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family had first approached the Delhi High Court, which said CANH was not medical treatment and therefore couldn’t be withdrawn.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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In a diverse country like India, where each State is socially, culturally, economically, and politically distinct, measuring Governance becomes increasingly tricky. The Public Affairs Index (PAI 2021) is a scientifically rigorous, data-based framework that measures the quality of governance at the Sub-national level and ranks the States and Union Territories (UTs) of India on a Composite Index (CI).
States are classified into two categories – Large and Small – using population as the criteria.
In PAI 2021, PAC defined three significant pillars that embody Governance – Growth, Equity, and Sustainability. Each of the three Pillars is circumscribed by five governance praxis Themes.
The themes include – Voice and Accountability, Government Effectiveness, Rule of Law, Regulatory Quality and Control of Corruption.
At the bottom of the pyramid, 43 component indicators are mapped to 14 Sustainable Development Goals (SDGs) that are relevant to the States and UTs.
This forms the foundation of the conceptual framework of PAI 2021. The choice of the 43 indicators that go into the calculation of the CI were dictated by the objective of uncovering the complexity and multidimensional character of development governance

The Equity Principle
The Equity Pillar of the PAI 2021 Index analyses the inclusiveness impact at the Sub-national level in the country; inclusiveness in terms of the welfare of a society that depends primarily on establishing that all people feel that they have a say in the governance and are not excluded from the mainstream policy framework.
This requires all individuals and communities, but particularly the most vulnerable, to have an opportunity to improve or maintain their wellbeing. This chapter of PAI 2021 reflects the performance of States and UTs during the pandemic and questions the governance infrastructure in the country, analysing the effectiveness of schemes and the general livelihood of the people in terms of Equity.



Growth and its Discontents
Growth in its multidimensional form encompasses the essence of access to and the availability and optimal utilisation of resources. By resources, PAI 2021 refer to human resources, infrastructure and the budgetary allocations. Capacity building of an economy cannot take place if all the key players of growth do not drive development. The multiplier effects of better health care, improved educational outcomes, increased capital accumulation and lower unemployment levels contribute magnificently in the growth and development of the States.



The Pursuit Of Sustainability
The Sustainability Pillar analyses the access to and usage of resources that has an impact on environment, economy and humankind. The Pillar subsumes two themes and uses seven indicators to measure the effectiveness of government efforts with regards to Sustainability.



The Curious Case Of The Delta
The Delta Analysis presents the results on the State performance on year-on-year improvement. The rankings are measured as the Delta value over the last five to 10 years of data available for 12 Key Development Indicators (KDI). In PAI 2021, 12 indicators across the three Pillars of Equity (five indicators), Growth (five indicators) and Sustainability (two indicators). These KDIs are the outcome indicators crucial to assess Human Development. The Performance in the Delta Analysis is then compared to the Overall PAI 2021 Index.
Key Findings:-
In the Scheme of Things
The Scheme Analysis adds an additional dimension to ranking of the States on their governance. It attempts to complement the Governance Model by trying to understand the developmental activities undertaken by State Governments in the form of schemes. It also tries to understand whether better performance of States in schemes reflect in better governance.
The Centrally Sponsored schemes that were analysed are National Health Mission (NHM), Umbrella Integrated Child Development Services scheme (ICDS), Mahatma Gandh National Rural Employment Guarantee Scheme (MGNREGS), Samagra Shiksha Abhiyan (SmSA) and MidDay Meal Scheme (MDMS).
National Health Mission (NHM)
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)
MID- DAY MEAL SCHEME (MDMS)
SAMAGRA SHIKSHA ABHIYAN (SMSA)
MAHATMA GANDHI NATIONAL RURAL EMPLOYMENT GUARANTEE SCHEME (MGNREGS)