The Last Choice: Should Every Indian Have the Right to Dignified Death?
A man lay still in a Delhi hospital bed for 12 years. His parents sat beside him, waiting for a system that didn’t quite know what to do with them.
Harish Rana was 32 years old when he fell from his balcony.
That fall didn’t kill him.
What it left behind was a body kept alive by machines and tubes — breathing, technically, but absent in every way that matters to those who loved him. For over twelve years, his parents watched their son persist in what doctors call a Persistent Vegetative State (PVS) — a condition where a person has lost all awareness and higher brain function, but the body continues its mechanical rhythms with medical assistance.
There are no conversations. No moments of recognition. Just the quiet hum of equipment, and a family slowly breaking apart under the weight of a question no one was willing to officially answer: Is this still living?
The Question Nobody Wanted to Ask
On March 11, 2026, India’s Supreme Court stepped into that question — and reframed it in a way that changed everything.
The court didn’t ask: Should Harish Rana be allowed to die?
It asked something subtler, and far more important: Is it in Harish Rana’s best interests to keep prolonging this existence?
That shift in framing — from the morality of death to the legitimacy of artificially prolonged life — is simple yet legally profound. It moves the conversation away from the uncomfortable territory of “letting someone die” and toward something more grounded: the question of dignity.
The Tube
To understand what the court was dealing with, you need to understand one acronym: CANH.
CANH stands for Clinically-Assisted Nutrition and Hydration — essentially, feeding and hydrating a patient through a tube when they cannot eat or drink on their own. For years, hospitals and courts treated CANH as “basic care” — like keeping someone warm or clean — rather than as a medical treatment. That distinction matters enormously, because if it’s just “care,” you can’t legally withdraw it. If it’s “treatment,” a patient (or their family, or a court) may have the right to refuse or stop it.
Rana’s family had first approached the Delhi High Court, which said CANH was not medical treatment and therefore couldn’t be withdrawn. A Supreme Court petition also failed. The family was trapped in a legal no-man’s-land.
Then they reframed the argument — asking the court to simply declare whether CANH is treatment.
It was a small tactical shift. It opened a door that had been shut for over a decade.
A Right That Was Already There
India’s Supreme Court had actually grappled with this question before — back in 2018, in a landmark case called Common Cause vs. Union of India.
That judgment established something quietly revolutionary: that Article 21 of the Indian Constitution — which guarantees the Right to Life — also includes the right to live with dignity, and therefore the right to refuse an undignified existence.
-
Passive Euthanasia — Passive euthanasia means withdrawing or withholding medical treatment to allow natural death, rather than administering something to end life. Think of it as removing the machines, not adding a lethal dose.
-
Living Wills (Advance Medical Directives) — A document you write while you are healthy and conscious, telling doctors and family what you want (or don’t want) done if you ever lose the ability to decide for yourself. Like a will for your future medical care.
But there was a catch: Parliament never passed a law to actually implement these rights. The Supreme Court had to step in using Article 142 — a special constitutional power that lets the court pass orders to do “complete justice” when the law has gaps — to lay down interim guidelines.
Eight years later, Parliament still hasn’t acted.
What the Court Decided — And Why It Matters
In the Harish Rana case, the Supreme Court did several things at once.
First, it definitively ruled that CANH is a medical treatment — not just basic care. This one declaration cuts through years of ambiguity. It means tube-feeding can be legally assessed, questioned, and — in appropriate cases — withdrawn.
Second, it convened medical boards that met with doctors, the family, and legal counsel, all of whom confirmed: Rana had no realistic prospect of recovery. The court ruled that withdrawing CANH was in his best interests.
Third — and this is crucial — it clarified that stopping treatment does not mean abandoning the patient. It is a transition: from aggressive, curative intervention to palliative care — a gentler, comfort-focused approach that manages pain and ensures dignity in the final phase of life.
Two Pathways to Dignity
The court confirmed what Common Cause had mapped out: there are two routes for end-of-life decisions in India.
1: The Living Will
You are conscious and well. You write a document saying: If I ever fall into a permanent vegetative state with no hope of recovery, I do not wish to be kept alive on machines. You name someone you trust to speak for you. This is your autonomy — your personal liberty extended into the future.
2: No Will Exists
If there is no living will, the decision doesn’t fall to one doctor or one family member’s panic. It must go through a structured process — medical boards, institutional oversight, documented safeguards — to determine what is genuinely in the patient’s best interest. The idea is that the absence of a prior choice should never lead to arbitrariness or exploitation.
The Problem Money Creates
What happens when a family wants to continue treatment but simply cannot afford it?
The fear is this: a decision that is supposed to be made on the basis of the patient’s dignity and best interests may, in reality, be made because the family’s savings have run out. Economic exhaustion can masquerade as a principled choice. The court directed that Rana be transferred to a government hospital — but government hospitals are already stretched thin, and the number of patients needing long-term palliative care is growing as India’s population ages and chronic illnesses rise.
What a Law Could Do That Courts Cannot
The Supreme Court has done something remarkable. Over eight years and two landmark cases, it has built a workable legal framework for end-of-life decisions in a country of 1.4 billion people — without a single act of Parliament.
But here’s the thing about courts: they decide cases. They cannot design systems.
Every family that ends up where the Ranas did — lost in procedural uncertainty, hospital refusals, and appeal after appeal — is paying the price for Parliament’s silence. A comprehensive law could:
-
Establish clear, accessible procedures that families can follow without going to court
-
Define which institutions are responsible for what
-
Build a living will registry — a national system where your advance directives are stored, retrievable, and legally binding
-
Set safeguards against misuse (ensuring that no one is pressured into withdrawing care for the wrong reasons)
-
Fund professional training so doctors and hospitals understand and apply these rights consistently
Countries like the Netherlands, Belgium, Canada, and Spain have already enacted detailed laws. They each took different approaches — different eligibility rules, different oversight bodies — but they all made the same fundamental choice: to treat this as a matter of public policy, not just judicial improvisation.
India doesn’t need to copy any of them. But it does need to do something.
Conclusion
The Constitution has been interpreted. The right has been recognised. The framework has been laid down by the highest court in the land.
Harish Rana’s story is not just about one man and one family in Delhi. It is about every person in India who might one day lie in a hospital bed, unable to speak, while the people who love them navigate a system that was never designed to handle this moment with grace.
That system needs a law. And Parliament needs to write it.
Receive Daily Updates
Recent Posts
Petrol in India is cheaper than in countries like Hong Kong, Germany and the UK but costlier than in China, Brazil, Japan, the US, Russia, Pakistan and Sri Lanka, a Bank of Baroda Economics Research report showed.
Rising fuel prices in India have led to considerable debate on which government, state or central, should be lowering their taxes to keep prices under control.
The rise in fuel prices is mainly due to the global price of crude oil (raw material for making petrol and diesel) going up. Further, a stronger dollar has added to the cost of crude oil.
Amongst comparable countries (per capita wise), prices in India are higher than those in Vietnam, Kenya, Ukraine, Bangladesh, Nepal, Pakistan, Sri Lanka, and Venezuela. Countries that are major oil producers have much lower prices.
In the report, the Philippines has a comparable petrol price but has a per capita income higher than India by over 50 per cent.
Countries which have a lower per capita income like Kenya, Bangladesh, Nepal, Pakistan, and Venezuela have much lower prices of petrol and hence are impacted less than India.
“Therefore there is still a strong case for the government to consider lowering the taxes on fuel to protect the interest of the people,” the report argued.
India is the world’s third-biggest oil consuming and importing nation. It imports 85 per cent of its oil needs and so prices retail fuel at import parity rates.
With the global surge in energy prices, the cost of producing petrol, diesel and other petroleum products also went up for oil companies in India.
They raised petrol and diesel prices by Rs 10 a litre in just over a fortnight beginning March 22 but hit a pause button soon after as the move faced criticism and the opposition parties asked the government to cut taxes instead.
India imports most of its oil from a group of countries called the ‘OPEC +’ (i.e, Iran, Iraq, Saudi Arabia, Venezuela, Kuwait, United Arab Emirates, Russia, etc), which produces 40% of the world’s crude oil.
As they have the power to dictate fuel supply and prices, their decision of limiting the global supply reduces supply in India, thus raising prices
The government charges about 167% tax (excise) on petrol and 129% on diesel as compared to US (20%), UK (62%), Italy and Germany (65%).
The abominable excise duty is 2/3rd of the cost, and the base price, dealer commission and freight form the rest.
Here is an approximate break-up (in Rs):
a)Base Price | 39 |
b)Freight | 0.34 |
c) Price Charged to Dealers = (a+b) | 39.34 |
d) Excise Duty | 40.17 |
e) Dealer Commission | 4.68 |
f) VAT | 25.35 |
g) Retail Selling Price | 109.54 |
Looked closely, much of the cost of petrol and diesel is due to higher tax rate by govt, specifically excise duty.
So the question is why government is not reducing the prices ?
India, being a developing country, it does require gigantic amount of funding for its infrastructure projects as well as welfare schemes.
However, we as a society is yet to be tax-compliant. Many people evade the direct tax and that’s the reason why govt’s hands are tied. Govt. needs the money to fund various programs and at the same time it is not generating enough revenue from direct taxes.
That’s the reason why, govt is bumping up its revenue through higher indirect taxes such as GST or excise duty as in the case of petrol and diesel.
Direct taxes are progressive as it taxes according to an individuals’ income however indirect tax such as excise duty or GST are regressive in the sense that the poorest of the poor and richest of the rich have to pay the same amount.
Does not matter, if you are an auto-driver or owner of a Mercedes, end of the day both pay the same price for petrol/diesel-that’s why it is regressive in nature.
But unlike direct tax where tax evasion is rampant, indirect tax can not be evaded due to their very nature and as long as huge no of Indians keep evading direct taxes, indirect tax such as excise duty will be difficult for the govt to reduce, because it may reduce the revenue and hamper may programs of the govt.
Globally, around 80% of wastewater flows back into the ecosystem without being treated or reused, according to the United Nations.
This can pose a significant environmental and health threat.
In the absence of cost-effective, sustainable, disruptive water management solutions, about 70% of sewage is discharged untreated into India’s water bodies.
A staggering 21% of diseases are caused by contaminated water in India, according to the World Bank, and one in five children die before their fifth birthday because of poor sanitation and hygiene conditions, according to Startup India.
As we confront these public health challenges emerging out of environmental concerns, expanding the scope of public health/environmental engineering science becomes pivotal.
For India to achieve its sustainable development goals of clean water and sanitation and to address the growing demands for water consumption and preservation of both surface water bodies and groundwater resources, it is essential to find and implement innovative ways of treating wastewater.
It is in this context why the specialised cadre of public health engineers, also known as sanitation engineers or environmental engineers, is best suited to provide the growing urban and rural water supply and to manage solid waste and wastewater.
Traditionally, engineering and public health have been understood as different fields.
Currently in India, civil engineering incorporates a course or two on environmental engineering for students to learn about wastewater management as a part of their pre-service and in-service training.
Most often, civil engineers do not have adequate skills to address public health problems. And public health professionals do not have adequate engineering skills.
India aims to supply 55 litres of water per person per day by 2024 under its Jal Jeevan Mission to install functional household tap connections.
The goal of reaching every rural household with functional tap water can be achieved in a sustainable and resilient manner only if the cadre of public health engineers is expanded and strengthened.
In India, public health engineering is executed by the Public Works Department or by health officials.
This differs from international trends. To manage a wastewater treatment plant in Europe, for example, a candidate must specialise in wastewater engineering.
Furthermore, public health engineering should be developed as an interdisciplinary field. Engineers can significantly contribute to public health in defining what is possible, identifying limitations, and shaping workable solutions with a problem-solving approach.
Similarly, public health professionals can contribute to engineering through well-researched understanding of health issues, measured risks and how course correction can be initiated.
Once both meet, a public health engineer can identify a health risk, work on developing concrete solutions such as new health and safety practices or specialised equipment, in order to correct the safety concern..
There is no doubt that the majority of diseases are water-related, transmitted through consumption of contaminated water, vectors breeding in stagnated water, or lack of adequate quantity of good quality water for proper personal hygiene.
Diseases cannot be contained unless we provide good quality and adequate quantity of water. Most of the world’s diseases can be prevented by considering this.
Training our young minds towards creating sustainable water management systems would be the first step.
Currently, institutions like the Indian Institute of Technology, Madras (IIT-M) are considering initiating public health engineering as a separate discipline.
To leverage this opportunity even further, India needs to scale up in the same direction.
Consider this hypothetical situation: Rajalakshmi, from a remote Karnataka village spots a business opportunity.
She knows that flowers, discarded in the thousands by temples can be handcrafted into incense sticks.
She wants to find a market for the product and hopefully, employ some people to help her. Soon enough though, she discovers that starting a business is a herculean task for a person like her.
There is a laborious process of rules and regulations to go through, bribes to pay on the way and no actual means to transport her product to its market.
After making her first batch of agarbathis and taking it to Bengaluru by bus, she decides the venture is not easy and gives up.
On the flipside of this is a young entrepreneur in Bengaluru. Let’s call him Deepak. He wants to start an internet-based business selling sustainably made agarbathis.
He has no trouble getting investors and to mobilise supply chains. His paperwork is over in a matter of days and his business is set up quickly and ready to grow.
Never mind that the business is built on aggregation of small sellers who will not see half the profit .
Is this scenario really all that hypothetical or emblematic of how we think about entrepreneurship in India?
Between our national obsession with unicorns on one side and glorifying the person running a pakora stall for survival as an example of viable entrepreneurship on the other, is the middle ground in entrepreneurship—a space that should have seen millions of thriving small and medium businesses, but remains so sparsely occupied that you could almost miss it.
If we are to achieve meaningful economic growth in our country, we need to incorporate, in our national conversation on entrepreneurship, ways of addressing the missing middle.
Spread out across India’s small towns and cities, this is a class of entrepreneurs that have been hit by a triple wave over the last five years, buffeted first by the inadvertent fallout of demonetization, being unprepared for GST, and then by the endless pain of the covid-19 pandemic.
As we finally appear to be reaching some level of normality, now is the opportune time to identify the kind of industries that make up this layer, the opportunities they should be afforded, and the best ways to scale up their functioning in the shortest time frame.
But, why pay so much attention to these industries when we should be celebrating, as we do, our booming startup space?
It is indeed true that India has the third largest number of unicorns in the world now, adding 42 in 2021 alone. Braving all the disruptions of the pandemic, it was a year in which Indian startups raised $24.1 billion in equity investments, according to a NASSCOM-Zinnov report last year.
However, this is a story of lopsided growth.
The cities of Bengaluru, Delhi/NCR, and Mumbai together claim three-fourths of these startup deals while emerging hubs like Ahmedabad, Coimbatore, and Jaipur account for the rest.
This leap in the startup space has created 6.6 lakh direct jobs and a few million indirect jobs. Is that good enough for a country that sends 12 million fresh graduates to its workforce every year?
It doesn’t even make a dent on arguably our biggest unemployment in recent history—in April 2020 when the country shutdown to battle covid-19.
Technology-intensive start-ups are constrained in their ability to create jobs—and hybrid work models and artificial intelligence (AI) have further accelerated unemployment.
What we need to focus on, therefore, is the labour-intensive micro, small and medium enterprise (MSME). Here, we begin to get to a definitional notion of what we called the mundane middle and the problems it currently faces.
India has an estimated 63 million enterprises. But, out of 100 companies, 95 are micro enterprises—employing less than five people, four are small to medium and barely one is large.
The questions to ask are: why are Indian MSMEs failing to grow from micro to small and medium and then be spurred on to make the leap into large companies?
At the Global Alliance for Mass Entrepreneurship (GAME), we have advocated for a National Mission for Mass Entrepreneurship, the need for which is more pronounced now than ever before.
Whenever India has worked to achieve a significant economic milestone in a limited span of time, it has worked best in mission mode. Think of the Green Revolution or Operation Flood.
From across various states, there are enough examples of approaches that work to catalyse mass entrepreneurship.
The introduction of entrepreneurship mindset curriculum (EMC) in schools through alliance mode of working by a number of agencies has shown significant improvement in academic and life outcomes.
Through creative teaching methods, students are encouraged to inculcate 21st century skills like creativity, problem solving, critical thinking and leadership which are not only foundational for entrepreneurship but essential to thrive in our complex world.
Udhyam Learning Foundation has been involved with the Government of Delhi since 2018 to help young people across over 1,000 schools to develop an entrepreneurial mindset.
One pilot programme introduced the concept of ‘seed money’ and saw 41 students turn their ideas into profit-making ventures. Other programmes teach qualities like grit and resourcefulness.
If you think these are isolated examples, consider some larger data trends.
The Observer Research Foundation and The World Economic Forum released the Young India and Work: A Survey of Youth Aspirations in 2018.
When asked which type of work arrangement they prefer, 49% of the youth surveyed said they prefer a job in the public sector.
However, 38% selected self-employment as an entrepreneur as their ideal type of job. The spirit of entrepreneurship is latent and waiting to be unleashed.
The same can be said for building networks of successful women entrepreneurs—so crucial when the participation of women in the Indian economy has declined to an abysmal 20%.
The majority of India’s 63 million firms are informal —fewer than 20% are registered for GST.
Research shows that companies that start out as formal enterprises become two-three times more productive than a similar informal business.
So why do firms prefer to be informal? In most cases, it’s because of the sheer cost and difficulty of complying with the different regulations.
We have academia and non-profits working as ecosystem enablers providing insights and evidence-based models for growth. We have large private corporations and philanthropic and funding agencies ready to invest.
It should be in the scope of a National Mass Entrepreneurship Mission to bring all of them together to work in mission mode so that the gap between thought leadership and action can finally be bridged.