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family had first approached the Delhi High Court, which said CANH was not medical treatment and therefore couldn’t be withdrawn.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.
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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.
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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:
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Establish clear, accessible procedures that families can follow without going to court
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Define which institutions are responsible for what
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Build a living will registry — a national system where your advance directives are stored, retrievable, and legally binding
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Set safeguards against misuse (ensuring that no one is pressured into withdrawing care for the wrong reasons)
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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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The United Nations has shaped so much of global co-operation and regulation that we wouldn’t recognise our world today without the UN’s pervasive role in it. So many small details of our lives – such as postage and copyright laws – are subject to international co-operation nurtured by the UN.
In its 75th year, however, the UN is in a difficult moment as the world faces climate crisis, a global pandemic, great power competition, trade wars, economic depression and a wider breakdown in international co-operation.
Still, the UN has faced tough times before – over many decades during the Cold War, the Security Council was crippled by deep tensions between the US and the Soviet Union. The UN is not as sidelined or divided today as it was then. However, as the relationship between China and the US sours, the achievements of global co-operation are being eroded.
The way in which people speak about the UN often implies a level of coherence and bureaucratic independence that the UN rarely possesses. A failure of the UN is normally better understood as a failure of international co-operation.
We see this recently in the UN’s inability to deal with crises from the ethnic cleansing of the Rohingya Muslims in Myanmar, to civil conflict in Syria, and the failure of the Security Council to adopt a COVID-19 resolution calling for ceasefires in conflict zones and a co-operative international response to the pandemic.
The UN administration is not primarily to blame for these failures; rather, the problem is the great powers – in the case of COVID-19, China and the US – refusing to co-operate.
Where states fail to agree, the UN is powerless to act.
Marking the 75th anniversary of the official formation of the UN, when 50 founding nations signed the UN Charter on June 26, 1945, we look at some of its key triumphs and resounding failures.
Five successes
1. Peacekeeping
The United Nations was created with the goal of being a collective security organisation. The UN Charter establishes that the use of force is only lawful either in self-defence or if authorised by the UN Security Council. The Security Council’s five permanent members, being China, US, UK, Russia and France, can veto any such resolution.
The UN’s consistent role in seeking to manage conflict is one of its greatest successes.
A key component of this role is peacekeeping. The UN under its second secretary-general, the Swedish statesman Dag Hammarskjöld – who was posthumously awarded the Nobel Peace prize after he died in a suspicious plane crash – created the concept of peacekeeping. Hammarskjöld was responding to the 1956 Suez Crisis, in which the US opposed the invasion of Egypt by its allies Israel, France and the UK.
UN peacekeeping missions involve the use of impartial and armed UN forces, drawn from member states, to stabilise fragile situations. “The essence of peacekeeping is the use of soldiers as a catalyst for peace rather than as the instruments of war,” said then UN Secretary-General Javier Pérez de Cuéllar, when the forces won the 1988 Nobel Peace Prize following missions in conflict zones in the Middle East, Africa, Asia, Central America and Europe.
However, peacekeeping also counts among the UN’s major failures.
2. Law of the Sea
Negotiated between 1973 and 1982, the UN Convention on the Law of the Sea (UNCLOS) set up the current international law of the seas. It defines states’ rights and creates concepts such as exclusive economic zones, as well as procedures for the settling of disputes, new arrangements for governing deep sea bed mining, and importantly, new provisions for the protection of marine resources and ocean conservation.
Mostly, countries have abided by the convention. There are various disputes that China has over the East and South China Seas which present a conflict between power and law, in that although UNCLOS creates mechanisms for resolving disputes, a powerful state isn’t necessarily going to submit to those mechanisms.
Secondly, on the conservation front, although UNCLOS is a huge step forward, it has failed to adequately protect oceans that are outside any state’s control. Ocean ecosystems have been dramatically transformed through overfishing. This is an ecological catastrophe that UNCLOS has slowed, but failed to address comprehensively.
3. Decolonisation
The idea of racial equality and of a people’s right to self-determination was discussed in the wake of World War I and rejected. After World War II, however, those principles were endorsed within the UN system, and the Trusteeship Council, which monitored the process of decolonisation, was one of the initial bodies of the UN.
Although many national independence movements only won liberation through bloody conflicts, the UN has overseen a process of decolonisation that has transformed international politics. In 1945, around one third of the world’s population lived under colonial rule. Today, there are less than 2 million people living in colonies.
When it comes to the world’s First Nations, however, the UN generally has done little to address their concerns, aside from the non-binding UN Declaration on the Rights of Indigenous Peoples of 2007.
4. Human rights
The Human Rights Declaration of 1948 for the first time set out fundamental human rights to be universally protected, recognising that the “inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world”.
Since 1948, 10 human rights treaties have been adopted – including conventions on the rights of children and migrant workers, and against torture and discrimination based on gender and race – each monitored by its own committee of independent experts.
The language of human rights has created a new framework for thinking about the relationship between the individual, the state and the international system. Although some people would prefer that political movements focus on ‘liberation’ rather than ‘rights’, the idea of human rights has made the individual person a focus of national and international attention.
5. Free trade
Depending on your politics, you might view the World Trade Organisation as a huge success, or a huge failure.
The WTO creates a near-binding system of international trade law with a clear and efficient dispute resolution process.
The majority Australian consensus is that the WTO is a success because it has been good for Australian famers especially, through its winding back of subsidies and tariffs.
However, the WTO enabled an era of globalisation which is now politically controversial.
Recently, the US has sought to disrupt the system. In addition to the trade war with China, the Trump Administration has also refused to appoint tribunal members to the WTO’s Appellate Body, so it has crippled the dispute resolution process. Of course, the Trump Administration is not the first to take issue with China’s trade strategies, which include subsidises for ‘State Owned Enterprises’ and demands that foreign firms transfer intellectual property in exchange for market access.
The existence of the UN has created a forum where nations can discuss new problems, and climate change is one of them. The Intergovernmental Panel on Climate Change (IPCC) was set up in 1988 to assess climate science and provide policymakers with assessments and options. In 1992, the UN Framework Convention on Climate Change created a permanent forum for negotiations.
However, despite an international scientific body in the IPCC, and 165 signatory nations to the climate treaty, global greenhouse gas emissions have continued to increase.
Under the Paris Agreement, even if every country meets its greenhouse gas emission targets we are still on track for ‘dangerous warming’. Yet, no major country is even on track to meet its targets; while emissions will probably decline this year as a result of COVID-19, atmospheric concentrations of greenhouse gases will still increase.
This illustrates a core conundrum of the UN in that it opens the possibility of global cooperation, but is unable to constrain states from pursuing their narrowly conceived self-interests. Deep co-operation remains challenging.
Five failures of the UN
1. Peacekeeping
During the Bosnian War, Dutch peacekeeping forces stationed in the town of Srebrenica, declared a ‘safe area’ by the UN in 1993, failed in 1995 to stop the massacre of more than 8000 Muslim men and boys by Bosnian Serb forces. This is one of the most widely discussed examples of the failures of international peacekeeping operations.
On the massacre’s 10th anniversary, then UN Secretary General Kofi Annan wrote that the UN had “made serious errors of judgement, rooted in a philosophy of impartiality”, contributing to a mass murder that would “haunt our history forever”.
If you look at some of the other infamous failures of peacekeeping missions – in places such as Rwanda, Somalia and Angola – it is the limited powers given to peacekeeping operations that have resulted in those failures.
2. The invasion of Iraq
The invasion of Iraq by the US in 2003, which was unlawful and without Security Council authorisation, reflects the fact that the UN is has very limited capacity to constrain the actions of great powers.
The Security Council designers created the veto power so that any of the five permanent members could reject a Council resolution, so in that way it is programmed to fail when a great power really wants to do something that the international community generally condemns.
In the case of the Iraq invasion, the US didn’t veto a resolution, but rather sought authorisation that it did not get. The UN, if you go by the idea of collective security, should have responded by defending Iraq against this unlawful use of force.
The invasion proved a humanitarian disaster with the loss of more than 400,000 lives, and many believe that it led to the emergence of the terrorist Islamic State.
3. Refugee crises
The UN brokered the 1951 Refugee Convention to address the plight of people displaced in Europe due to World War II; years later, the 1967 Protocol removed time and geographical restrictions so that the Convention can now apply universally (although many countries in Asia have refused to sign it, owing in part to its Eurocentric origins).
Despite these treaties, and the work of the UN High Commission for Refugees, there is somewhere between 30 and 40 million refugees, many of them, such as many Palestinians, living for decades outside their homelands. This is in addition to more than 40 million people displaced within their own countries.
While for a long time refugee numbers were reducing, in recent years, particularly driven by the Syrian conflict, there have been increases in the number of people being displaced.
During the COVID-19 crisis, boatloads of Rohingya refugees were turned away by port after port. This tragedy has echoes of pre-World War II when ships of Jewish refugees fleeing Nazi Germany were refused entry by multiple countries.
And as a catastrophe of a different kind looms, there is no international framework in place for responding to people who will be displaced by rising seas and other effects of climate change.
4. Conflicts without end
Across the world, there is a shopping list of unresolved civil conflicts and disputed territories.
Palestine and Kashmir are two of the longest-running failures of the UN to resolve disputed lands. More recent, ongoing conflicts include the civil wars in Syria and Yemen.
The common denominator of unresolved conflicts is either division among the great powers, or a lack of international interest due to the geopolitical stakes not being sufficiently high. For instance, the inaction during the Rwandan civil war in the 1990s was not due to a division among great powers, but rather a lack of political will to engage.
In Syria, by contrast, Russia and the US have opposing interests and back opposing sides: Russia backs the government of the Syrian dictator Bashar al-Assad, whereas the US does not.
5. Acting like it’s 1945
The UN is increasingly out of step with the reality of geopolitics today.
The permanent members of the Security Council reflect the division of power internationally at the end of World War II. The continuing exclusion of Germany, Japan, and rising powers such as India and Indonesia, reflects the failure to reflect the changing balance of power.
Also, bodies such as the IMF and the World Bank, which are part of the UN system, continue to be dominated by the West. In response, China has created potential rival institutions such as the Asian Infrastructure Investment Bank.
Western domination of UN institutions undermines their credibility. However, a more fundamental problem is that institutions designed in 1945 are a poor fit with the systemic global challenges – of which climate change is foremost – that we face today.