The Right to Let Go

With the Harish Rana case, the Supreme Court has turned a philosophical right into a practical pathway, redefining dignity at the end of life.

For years, India’s debate over euthanasia lingered in the realm of theory while being ethically fraught, legally ambiguous and emotionally charged. Now, with its verdict in the Harish Rana case, the Supreme Court has moved the question from abstraction to application. In doing so, it has redrawn the boundaries of life, death and dignity under the Constitution.

Barely a fortnight after its March 11 ruling clarifying the contours of “passive euthanasia,” the court saw its framework tested in the most intimate of settings. A division bench of Justices J. B. Pardiwala and K. V. Viswanathan permitted the withdrawal of life-sustaining treatment for Harish Rana, a 31-year-old man who had remained in a permanent vegetative state for nearly 13 years. Days later, on March 24, Rana’s death marked the first full implementation of the court’s guidelines in Common Cause v. Union of India.

The significance of the moment lay not merely in its outcome, but in what it represented. It was the transformation of a constitutional ideal into a workable legal reality.

At the heart of the ruling is a distinction that may appear technical but carries profound consequences. The court held that Clinically Assisted Nutrition and Hydration (CANH) - tube-based feeding used to sustain patients in irreversible conditions - constitutes medical treatment rather than basic care. This classification brings such interventions within the legal framework governing the withdrawal of life support, aligning them with ventilators and other artificial systems.

Grey Zone

For years, this grey zone had paralysed decision-making. Families, caught between hope and despair, often found themselves unable to act. Doctors, wary of legal repercussions, erred on the side of prolonging life at all costs. By clarifying that withdrawing, or even withholding, such treatment in appropriate cases does not amount to criminal negligence, the court has replaced hesitation with a measure of certainty.

This ruling builds upon, and sharpens, the principles laid down in Common Cause (2018), where a Constitution Bench recognised the “right to die with dignity” as intrinsic to Article 21. A subsequent clarification in 2023 streamlined the procedural aspects, particularly concerning living wills. Yet until now, these remained largely normative statements awaiting real-world validation. The Rana case has changed that by demonstrating that the right is not merely symbolic but enforceable.

In doing so, the court has also foregrounded a central ethical question: not whether death is desirable, but whether life, when artificially prolonged in the absence of recovery, retains meaning. Its answer is careful and conditional. Passive euthanasia, it insists, is neither abandonment nor an act of killing. It is a regulated medical decision, bounded by safeguards and guided by the patient’s best interests.

Those safeguards are elaborate by design. The court mandates a two-tier medical evaluation, involving both a primary and an independent board, to confirm the irreversibility of the patient’s condition. It emphasises that withdrawal of treatment must be gradual, medically supervised and accompanied by palliative care. Judicial intervention, while available, is not intended to be routine where clinical consensus exists. The aim is to create a system that is both humane and resistant to misuse.

Equally significant is the court’s reliance on the principle of “substituted judgment.” In the absence of a living will, it allows decision-makers to infer what the patient would have chosen, based on their values, circumstances and prognosis. In Rana’s case, the court concluded that prolonged artificial support would not align with his likely wishes, thereby extending the idea of autonomy even to those unable to speak.

The ruling also acknowledges the role of the family, often the silent participants in such decisions. By accepting the plea of Rana’s parents, who argued that continued treatment merely prolonged suffering without hope of recovery, the court has accorded moral legitimacy to familial judgment. In a society where end-of-life care is as much a cultural as a medical question, this recognition matters.

Yet the judgement’s implications extend beyond the courtroom. By mandating palliative care alongside the withdrawal of treatment, the court has drawn attention to a glaring gap in India’s healthcare system. End-of-life care remains underdeveloped, unevenly distributed and often inaccessible. If the right to die with dignity is to be meaningful, it must be supported by institutions capable of delivering comfort, not just cure.

Pragmatic Compromise

For doctors, too, the ruling offers clarity and with it, a degree of protection. By situating their decisions within a structured legal framework, it reduces the fear of liability that has long haunted end-of-life care. For patients and their families, it offers something more intangible but equally important: relief from the emotional and financial burdens of sustaining life where recovery is no longer possible.

In time, the judgement may also encourage wider adoption of living wills, allowing individuals to articulate their preferences before crisis strikes. Such directives, once rare, could become a cornerstone of patient autonomy in India.

None of this resolves the deeper moral unease surrounding euthanasia. Nor does the court claim to. Instead, it offers a pragmatic compromise that acknowledges the limits of medicine, the complexity of human dignity and the necessity of legal safeguards.

According to advocate Sonam Chandwani, Managing Partner, K.S. Legal & Associates, the verdict is a decisive maturation of Article 21 jurisprudence by transforming the “right to die with dignity” into a practical, rights-based framework.

“It has brought legal clarity by recognising Clinically Assisted Nutrition and Hydration (CANH) as life-sustaining treatment that may be lawfully withdrawn, removing the grey zone that exposed doctors and families to civil and criminal liability,” she observes.

The Court’s reliance on medical boards, alongside “best interest” and substituted judgment standards, ensures decisions remain patient-centric, evidence-based, and safeguarded against misuse. For the public, it alleviates prolonged emotional, ethical, and financial distress in irreversible cases, affirming dignity in both life and death.

Crucially, the judgment enables a structured, doctor-led decision-making process, reducing litigation and uncertainty. It sets a workable precedent for faster, consistent outcomes, while likely boosting adoption of living wills, strengthening hospital protocols, and accelerating palliative care - aligning legal doctrine with humane medical practice and social realities.

Same-Sex Marriage, The Constitutional Arc Bends

In October 2023, the Supreme Court of India confronted one of the most contentious questions of modern constitutional law: whether the right to marry extends to same-sex couples. Its answer was both expansive and restrained. Queer Indians, the court held, are entitled to dignity, protection and freedom from discrimination. But marriage, with all its legal consequences, would remain out of reach for now.

The five-judge Constitution Bench drew a careful line. Courts, it said, exist to protect rights, not to create entirely new legal institutions. Marriage, in India, is not a fundamental right explicitly guaranteed by the Constitution but a statutory construct, governed by laws such as the Special Marriage Act, 1954. To extend its ambit to same-sex couples would require more than interpretation; it would demand legislative redesign.

Holding that the Constitution does not explicitly guarantee a right to marry, the SC unanimously held that marriage remains a creation of statute under laws like the Special Marriage Act, 1954. It also unanimously declined to reinterpret or strike down the Special Marriage Act, 1954 to include same-sex couples, noting that it was originally created to enable inter-faith and inter-caste marriages, but any alterations could trigger consequences across multiple laws.

The SC also clarified that earlier rulings upholding the right to choose a partner, was applicable only where couples were already ‘legally eligible’ to marry, but expanding that criteria to include same-sex couples cannot be done through judicial interpretation alone. The then Chief Justice D. Y. Chandrachud emphasized that courts have the authority to intervene when fundamental rights are violated.

However, the majority, led by Justice S. R. Bhat, held that recognising same-sex unions would require building an entirely new legal framework – ranging from divorce, maintenance, succession to inheritance – all of which are the Parliament’s domain. They sounded a caution that any judicial overreach here could upset the constitutional balance of powers.

In a 3:2 verdict, the SC also rejected legal recognition to same-sex marriages, and the two judges, including CJI, felt that the right to form unions flows from fundamental freedoms like personal liberty and association, and denying recognition based on sexual orientation violates equality guarantees.

Disagreeing, the other 3 judges said that though queer couples have the right to cohabit and form relationships, the State is not bound to grant them a legal status, and recognising them would create a ‘new universe’ or rights beyond the judiciary’s jurisdiction.

Rejecting adoption rights, the court upheld the current restrictions under Juvenile Justice Act, 2015 that allows only married couples to adopt jointly, observing that this framework is designed to best safeguard the child’s interests through structured provisions relating to custody, maintenance and inheritance; but any changes must come through legislation.

The SC adopted a progressive view by affirming that transgender persons in heterosexual relationships can marry under existing laws, as it aligns with protections under the Transgender Persons (Protection of Rights) Act, 2019.

This implies that legal recognition must be based on ‘gender identity’ rather than ‘biological classification’ - an important step toward inclusion, said experts.

Despite declining marriage equality, many positive measures came forth including: anti-discrimination mandate with equal access to goods and services; protection from violence with police directed to respect queer relationships and prevent harassment/coercion; Ban on conversion therapy declaring them as ‘harmful’ and unconstitutional; States to create support systems safe houses and helplines; banning forced surgeries on intersex children as gender recognition cannot depend on medical procedures; and focus on their mental health under the Mental Healthcare Act, 2017.

The SC directed the Centre to set up a high-powered committee led by the Cabinet Secretary, to explore extending practical entitlements to queer couples like joint bank accounts, nominations, hospital decision-making, prison visitation, last rites, issues like insurance, pensions and succession.

In a separate but related development this week, the Parliament passed amendments refining the definition of transgender persons under the Transgender Persons (Protection of Rights) Act, 2019. The revised framework narrows the scope by introducing more specific eligibility criteria for official recognition, earning the ire of the transgenders and protests.

Now, greater emphasis is placed on formal certification processes, with district-level screening mechanisms involved - a shift away from the earlier, more self-identification-based approach - upheld in past court rulings.

Critics say the tighter definition risks excluding sections within the transgender spectrum - particularly non-binary and gender-fluid individuals - who may not fit neatly into prescribed categories.

According to advocate Asim Sarode: “The present Bill (March 2026) is constitutionally suspect because it dilutes the rights already recognised by the Supreme Court for transgender and queer persons, making it regressive and violative of fundamental rights. By taking away the right to self-perceived gender identity and reintroducing medical and administrative control over recognition, it undermines dignity, autonomy, privacy and equality under Articles 14, 15, 19 and 21 of the Constitution.”

He says these are fresh barriers for transgenders to be recognised as ‘equal citizens’ with equal access to identity, welfare, healthcare, jobs and justice.

Abortion Rights, Freedom With Boundaries

Few areas of law expose the tension between rights and restraint as starkly as abortion. In recent years, the Supreme Court of India has sought to clarify that tension, delivering a pair of consequential rulings between 2022 and 2023 that both widened and circumscribed reproductive freedom. The result is a framework that gestures towards autonomy, yet remains tethered to medical and legal gatekeeping.

At the centre of these rulings lies the Medical Termination of Pregnancy (Amendment) Act, 2021, which raised the upper gestational limit for certain categories of pregnancies from 20 to 24 weeks. The amendment was itself a response to years of litigation, with women increasingly approaching courts for permission to terminate late-stage pregnancies under distressing circumstances.

The court’s 2022 judgement marked a decisive shift. In extending access to abortion up to 24 weeks for unmarried women, thus placing them on par with married ones, it struck down distinctions rooted solely in marital status. Doing so, it invoked both Article 14 (equality) and Article 21 (life and personal liberty), framing reproductive choice as integral to bodily autonomy and dignity.

The reasoning was notably grounded in lived realities. Unwanted pregnancies, the court acknowledged, can derail education, disrupt careers and strain mental health. It also clarified that survivors of marital rape - long a legal blind spot - should not be excluded from seeking abortion. In tone and substance, the ruling appeared to align constitutional principles with social change.

Yet this expansion came with a caveat that would become more pronounced a year later: abortion in India is not an unfettered right. It remains embedded in a “grounds-based” framework, requiring medical approval and confined within statutory categories.

This tension was laid bare in 2023, when the court confronted a more complex case. A 27-year-old married woman sought to terminate her pregnancy at nearly 24 weeks, citing post-partum depression, severe distress and fears of harming herself and her children. Despite the evident psychological strain, her plea was denied.

The court’s reasoning turned on two considerations. First, she did not fall within the legally specified categories such as rape survivors, minors or cases involving foetal abnormalities. Second, medical reports indicated no immediate threat to her life, and the pregnancy had reached a stage where foetal viability carried legal weight.

The bench, led by D. Y. Chandrachud at the time, ultimately refused relief, underscoring that statutory limits cannot be bypassed solely on the basis of individual distress.

Notably, the case exposed divergences within the bench itself. B. V. Nagarathna favoured a more expansive, rights-based approach, emphasising the primacy of a woman’s autonomy. Hima Kohli, by contrast, leaned towards preserving the pregnancy. The split reflected a broader judicial ambivalence: how far should autonomy extend when weighed against statutory constraints and medical opinion?

The outcome has significant implications. While the court has affirmed that reproductive choice forms part of Article 21, it has also made clear that this right is not absolute, particularly beyond the 24-week threshold. In such cases, medical boards, legal categories and judicial scrutiny assume decisive roles, often overriding personal choice.

For many, this reinforces an uncomfortable reality. India’s abortion regime, though progressive in parts, remains system-driven rather than fully rights-based. Women seeking termination, especially in late-term scenarios, must navigate a labyrinth of approvals, medical assessments and, at times, conflicting opinions. Delays, repeated hearings and procedural uncertainties can dilute the very autonomy the law seeks to protect.

The 2023 case highlighted a grey area that remains unresolved: the status of mental health. While the court has acknowledged the psychological impact of unwanted pregnancies, it stopped short of treating severe distress or suicidal tendencies as sufficient grounds for termination beyond statutory limits. This raises a difficult question: what, in legal terms, constitutes a “threat to life”?

The answer, for now, appears to lie less with the individual and more with institutions. Medical boards, in particular, have emerged as pivotal arbiters, their assessments often determining the outcome. This has led to concerns about ‘medical gatekeeping,’ where access depends not only on law but on the discretion of healthcare providers.

Social realities compound these challenges. Abortion in India, though legal, remains heavily stigmatised. Unmarried women, in particular, face moral scrutiny, misinformation and reluctance from providers. Legal rights, in such an environment, can prove difficult to exercise.

According to Vinod Tiwari, Director, Law Chartered & President, Council for Protection of Rights: “Women still continue to face common barriers like societal attitudes, since despite the law, abortion is stigmatised and most women fear being judged or labelled, especially if they are unmarried. There is too much misinformation bandied around by questionable experts on aspects like abortion pills and legality, all of which can be really frustrating and do not reflect the rights of women guaranteed under the law.”

Moreover, medical gate-keeping in the form of certain providers refusing care, demanding unnecessary permissions, or imposing personal opinions is rampant, defeating the letter and intent of MTP Act.

None of this negates the significance of the court’s earlier intervention. By extending access to unmarried women and recognising the broader implications of reproductive choice, the 2022 ruling marked a meaningful step forward. It signalled a judiciary willing to reinterpret the law in light of changing social norms.