a court order.
—The writer is a New Delhi-based journalist, lawyer and trained mediator
The post When Care and Consent Collide appeared first on India Legal.