Harish Rana v. Union of India
Supreme Court of India, 11 March 2026, 2 judges, 2026 INSC 222
Clinically assisted nutrition and hydration is medical treatment; applying the Common Cause guidelines and the best interest principle, the Court directed its withdrawal from a man in a permanent vegetative state for 13 years, and streamlined the guidelines.
Facts
In 2013 the applicant, then a 20 year old student, fell from the fourth floor of his accommodation and suffered a diffuse axonal brain injury. He remained in a persistent vegetative state, kept alive at home by clinically assisted nutrition and hydration (CANH) through a PEG tube, with a tracheostomy and urinary catheter. The Delhi High Court dismissed his parents' writ petition, holding he was not kept alive mechanically. The Supreme Court disposed of the SLP on 08.11.2024 by recording a home care arrangement, with liberty to return. His parents then filed this application seeking a declaration that CANH is medical treatment and assessment under Common Cause v. Union of India (2018), as modified in 2023. On the Court's directions, a primary medical board and an AIIMS secondary medical board examined him; both found irreversible brain damage with negligible chance of recovery, and the family supported withdrawal.
Questions before the Court
- Whether the administration of CANH is to be regarded as medical treatment.
- What are the meaning, scope and contours of the best interest of the patient principle in deciding whether medical treatment should be withdrawn or withheld?
- Whether it is in the applicant's best interest that his life be prolonged by continuation of medical treatment.
- What further steps follow a decision to withdraw or withhold medical treatment, and how should the Common Cause guidelines be streamlined?
What the Court held
- CANH is not mere basic sustenance or primary care but a technologically mediated medical intervention prescribed, supervised and reviewed by professionals. It is medical treatment even when given at home, so the medical boards may decide on its withdrawal or withholding like any other treatment under the Common Cause guidelines.
- For an incompetent patient, the question is not whether death is in his best interests but whether prolonging his life by continued treatment is. There is a strong but rebuttable presumption in favour of life; medical and non-medical considerations, including what the patient would have wanted (substituted judgment), are weighed in a balance sheet.
- If both medical boards certify withdrawal or withholding, no further court intervention is needed. As streamlined: home-care patients may be admitted to hospital for the process, district CMOs must keep panels of doctors for secondary boards, a 30 day reconsideration period applies, and the High Court may be moved under Article 226 if a hospital fails to start the process.
- Withdrawal must move the patient to a supervised palliative and end-of-life care plan and must not amount to abandonment; the Court disapproved routine use of discharge against medical advice in such cases.
- On the facts both requirements were met. The Court directed withdrawal of the applicant's treatment including CANH, waived the 30 day period, and ordered AIIMS to admit him to palliative care. High Courts must direct Magistrates to receive hospital intimations, and the Union must ensure CMO panels, reviewed at least every twelve months.
- Concurring, Viswanathan, J. held that the High Court erred in requiring terminal illness: a patient in a permanent vegetative state undergoing prolonged treatment for an incurable condition satisfies the prerequisites for constituting the medical boards.
Why it matters
This is described in the judgment as the first case before the Supreme Court applying the Common Cause guidelines in full. It holds that artificial nutrition and hydration is medical treatment, sets out the content of the best interest principle for incompetent patients, adds practical steps to the guidelines (CMO panels, home-care patients, a 30 day reconsideration period, recourse under Article 226), and urges the Union Government to consider enacting comprehensive end-of-life legislation.
In the Court's words
Copied from the official judgment; each passage links to its page.
“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 clinical and procedural characteristics of CANH, therefore, indicate, without an iota of doubt, that CANH cannot be regarded as a mere means of basic sustenance or primary care, but should be recognised as a technologically mediated medical intervention that is prescribed, supervised and periodically reviewed by trained healthcare professionals in accordance with established medical standards.”
“In other words, we would like to reiterate that if both the primary medical board and secondary medical board certify the withdrawal or withholding of medical treatment, there is no further requirement for Court intervention.”
“Hence, the conclusion in para 199.1 and 199.2 of Common Cause (supra) read in the entire context of the judgment in Common Cause (supra) would indicate that for constitution of Primary Medical Board and consequently Secondary Medical Board, the patient need not necessarily be terminally ill. If the patient is in a permanent vegetative state or in any other like condition and is undergoing prolonged treatment in respect of ailment which is incurable or where there is no hope of being cured, the essential pre-requisites would be satisfied.”
Provisions interpreted
Related judgments
- Follows Common Cause v. Union of India (2018)“it is permissible for the primary medical board and secondary medical board to exercise their clinical judgment with regard to the continuation or withdrawal or withholding of the CANH, like any other form of medical treatment, in accordance with the guidelines as laid down in Common Cause (supra).” (page 273)
Case and bench
- Parties
- Harish Rana v. Union of India
- Case
- Miscellaneous Application No. 2238 of 2025 in Special Leave Petition (Civil) No. 18225 of 2024
- Decided
- 11 March 2026
- Bench
- J.B. Pardiwala, K.V. Viswanathan
- Opinions
- Unanimous. Main judgment by J.B. Pardiwala, J.; K.V. Viswanathan, J. wrote a separate concurring opinion and allowed the application in terms of the directions in the main judgment.