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family had first approached the Delhi High Court, which said CANH was not medical treatment and therefore couldn’t be withdrawn.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.

That 2018 judgment also gave legal standing to two important concepts:
  • 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.


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    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.

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    Norman Borlaug and MS Swaminathan in a wheat field in north India in March 1964

    Political independence does not have much meaning without economic independence.

    One of the important indicators of economic independence is self-sufficiency in food grain production.

    The overall food grain scenario in India has undergone a drastic transformation in the last 75 years.

    India was a food-deficit country on the eve of Independence. It had to import foodgrains to feed its people.

    The situation became more acute during the 1960s. The imported food had to be sent to households within the shortest possible time.

    The situation was referred to as ‘ship to mouth’.

    Presently, Food Corporation of India (FCI) godowns are overflowing with food grain stocks and the Union government is unable to ensure remunerative price to the farmers for their produce.

    This transformation, however, was not smooth.

    In the 1960s, it was disgraceful, but unavoidable for the Prime Minister of India to go to foreign countries with a begging bowl.

    To avoid such situations, the government motivated agricultural scientists to make India self-sufficient in food grain production.

    As a result, high-yield varieties (HYV) were developed. The combination of seeds, water and fertiliser gave a boost to food grain production in the country which is generally referred to as the Green Revolution.

    The impact of the Green Revolution, however, was confined to a few areas like Punjab, Haryana, western Uttar Pradesh in the north and (unified) Andhra Pradesh in the south.

    Most of the remaining areas were deficit in food grain production.

    Therefore the Union government had to procure food grain from surplus states to distribute it among deficit ones.

    At the time, farmers in the surplus states viewed procurement as a tax as they were prevented from selling their surplus foodgrains at high prices in the deficit states.

    As production of food grains increased, there was decentralisation of procurement. State governments were permitted to procure grain to meet their requirement.

    The distribution of food grains was left to the concerned state governments.

    Kerala, for instance, was totally a deficit state and had to adopt a distribution policy which was almost universal in nature.

    Some states adopted a vigorous public distribution system (PDS) policy.

    It is not out of place to narrate an interesting incident regarding food grain distribution in Andhra Pradesh. The Government of Andhra Pradesh in the early 1980s implemented a highly subsidised rice scheme under which poor households were given five kilograms of rice per person per month, subject to a ceiling of 25 kilograms at Rs 2 per kg. The state government required two million tonnes of rice to implement the scheme. But it received only on one million tonne from the Union government.

    The state government had to purchase another million tonne of rice from rice millers in the state at a negotiated price, which was higher than the procurement price offered by the Centre, but lower than the open market price.

    A large number of studies have revealed that many poor households have been excluded from the PDS network, while many undeserving households have managed to get benefits from it.

    Various policy measures have been implemented to streamline PDS. A revamped PDS was introduced in 1992 to make food grain easily accessible to people in tribal and hilly areas, by providing relatively higher subsidies.

    Targeted PDS was launched in 1997 to focus on households below the poverty line (BPL).

    Antyodaya Anna Yojana (AAY) was introduced to cover the poorest of the poor.

    Annapoorna Scheme was introduced in 2001 to distribute 10 kg of food grains free of cost to destitutes above the age of 65 years.

    In 2013, the National Food Security Act (NFSA) was passed by Parliament to expand and legalise the entitlement.

    Conventionally, a card holder has to go to a particular fair price shop (FPS) and that particular shop has to be open when s/he visits it. Stock must be available in the shop. The card holder should also have sufficient time to stand in the queue to purchase his quota. The card holder has to put with rough treatment at the hands of a FPS dealer.

    These problems do not exist once ration cards become smart cards. A card holder can go to any shop which is open and has available stocks. In short, the scheme has become card holder-friendly and curbed the monopoly power of the FPS dealer. Some states other than Chhattisgarh are also trying to introduce such a scheme on an experimental basis.

    More recently, the Government of India has introduced a scheme called ‘One Nation One Ration Card’ which enables migrant labourers to purchase  rations from the place where they reside. In August 2021, it was operational in 34 states and Union territories.

    The intentions of the scheme are good but there are some hurdles in its implementation which need to be addressed. These problems arise on account of variation in:

    • Items provided through FPS
    • The scale of rations
    • The price of items distributed through FPS across states. 

    It is not clear whether a migrant labourer gets items provided in his/her native state or those in the state s/he has migrated to and what prices will s/he be able to purchase them.

    The Centre must learn lessons from the experiences of different countries in order to make PDS sustainable in the long-run.

    For instance, Sri Lanka recently shifted to organic manure from chemical fertiliser without required planning. Consequently, it had to face an acute food shortage due to a shortage of organic manure.

    Some analysts have cautioned against excessive dependence on chemical fertiliser.

    Phosphorus is an important input in the production of chemical fertiliser and about 70-80 per cent of known resources of phosphorus are available only in Morocco.

    There is possibility that Morocco may manipulate the price of phosphorus.

    Providing excessive subsidies and unemployment relief may make people dependent, as in the case of Venezuela and Zimbabwe.

    It is better to teach a person how to catch a fish rather than give free fish to him / her.

    Hence, the government should give the right amount of subsidy to deserving people.

    The government has to increase livestock as in the case of Uruguay to make the food basket broad-based and nutritious. It has to see to it that the organic content in the soil is adequate, in order to make cultivation environmentally-friendly and sustainable in the long-run.

    In short, India has transformed from a food-deficit state to a food-surplus one 75 years after independence. However, the government must adopt environmental-friendly measures to sustain this achievement.