Feeding Tube and the Constitution: What Harish Rana Case Actually Changed

Authored by Aaishwary Raj, a 3rd-year law student at Gujarat National Law University, Gandhinagar

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Introduction

On March 24, 2026, at 4:10 PM, Harish Rana died at the Palliative Oncology Unit of AIIMS, New Delhi. He was 32. He had been in a permanent vegetative state for thirteen years since a fall from the fourth floor of his student accommodation in Chandigarh in 2013, which left him with a diffuse axonal injury and complete quadriplegia. His family had sold their house to pay for his care. On March 11, a bench of Justices J. B. Pardiwala and K.V. Viswanathan had permitted the withdrawal of the clinically assisted nutrition and hydration (CANH) that was keeping him alive.

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The Harish Rana case is being read as a procedural milestone. It is actually a philosophical one, specifically, a judicial rewriting of how Indian courts may reconstruct the will of a person who can no longer express one. Most commentary has converged on the expected conclusions: Article 21 now encompasses the right to die with dignity. The Common Cause guidelines laid the procedural framework for passive euthanasia and, later, simplified by the 2023 five-judge bench, further removed the requirement of a Judicial Magistrate’s attestation for advance medical directives. Both were finally applied in practice in Harish Rane, where it was established that CANH is medical treatment and not basic care, an aberration from the earlier Delhi HC Judgement. All of this is true. But the case does something less noticed and more constitutionally original than these takeaways suggest. It quietly rewrites how Indian courts may reconstruct the will of a person who can no longer express one. That is the argument worth having.

Ventilators and the Unreasonable Threshold: Delhi High Court's Error

To understand what the Supreme Court corrected, we need to understand what went wrong below. On 2nd July 2024, the Delhi High Court dismissed the petition. Harish’s father filed a petition in the Delhi High Court seeking permission to withdraw the PEG feeding tube. The Court rejected the petition because Harish was not on mechanical ventilation. He was, in the Court’s understanding, self-sustaining, which is not a candidate for passive euthanasia.

The logic produced an unfair and almost cruel outcome. Had Harish been more severely injured, that is to say, had his brainstem been too compromised to sustain even basic autonomic function without a ventilator, he would have qualified for passive euthanasia. Being less dependent made him, paradoxically, ineligible for a dignified death. In other words, the less dependent he was on machines, the less the law was willing to protect him from a prolonged and undignified existence. That is what happens when a court reads passive euthanasia through the lens of ventilators and machines rather than asking the right question of whether continued treatment serves any meaningful purpose or only prolongs suffering.

The Supreme Court corrected this interpretation by stating CANH administered through a PEG is an ongoing medical treatment that requires professional care, which is not spoon-feeding and cannot be treated as such. Relying on Lord Browne-Wilkinson’s reasoning in Airedale NHS Trust v. Bland and Glanville Williams’s Textbook of Criminal Law, Justice Pardiwala held that removing the tube is not a positive act causing death, but rather an omission that allows the patient’s own irreversible condition to take its natural course.

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Authorised Omission: Act, Omission, and Institutional Accountability

The judgment’s index uses a phrase worth pausing and deliberating, “authorised omission in consonance with the duty of care of doctors”. This is not just a filler but a well-thought-out statement. It is the Court’s most precise answer to the act-omission problem that has disturbed euthanasia jurisprudence for decades in the country.

H.L.A. Hart and Tony Honoré, in Causation in the Law, argued that legal liability follows acts more naturally than omissions because acts introduce new causal sequences into the world. Whereas omissions merely fail to interrupt an existing motion. Lord Browne-Wilkinson’s innovation in Bland was to characterise the disconnection of a ventilator physically, a positive act and as an omission to continue treatment, since the underlying cause of death remained the patient’s pre-existing condition, not any new agency introduced by the physician. Justice Pardiwala adopted and extended that reasoning to CANH withdrawal.

In his book “Active and Passive Euthanasia,” James Rachels argued that if the result is the same, there is no moral distinction between acts and omissions. The Court does not engage with Rachels directly. But the word ‘authorised’ points, even if obliquely, to an institutional answer to this challenge, that the moral weight of the distinction lies not in the act or omission itself but in the accountability structure within which it occurs.

What makes the omission “authorised” is the framework surrounding it. Two independent medical boards, family consultation, judicial oversight, and a mandatory palliative end-of-life care plan. The omission is lawful because it is embedded in a structure of institutional accountability. This is the Court’s answer to concerns about arbitrary or unilateral decision-making: the omission is not private or unilateral; it is supervised and documented at every stage.

Reconstructing the Self: Dworkin’s Critical Interests and the Substituted Judgement Standard

Harish had no living will. That single fact is what makes this section of the judgment constitutionally original. The Common Cause framework primarily applies to patients who have pre-signed advance medical directives. Harish, however, had expressed no such preference. The Court was therefore required to apply the ‘substituted judgment standard’, placing itself, as Justice Pardiwala states, in the position of the patient and considering, in a patient-centric manner, what that patient would have wanted if he had retained the capacity to decide.

To do this, the Court reached for non-medical evidence. Harish had been energetic, sports-loving, and active in the gym before his injury. On that basis, the Court concluded he would not have chosen CANH continuation under these circumstances.

This is, without being named as such, a direct application of Ronald Dworkin’s distinction between “critical interests” and “experiential interests” as stated in Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom. Dworkin argued that experiential interests and the pleasures derived from immediate sensation are not the only morally relevant interests a person has. Critical interests, by contrast, are the values and commitments that constitute a life’s overall character, interests that it does make a person’s life genuinely better to satisfy, interests they would be mistaken, and genuinely worse off, if they did not recognise. For Dworkin, these persist even when the person can no longer experience their satisfaction. In the Dworkinian sense, a person who previously valued physical vitality and independence becomes worse off if their critical interests are frustrated by indefinite biological maintenance, which preserves none of the qualities they previously found constitutive of a good life.

The Court reconstructed Harish’s critical interests through lifestyle inference before the accident. Harish’s values can be inferentially established, since his present condition was incapable of expressing any meaningful preferences. Paul Ricoeur called this dimension of selfhood “narrative identity” in Oneself as Another as a Personal identity constituted not by momentary psychological states but by the coherent arc of a life. The Court did exactly this, without acknowledging or mentioning either Dworkin or Ricoeur.

Justice D.Y. Chandrachud’s concurring opinion in K.S. Puttaswamy v. Union of India also states that privacy was located not merely in informational control but in the “autonomy of the individual to make essential choices which affect the course of life”. This is a foundational premise in Harish Rana’s substituted judgment, which is now enacted in the end-of-life context.

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A problem with the substituted judgment standard is that, without being strictly codified in statute with a clear yardstick, it could embed assumptions about class and culture in determining who has access to a dignified death. A person who lived a pre-injury life that could hardly be traced, like someone poor or undocumented, would struggle to have his judgment substituted.

Dignity Beyond the Procedure: Withdrawal as Accompaniment

This case shows that withdrawing treatment is not the same as abandoning the patient. This is why the Court ensures that treatment withdrawal should not lead to abandonment of the patient. It asked AIIMS to come up with a medical palliative care plan for the end of life of Harish.

This is where Emmanuel Levinas, as stated in pertinent work Totality and Infinity, becomes relevant. The Court’s insistence that Harish must be accompanied through death, not to be abandoned, cannot be explained by legal doctrine alone. This is where Levinas becomes relevant, where he argued that the vulnerability of another person creates an ethical demand that no procedure, however lawfully authorised, can exhaust. Seeing another person’s vulnerability creates a moral duty that cannot be reduced to legal formalities. Judicial permission to withdraw treatment does not end the moral relationship between patient, doctor, and family. Their ethical, moral and human responsibilities exist even after. Dignity, once invoked as the constitutional ground for withdrawal, cannot be quietly set aside in the final stages.

Conclusion

The Court, again, strongly urged Parliament to enact a comprehensive statute on end-of-life decision-making. The case of Aruna Shanbaug (2011) made the same request. The Common Cause (2018) made it again. Fifteen years have passed, but the  Legislature remains silent on this aspect. The consequences of legislative silence are real. Every future family that finds itself in the same position as the Rana must now replicate the Rana's two-year ordeal, from the Delhi High Court to the Supreme Court, through the medical boards, and in miscellaneous applications. The same ordeal will follow, as no statutory mechanism fully removes the requirement of judicial authentication. The 2023 simplification of the Common Cause guidelines helped with the procedure. But without a dedicated statute, the right to die with dignity remains, for most Indian families, the right to litigate for the right to die with dignity.

There is also a structural injustice that the Court did not name directly. The Rana family had access to constitutional counsel and huge media attention. Most families will have none of that. The right is real, but access to it is not. That gap will not be closed by another set of judicial guidelines. It requires a Parliament willing to govern this critical aspect.

Harish Rana’s case closed a thirteen-year chapter for his family, but the legal question it leaves open is older and relevant. It asks the pertinent question of how long a constitutional right remains meaningful when it can only be vindicated by those already capable of reaching the Supreme Court.