'Life Support Withdrawal Is About Reducing Suffering, Not Ending Life'

'Families go through turmoil at that time. There is a feeling of guilt and uncertainty, and they do not know what they should be doing.'
'Now that the new judgment has clarified what the procedure is, doctors will be confident enough to talk to the families and explain what is to be done.'

According to legal and medical experts, the Supreme Court's March 2026 judgment in the Harish Rana vs Union of India case, has cleared the confusion from the 2011 Aruna Shanbaug vs Union of India case and the 2018 Common Cause vs the Union of India case.

What is important about the Harish Rana case judgment is that for the first time in India, the Right to Die with dignity has been exercised in practice in India.

It is very important to note what the court says regarding the usage of the term passive euthanasia.

It says Conversely, passive euthanasia is understood as allowing death to occur.

By withdrawing or withholding life support, the physician is not creating a new risk of death.

Rather, the doctors are choosing to allow the underlying fatal condition to take its natural course by no longer continuing the medical intervention that artificially prolonged life.

In this sense, the doctor simply allows the original harm-causing event to run its natural course, returning the patient to their natural path towards death.

The undeniable fact remains that the patient's affliction -- the underlying medical condition -- is not caused by any act or omission of the doctor.

Rather, the underlying condition is due to factors independent of the doctor or their actions.

Another very important observation of the court was that Clinically Assisted Nutrition and Hydration (CANH) is a medical treatment and not primary care.

Dr Nagesh Simha, Medical Director, Karunashraya Institute for Palliative Care Education and Research, Bengaluru discusses the implications of the judgment with Shobha Warrier/Rediff.

Do you consider the Supreme Court ruling in the Harish Rana case a landmark judgment?

Yes, I do consider it a landmark judgment. This ruling improves upon the earlier judgment on 'withholding and withdrawing' procedure.

These two judges, Justice (J B) Pardiwala and Justice (K V) Viswanathan have made everything clearer.

For example, they said that 'Clinically Assisted Nutrition and Hydration' was medical treatment and not primary care.

They have also clearly said that we should stop using the term 'passive euthanasia' as the procedure is withholding and withdrawal of life support system. That term should never be used again.

'Euthanasia can never be passive, it is active'

You feel it gives a negative connotation to the whole process?

One, it is a very old definition. I am of the opinion that euthanasia can never be passive, it is active.

Where you are withholding and withdrawing life support treatment particularly when it is of no use to the patient and continuing that only increases the suffering, you cannot call it euthanasia.

The terminology has changed like many other terms. It is very important to use a better word. When you say, withholding and withdrawing, it prevents unnecessary confusion.

But the term 'passive euthanasia' is used everywhere...

It is not the right term to use. It gives a wrong connotation to the whole process. When you say passive euthanasia, it is like you are killing somebody.

The fact is, you are not killing somebody, you are allowing nature to take its course.

Even after it was legalised in the 2018 judgment, there was a need for the court to make a ruling in 2026 in the case of Harish Rana...

That's okay because there was a need to clarify many points.

The 2026 judgment clarifies a lot of points that were implied in the 2023 five-judge bench judgment.

In fact, the 2023 judgment also modifies and simplifies many points that were there in the 2018 Common Cause vs Union of India judgment.

The judges understood that people could not go to court each time there is a case.

Even though the 2023 judgement has made it easier, the 2026 judgment has clarified and made it more specific.

For example, 'physically assisted nutrition' is medical treatment and not primary care. So, it can be withdrawn if it is felt that it was not going to benefit the patient.

Does that mean people do not have to go to the court every time they have to withhold and withdraw life support system?

Even with the earlier judgment also, you need not go to court every time there is a case.

In the 2023 judgment, the judges had clearly said, you need not go to court unless and until there is a conflict.

For example, the doctors wanted it but the family did not want, or within the family, there is a conflict. Then, you have to go to court.

This judgment is an improvement upon the 2023 judgment. What I mean is, the previous judgment also talks about not going to court each time there is a case like this.

'I don't think a Living Will will make things easier'

Do you feel this clearly shows the importance of a Living Will?

I don't think a Living Will will make things easier. If you look at the country, hardly a few thousand people must have written a Living Will or an Advance Medical Directive.

First, people and the hospitals need to be aware of it. This is the first step which is required. But it is a very slow evolving process.

This two-judge bench has reminded the government that they should do certain things which the previous judgment has also said.

Like, make sure people are aware of where they should send a copy of the Living Will.

Even though you may not have an Advance Medical Directive, there is a system like the Primary and Secondary Medical Board that is in place for withholding and withdrawing life support system.

And even when you have a Advance Medical Directive, you cannot bypass the Primary and Secondary Medical Board.

But it will become a little easier for people to take a decision because the person concerned has already written down his or her desire.

Do you think many families go for the life support system and not palliative care because whether it is children or spouse, they think they are doing their duty better by opting for a life support system? Does guilt play a role here?

There is certainly an element of guilt behind such decisions.

They always think, are we doing something wrong? That is what works in the minds of the family members. I agree that is an important aspect.

Do you think palliative care is misunderstood and there is a lack of awareness among people?

The awareness is much better now. I have been in palliative care for more than 30 years, and I know what the situation was then and what the situation is today.

Today, more and more people are aware of palliative care. Many hospitals have palliative care departments.

Central and state governments have a palliative care policy and the government has made a rule that all medical colleges should have a palliative care department.

After the Narcotic Drugs and Psychotropic Substances Act was amended in 2014, morphine is legally permitted as medically essential for palliative care.

This has made a significant change in palliative care treatment. How much of awareness is there on ground, I don't know.

Yes, there is a long way to go and a lot of improvement has to be made.

Do you think people have the misconception that palliative care is the end of life?

That is a well known misconception. Apart from the misconception, it is the way it is communicated by the medical profession. So, doctors need to know the importance of palliative care.

In many countries, doctors have to undergo training on how to talk to patients about many things. In India also, they have introduced that but it is still a long way to go.

'Putting a person on life support and prolonging his or her misery is unethical'

Do you agree that by putting patients onto life support system, you are doing an injustice to them as it increases their suffering?

Of course, you are doing an injustice to the patients. Putting a person on life support and prolonging his or her misery is unethical.

I am not counting on the expenditure the families have to bear. I will not bring money into the picture.

So, families need to understand?

Yes, families need to understand but families go through a turmoil at that time. There is a feeling of guilt and uncertainty, and they do not know what they should be doing.

Now that the new judgment has clarified what the procedure is, doctors will be confident enough to talk to the families and explain what is to be done.

So, the hospitals and doctors need not to be worried as withholding and withdrawing life support system is not illegal.

Feature Presentation: Rajesh Alva/Rediff