Harish Rana, like any other 20-year-old, was once a wide-eyed youth with hopes, dreams, and a determination to make it big. He embarked on this journey by pursuing an engineering degree. Unfortunately, fate – the inexplicable wind that charters one's life, had different plans. One evening in 2013, Harish fell from the fourth floor of his PG accommodation and sustained critical injuries. His condition confined him to a bed while tubes, unbeknownst to Harish, pumped him with life support. Owing to his Permanent Vegetative State (PVS), he responded to no stimuli around him and was largely nursed by his parents, with frequent visits to the hospital. Harish's closest, who fondly described him as energetic and exuberant were faced with the agonising pain of witnessing his stasis. The parents, along with doctors, devoted 13 years in tending to Harish. No improvement was seen. Confronted with despairing circumstances, the parents, who were unflinching in their love, moved the Supreme Court praying that the life support be withdrawn, and nature be allowed to take its course. What followed was a pivotal discourse on the import of life under Article 21 of our Constitution.
The Constitution's tryst with Right to Life with 'Dignity' was first laid down in Gian Kaur v. State of Punjab (1996) where the Supreme Court held that 'Life' under Article 21 included the right to live with dignity. However, in Gian Kaur, the Court opined that Article 21 did not include the right to die.
Fifteen years later, a similar case reached the Supreme Court when a young Aruna Shanbaug, owing to a brutal sexual assault, was left in PVS. Pinki Virani, journalist, and human-rights activist petitioned Supreme Court as Aruna's friend and prayed for withdrawal of her life support. This culminated in the crucial decision of Aruna R. Shanbaug v. Union of India (2011). Although under its own circumstances, Virani's plea was rejected. Yet, the Supreme Court drew sustenance from foreign legal frameworks and recognized passive euthanasia in cases of patients with terminal illness and undergoing prolonged, but ineffective treatment. Guidelines were framed which were meant to bridge the legislative gap, until the Parliament promulgated on the subject.
It's important to highlight that the Law Commission in 2006 and 2012, entered an in-depth examination of the above-detailed issues and made extensive observations. It reported that withholding life support, from terminally ill patients, should not attract criminal liability if done in pursuance of the “best interest of the patient.”
The watershed moment came in the form of the 2018 Constitution Bench decision of the Supreme Court in Common Cause v. Union of India. Armed with the benefit of developing jurisprudence on the subject, the Court unequivocally recognized and permitted the withdrawal/withholding of medical treatment to fall within Article 21. The right of refusal of medical treatment was held to be a manifestation of dignity intersecting with privacy, autonomy, and self-determination. This judgment provided extensive guidelines and underwent certain modifications in a similarly titled 2023 decision. These are now cumulatively referred to as the 'Common Cause guidelines', which rest on two core principles: First, the intervention in question must qualify as “medical treatment”; and second, its withdrawal must be strictly in the patient's “best interest.”
The Supreme Court embedded various safeguards to prevent misuse and a detailed procedure involving opinions of Primary and Secondary Medical Boards prior to undertaking such decisions. They also delineated the role of courts in such situations. The legislative void was once again highlighted by the Court and one Judge expressed the “pious hope” for legislative intervention – a hope that lingers!
The Harish Rana chronicle has now reached its end with much appreciation and intervention by the Supreme Court. Speaking through two Judges, who authored separate but concurring Judgments, the Court allowed the withdrawal of life support from Harish on the anvil of considerations under the Common Cause guidelines. Since Harish relied on Clinically Assisted Nutrition and Hydration (“CANH”), the first question which required consideration was whether CANH qualified as a “medical treatment?” To answer this, Court noted that administration of CANH requires careful and experienced medical supervision. Since such skills are only available by drawing upon medical knowledge, and owing to its continuous periodic evaluation, emergency medical management and supervision, it was held to be “medical treatment.”
The second question was whether withdrawal of CANH from Harish was in his best interests? Upon examining various foreign decisions, Law Commission Reports, and the Courts opinion in Common Cause, it held that the “best interest” must be envisaged from the lens of the stakeholders – being the next of kin and medical boards. It was rightly opined that a doctor's duty to perform treatment continues till it is capable of “conferring some therapeutic benefit.” When recovery is impossible, the continuation of treatment merely prolongs the biological existence de-hors any benefits. Both Judges, while referring to opinions of Medical Boards were unanimous in holding that the continuation of CANH to Harish served no therapeutic purpose. It led to the sole and irresistible conclusion - withdrawal of medical treatment and noted that to be in the best interests.
“For in that sleep of death what dreams may come, when we have shuffled off this mortal coil, must give us pause.” Through his prose, the immortal Bard cautioned that hesitation of death stems from the uncertainty of afterlife. Whether it is really a dreamless sleep or the beginning of another life, what is definitive is that the ones who die tend to live through us. Harish will soon pass-on. Yet, he will not be forgotten. His contributions will forever be etched in history and in our constitutional jurisprudence, which will ensure his legacy lives on forever.
Harish Rana's case compels us to accept that the advancement of constitutional morality is not circumscribed only to legislative actions which reach the country at large. It is also through addressing uncomfortable issues that advance the cause for humanity and our existence, even if they concern just an indiscernible minority. And therefore, the recent verdict should serve as a reminder for our Parliament that urgent and immediate legislative steps are needed to deal with matters of life and death.
Harish, even in your dying moments, you breathed life into various others who, like you, can now get a dignified farewell. Travel well my dear… Aum Shanti.
Author Satvik Varma is a Senior Advocate in New Delhi and Advocate provided invaluable research assistance by Shantanu Parma. Views are personal.