The Supreme Court on Wednesday permitted the withdrawal of life support to a 32-year-old man who has been in a permanent vegetative state for 13 years, in a first-ever court order allowing passive euthanasia in the country.

A bench of Justices J.B. Pardiwala and K.V. Viswanathan, in a 338-page judgment, asked AIIMS Delhi to shift Harish Rana from his house to the institute for withdrawal of life support, including clinically assisted nutrition and hydration (CANH), and directed the Centre to come out with legislation to deal with such cases.

The apex court passed the direction while allowing the appeal filed by Rana’s family seeking passive euthanasia in accordance with the guidelines issued by a five-judge constitution bench in the Common Cause Vs UoI case in 2018 concerning terminally ill patients or those in a permanent vegetative state.

The 2018 judgment stated that any decision for passive euthanasia should be approved by a “primary medical board” and by a “secondary medical board” after consultations with family members of the patient.

“In the facts and circumstances of the present case, we record our satisfaction that the twin legal requirements for the withdrawal and withholding of medical treatment have been unequivocally met. First, it is established that the CANH currently being administered to the applicant constitutes ‘medical treatment’.

“Secondly, it has been conclusively determined that the continued administration of the same is no longer in the ‘best interests’ of the applicant. In light of the unanimous consensus arrived at by the parents/next of kin and the constituted medical boards respectively, we are of the opinion that the medical treatment ought not to be prolonged any further,” the bench said in two separate but concurring judgments while referring to the practice adopted in countries such as the US, Australia, Italy and New Zealand.

Passive euthanasia involves the withdrawal of an artificial life support system unlike active euthanasia, where a patient is administered a lethal injection, which is not permissible in India.

“The respondent no. 2/AIIMS shall grant admission to the applicant in its palliative care department so that the withdrawal and/or withholding of the applicant’s medical treatment, including CANH, can be given effect to. For this purpose, respondent no. 2/AIIMS shall provide all necessary facilities for shifting the applicant from his residence to the said palliative care department,” the bench said.

The bench directed AIIMS to ensure that such withdrawal and/or withholding of medical support is carried out through a robust palliative and end-of-life care plan specifically tailored to manage symptoms without causing discomfort to the patient and preserve his dignity.

The court said the medical fraternity was competent to take a decision instead of seeking judicial permission for cases requiring passive euthanasia.

The bench asked high courts to issue appropriate directions to all judicial magistrates of first class (JMFC) to receive intimations from the hospitals, in accordance with the guidelines laid down in the Common Cause case, when primary and secondary medical boards are unanimous in their decision to withdraw medical care of any patient. This will ensure legal compliance in end-of-life decisions.

Rana was 20 and pursuing a BTech degree at Punjab University when he fell from the fourth floor of his paying guest accommodation on August 20, 2013, suffering a head injury.

Since then, he had undergone tracheostomy, had to use a catheter and had CANH administered through the PEG (percutaneous endoscopic gastrostomy) tube.

He has sleep-wake cycles and sleeps through the night. His eyes blink normally but have no purposeful movement as a response to auditory, verbal, tactile or painful stimuli.

Rana has suffered painful bedsores and is in a persistent vegetative state (PVS) with complete sensorimotor dysfunction and 100 per cent permanent physical impairment.

“The medical considerations in the present case admit of no ambiguity. The treatment being administered to the applicant has become prolonged, futile, and offers no hope of recovery. The applicant has remained in a PVS for over 13 years, with irreversible and non-progressive brain damage, and the continuation of CANH serves only to sustain biological existence without any prospect of cognitive recovery or improvement in condition,” the top court observed.

Larger interest: Dad

Ashok Rana, Harish’s father, said the court order would not bring any personal benefit to the family but in the larger public interest, the decision could help others facing similar situations. “As a father, it is extremely painful. No parent would ever want to see their son in such a condition,” he said.