Harish Rana was once a 18 year-old engineering student with the easy confidence of youth and the promise of a long life ahead. A tragic fall from the fourth floor of a building changed everything. Doctors managed to save his life, but not his brain. For the past 13 years, Harish has remained trapped in a body that breathes but does not live. The lives of his parents have been consumed by an exhausting cycle of caregiving, emotional anguish, financial burden and helplessness. This forced his family, and then the courts, to confront one of the most difficult ethical questions of modern medicine: Are we extending his life or merely postponing his inevitable death? What does dignity demand?
The Supreme Court of India has already recognised the right to die with dignity in the landmark Common Cause judgment. Yet, the Delhi High Court rejected Harish’s parents’ petition to allow him to pass away. The Court observed that earlier rulings on passive euthanasia largely concerned patients who were kept alive through life-support systems such as ventilators, dialysis or heart-lung machines. Harish, however, was not dependent on such equipment.
The Supreme Court directed the constitution of two independent medical boards to examine his condition. Both boards concluded unequivocally that there was no chance of meaningful neurological recovery.
Still, a difficult legal question remained unresolved. Withdrawal of medical support such as a ventilator is one thing; withholding artificial feeding is another. Would withholding feeding amount to active euthanasia? If so, it would be illegal in India.
After a long wait, the judgment was delivered, fortunately, in favour of Harish and his parents.
Harish may soon be gone. But his story will live on in the minds of countless families who face — or may one day face — similar situations caused by devastating neurological injuries, advanced age, or conditions such as Alzheimer’s or terminal illnesses such as cancer.
This case is likely to have a lasting impact on medical ethics and end-of-life decision-making in India. Even today, the Code of Medical Ethics considers euthanasia — except in cases of brain death for organ donation — to be an “unethical act”. In a public interest litigation that I filed before the Bombay High Court, I highlighted this contradiction between evolving constitutional principles and outdated ethical guidelines. In April 2024, the High Court directed the National Medical Commission to examine the issue; yet, those directions have still not been implemented. The Supreme Court’s order in the Harish Rana case will now push medical regulators to adopt a more humane and practical understanding of passive euthanasia.
The case also exposes serious gaps in the implementation of the Common Cause guidelines. Harish’s parents must have had to approach the courts because they had no practical way to access a medical board. Under the Common Cause framework, the responsibility of setting up such boards lies with the hospital in which the patient is admitted. But Harish was being cared for at home.
Furthermore, the guidelines require one doctor on the board to represent the district’s chief medical officer. In my PIL, I had urged the Court to direct the state to create panels of such doctors in every district. Unfortunately, most states have not acted on this requirement.
The Harish Rana case also highlights the importance of living wills, or advanced medical directives. A living will is a document in which an individual records his or her wishes regarding medical interventions such as ventilators, dialysis, feeding tubes or other invasive procedures in the event of serious and irreversible illness. Such directives can guide both doctors and family members when the patient is unable to communicate.
Expecting a healthy 24-year-old Harish to create such a document would have been unrealistic. But, hypothetically, if such a directive had existed, the legal and ethical dilemma might have been far easier to resolve.
After the Supreme Court clarified the law on living wills in 2023, I prepared my own advance directive. Yet I could not find a custodian in Mumbai because the state had not appointed one. Following directions in my PIL, the Maharashtra government finally appointed 413 custodians in March 2024. To my knowledge, very few other states — except Goa — have taken similar steps.
To talk about death remains a taboo in India. Many elders assume their families will automatically make the right decisions when difficult medical questions arise. In reality, such situations often lead to confusion, disagreement, emotional distress and enormous financial strain. Clear written instructions in the form of a living will can spare families this suffering and ensure that the patient’s own wishes remain central.
Without widespread awareness of living wills, reform of medical ethics around end-of-life care, accessible palliative care and an administrative system that allows families to seek timely medical review, the constitutional right to die with dignity will remain largely theoretical.
For 13 years, Harish Rana’s life has been suspended between biology and humanity filled with unimaginable suffering. If this case helps India to speak more openly about death, encourages people to write living wills, and pushes institutions to act with compassion, then Harish’s silent death will leave behind a powerful legacy.
Nikhil Datar is a senior obstetrician-gynaecologist. The views expressed are personal
