New Delhi, March 11 -- Invoking the timeless Shakespearean dilemma of "to be or not to be" in India's first judicially sanctioned case of passive euthanasia, the Supreme Court on Wednesday permitted the withdrawal of life-sustaining medical treatment for a 32-year-old man who has remained in a permanent vegetative state for more than a decade, holding that life-sustaining medical treatment cannot be prolonged when it no longer serves the patient's best interests or dignity. A bench of Justices JB Pardiwala and KV Viswanathan, in separate but concurring judgments running into 338 pages, allowed the plea filed by the parents of Harish Rana, directing that clinically assisted nutrition and hydration (CANH) being administered to him be withdrawn under a structured palliative care plan at the All India Institute of Medical Sciences (AIIMS), Delhi. The bench emphasised that the decision was not about choosing death but about refusing to artificially prolong life where medical treatment had ceased to serve any therapeutic purpose. "Our decision today does not neatly fit within logic and reason alone. It sits in a space between love, loss, medicine and mercy. This decision is not about choosing death, but is rather one of not artificially prolonging life. It is the decision to withdraw life sustaining treatment when that treatment no longer heals, restores, or meaningfully improves life.because survival is not always the same as living," said the bench. Rana, a former Panjab University student and currently a resident of Ghaziabad in Uttar Pradesh, suffered catastrophic head injuries in 2013 after falling from the fourth floor of his paying guest accommodation. Since then, he has remained completely unresponsive and bedridden, dependent on feeding tubes for nutrition and hydration. Although he is not on mechanical ventilation, he requires round-the-clock care and has shown no neurological improvement for more than ten years. After years of treatment and therapy, his parents approached the Supreme Court seeking permission to withdraw life-sustaining treatment, contending that continued medical intervention served no therapeutic purpose and merely prolonged suffering. During the course of proceedings, the court ordered multiple medical evaluations and also interacted personally with Rana's family. The judgment on Wednesday answered a crucial legal question that arose in the case -- whether clinically assisted nutrition and hydration can be treated as medical treatment capable of withdrawal under the passive euthanasia framework recognised in the top court's 2018 Common Cause ruling. Both the judges held that CANH cannot be regarded as basic care. "The clinical and procedural characteristics of CANH 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 prescribed, supervised and periodically reviewed by trained healthcare professionals," said the judgment authored by Justice Pardiwala. Since Rana's survival depended on CANH administered through a surgically installed PEG tube, the court held that its continuation involved an ongoing clinical decision-making process and therefore qualified as medical treatment. The court also elaborated on the "best interest of the patient" principle, which governs decisions relating to withdrawal of treatment in cases where patients are incapable of making decisions themselves. Justice Pardiwala explained that the inquiry is not about deciding whether a patient should die but about determining whether life should continue to be prolonged by medical intervention. "The correct inquiry is not whether it is in the best interests of the patient that he should die, but rather whether it is in the best interests of the patient that his life should be prolonged by the continuance of such forms of medical treatment," he wrote. The decision must involve a holistic assessment of both medical and non-medical considerations, including whether treatment has become futile, whether it merely prolongs suffering, and what the patient himself might have chosen had he been capable of expressing a view. Justice Viswanathan, in his concurring opinion, similarly held that the best interest test requires a careful balancing of multiple factors. "There is a strong presumption in favour of preservation of life grounded in the sanctity of life principle," he wrote, adding that this presumption can be displaced where continuation of treatment no longer serves the patient's welfare. Among the factors to be considered are whether the treatment serves any therapeutic purpose, whether it causes indignity to the patient, the futility of treatment, the opinion of medical experts and the views of family members. In the present case, both the primary and secondary medical boards unanimously concluded that Rana's condition was irreversible and that continuation of CANH served no therapeutic purpose. Justice Pardiwala noted that ordinarily, once both boards concur on withdrawal of treatment, court intervention is not necessary. However, the Supreme Court examined the case in detail because it is the first instance where the Common Cause guidelines are being fully implemented. The court recorded that Rana's parents and siblings had cared for him tirelessly for more than 12 years before approaching the court. "For the past thirteen years, the applicant has lived a life defined by pain and suffering. his family never left his side," Justice Pardiwala wrote, describing their devotion as "a testament to the true meaning of love." Justice Viswanathan also acknowledged the emotional burden borne by the family, observing that they had "left no stone unturned in ensuring best treatment for Harish" before approaching the court to relieve him from suffering. The judgment stressed that withdrawal of life-sustaining treatment must not amount to abandonment of the patient. Instead, it must mark a transition from curative treatment to structured palliative and end-of-life care aimed at alleviating pain and preserving dignity. "The withdrawal or withholding of treatment must not result in the abandonment of the patient," said Justice Pardiwala, adding that it should be implemented through a medically supervised palliative care plan to manage symptoms and minimise suffering. Allowing the application, the court directed AIIMS to admit Rana to its palliative care unit so that the withdrawal of CANH can be carried out under medical supervision. It waived the 30-day reconsideration period prescribed under the Common Cause guidelines because the medical boards and family members were unanimous in their view. The court also issued directions to streamline the procedure for passive euthanasia cases across the country. Chief medical officers of districts have been directed to maintain panels of qualified doctors who can be nominated to medical boards examining such cases, while High Courts have been asked to instruct magistrates to receive statutory intimation from hospitals where withdrawal of treatment is approved. The bench further urged the Union government to enact a comprehensive law on end-of-life care, noting that the absence of legislation has forced courts to fill the vacuum. "The prolonged absence of a comprehensive legislation on end-of-life care has compelled this Court, time and again, to step in to fill the vacuum," Justice Pardiwala said, urging Parliament to provide a clearer statutory framework....