In 1975, James Rachels argued in The New England Journal of Medicine that the moral distinction between active and passive euthanasia cannot be sustained. The doctrine rests on what philosophers call the acts/omissions distinction. It holds that there is a moral difference between killing a patient and letting one die. Rachels showed that this difference collapses once you hold all other variables constant. The essay became one of the most cited in bioethics. A 2024 assessment in the journal, Bioethics, marking 50 years of the debate, found that while responses to Rachels abound, the distinction remains philosophically unstable. In 2011, the Canadian philosopher, L.W. Sumner, consolidated the argument. In the book, Assisted Death, Sumner concluded that no bright line can be drawn between assisted death and the withdrawal of treatment. What matters is not whether the physician acts or omits to act. What matters is the intention, the clinical context, and the patient’s interests.
India’s entire end-of-life legal architecture is built on precisely this distinction. From Aruna Shanbaug (2011) through Common Cause (2018) to the 2023 simplification of guidelines, Indian courts have permitted ‘passive euthanasia’ while prohibiting the active variety. The phrase is itself an oxymoron: euthanasia denotes the deliberate bringing about of death, while ‘passive’ denotes the absence of action. The Supreme Court acknowledged this in Harish Rana vs Union of India (2026), calling the term a misnomer. The health ministry’s 2024 draft guidelines avoid it entirely. Yet, the procedural framework built under the old terminology persists. Harish Rana, in a vegetative state since 2013, died at AIIMS in March 2026. His family had to litigate across two courts, secure two medical board assessments, and await a 286-page judgment before treatment could be withdrawn. The Delhi High Court had dismissed the plea in 2024, reasoning that the patient was not on a ventilator and was therefore not terminally ill. It treated tube withdrawal as tantamount to starvation.
It is worth examining what is happening in Britain. Not because Indian law should mimic English law, but because Britain is conducting two debates that bear directly on India’s predicament. Each offers a distinct lesson.
The first concerns withdrawal of treatment. In Airedale NHS Trust vs Bland (1993), the House of Lords required court approval before withdrawing nutrition and hydration from a vegetative state patient. For 25 years, hospitals sought judicial approval. Then, in NHS Trust vs Y (2018), the UK Supreme Court held that court authorisation is no longer mandatory. Where clinicians and family agree that treatment is not in the patient’s best interests, the decision rests with them. The Mental Capacity Act 2005 provides the statutory framework. Courts remain available for contested cases. The default is clinical governance.
The second debate is more striking. In October 2024, Kim Leadbeater introduced the Terminally Ill Adults (End of Life) Bill as a private member’s bill. It proposes to legalise assisted dying for adults with six months or less to live. It passed the House of Commons in June 2025 by 314 votes to 291. It is now before the House of Lords, where over 1,200 amendments have been tabled. The government has said no further parliamentary time will be made available. The Bill is almost certain to fall when the current session ends in May. But the arguments produced during its scrutiny stand on their own merits.
The Bill originally required high court approval for every assisted death. Leadbeater called this the strictest safeguard in the world. She had earlier assured The Times she would not remove the provision. She reversed her position after hearing expert evidence. In March 2025, the committee voted 15 to 7 to remove it, with Leadbeater herself voting in favour.
It was replaced with multidisciplinary expert panels comprising a senior lawyer, a psychiatrist, and a social worker. Retired judges called judicial sign-off unnecessary and undesirable. Courts, they argued, lack the capacity and the expertise. The decision was contested. Some MPs reversed their support. But the reasoning was clear: for decisions that turn on clinical judgment, medical capacity, and the risk of coercion, courts are the wrong forum.
The broader British debate has sharpened these questions. A 2025 article in ScienceDirect asked whether withdrawal of treatment is really different from assisted dying. It concluded that the ethical distinctions centre on interpretation rather than principle. The British Journal of Anaesthesia carried an extended exchange through 2024 and 2025 on whether physicians should participate in assisted dying at all. Baroness Finlay, writing in Palliative Medicine, argued that the Leadbeater Bill is silent on pain and suffering, and that palliative care must come first. Across four independent surveys, between 75%-85% of palliative care physicians oppose the Bill. The Times, in an editorial on March 26, called the legislation dangerously flawed. Public opinion runs the other way: a 2024 British Social Attitudes survey found 79% support for assisted dying in terminal illness. These are serious and divided arguments. But they are arguments within a system that has already moved withdrawal of treatment out of the courtroom. India has not taken even that first step.
The anomaly is stark. Britain is debating whether to remove judicial oversight for the deliberate ending of a life. India still requires it for withdrawing a feeding tube from a patient in an irreversible vegetative state. A multidisciplinary panel of the kind debated in Britain would not have made the error made by the Delhi High Court. The expertise required is medical and ethical, not judicial.
The Supreme Court in Harish Rana urged Parliament to legislate. The 241st Law Commission Report (2012), titled Passive Euthanasia: A Relook, recommended the same. What is needed is a statute that does for India what the Mental Capacity Act 2005 did for England. It should embed withdrawal decisions in clinical governance. It should create statutory panels at the district level. It should reserve courts for contested cases. And it should include safeguards against coercion, including independent social work assessments. The infrastructure is not wholly absent. Common Cause already provides for medical boards. The Rana judgment directed district CMOs to maintain practitioner panels. What is missing is the statute that converts judicial directions into a clinical framework.
The vocabulary has changed. The Supreme Court has called the phrase a misnomer. The health ministry has dropped it. The architecture has not followed. The right to withdraw futile treatment exists in principle. In practice, it demands the resources to litigate to the Supreme Court. A statute that places withdrawal decisions where they belong, with clinicians, families, and expert panels, would convert a judicial privilege into a clinical right. That is what the British experience teaches. That is what the scholarship has long demanded. And that is what the Harish Rana judgment, for all its length, has left for Parliament to do.
V. Venkatesan is a senior legal journalist and researcher