Passive euthanasia permitted only in limited cases, with High Court oversight and medical safeguards before life support withdrawal.

Passive euthanasia was recognised as legally permissible in India only in limited cases where life-sustaining treatment is futile and continuation is not in the patient's best interest. Active euthanasia remained unlawful, and the Court rejected any general right to die under Article 21. For an incompetent patient with no prior directive, withdrawal of life support could be considered by close relatives or doctors only with mandatory High Court approval after independent medical opinion and hearing the relevant parties. The patient was not treated as dead because she was not brain dead, so feeding could not be stopped on that basis. The Court issued prospective safeguards until Parliament acts.

---

---

Issues: (i) whether passive euthanasia, namely withholding or withdrawal of life-sustaining treatment in a permanent vegetative state, can be permitted in India and in what circumstances; (ii) who is competent to decide withdrawal of life support for an incompetent patient and whether prior approval of the High Court is required; (iii) whether the patient in question could be treated as already dead for the purpose of discontinuing feeding.

Issue (i): whether passive euthanasia, namely withholding or withdrawal of life-sustaining treatment in a permanent vegetative state, can be permitted in India and in what circumstances

Analysis: The distinction between active and passive euthanasia was accepted. Active euthanasia was held to remain unlawful in India, while passive euthanasia was held to be legally permissible in limited circumstances where treatment is futile and continued life support is not in the best interest of the patient. The Court treated the principle of self-determination and the best-interest standard as the governing considerations, but rejected any right to die under Article 21.

Conclusion: Passive euthanasia was held permissible in India only in restricted cases subject to safeguards, but the petitioner was not entitled to direct withdrawal of life support on the facts.

Issue (ii): who is competent to decide withdrawal of life support for an incompetent patient and whether prior approval of the High Court is required

Analysis: For an incompetent patient who has not expressed any prior wish, the decision may be taken by the parents, spouse, close relatives, next friend, or treating doctors, but the Court held that this decision cannot be left solely to them because of the risk of misuse. Applying the doctrine of parens patriae, the Court held that the High Court must grant approval before life support is withdrawn, after obtaining a report from a panel of doctors and hearing the State and close relatives. The Court also held that, on the facts, the KEM Hospital staff was the real next friend of the patient and that their wish was to continue treatment.

Conclusion: Prior approval of the High Court was made mandatory for withdrawal of life support in such cases, and no such approval was warranted on the facts before the Court.

Issue (iii): whether the patient in question could be treated as already dead for the purpose of discontinuing feeding

Analysis: The medical material showed that the patient was not brain dead. She had spontaneous respiration, circulation, swallowing ability, and some limited responses, though she remained in a permanent vegetative state with severe brain damage. The Court therefore held that she could not be regarded as dead merely because her condition was irreversible.

Conclusion: The patient was held not to be dead, and feeding could not be stopped on that basis.

Final Conclusion: The writ petition failed, but the Court laid down prospective guidelines permitting passive euthanasia in India in limited cases only through High Court oversight and medical safeguards until Parliament enacts a law.

Ratio Decidendi: Passive euthanasia may be lawfully permitted for an incompetent patient in a permanent vegetative state only when discontinuance of life support is in the patient's best interest and is approved by the High Court after obtaining independent medical opinion and hearing the concerned parties.

---