This article examines whether artificial nutrition and hydration should be classified as medical treatment under Indian constitutional law, and argues that the answer may redefine the scope of dignity under Article 21 in end-of-life decision-making.

On the morning of 16 March, a quiet moment of forgiveness beside Harish Rana brought into focus a difficult question that modern law can no longer avoid. His parents stood close to the son they had cared for through more than thirteen years of suspended life. Medical technology had kept his body alive with clinical precision. Artificial nutrition and hydration sustained him. Tubes delivered oxygen and nourishment. Yet the person they once knew had long been absent. There was no awareness, no voluntary movement, no recognition of the world around him. A Brahma Kumaris sister gently placed a tilak on his forehead and spoke softly, asking him to forgive those who might have wronged him and to seek forgiveness from others. For a brief moment the room seemed to move beyond medicine and enter a quieter space shaped by faith, reflection and the human instinct for reconciliation. That moment, deeply human and profoundly still, forces us to confront one of the most difficult questions of modern constitutional law: when medicine can prolong biological life indefinitely, what does dignity require?

The central legal question, therefore, is whether the continuation of artificial nutrition and hydration is an obligation of care or a form of medical treatment capable of lawful withdrawal.

Thirteen Years Between Life and Death

Harish Rana had been a young engineering student in 2013 when a fall from the fourth floor of his accommodation caused a devastating brain injury. Doctors later described his condition as a persistent vegetative state. The injury eliminated the possibility of conscious awareness, even though modern medicine could continue to sustain the body’s biological functions through tracheostomy support, catheterisation and clinically assisted nutrition and hydration delivered through a PEG tube. For thirteen years his parents lived with a form of suspended time. Their lives revolved around hospital consultations, medical procedures and the relentless routine of caregiving. Medicine allowed the body to survive, but it could not restore the life that had once animated it. After years of caring for him, his parents eventually turned to the Supreme Court seeking clarity on a question that increasingly confronts families and doctors in the age of advanced medical technology. Their petition in Harish Rana v Union of India [1] did not ask the Court to sanction euthanasia. Instead, it raised a narrower but crucial issue: whether clinically assisted nutrition and hydration should be treated as medical treatment rather than basic care. If artificial feeding is classified as medical treatment, its continuation can be evaluated under the principle of the patient’s best interests. In certain circumstances, the withdrawal of such treatment may become legally permissible.

The classification of artificial nutrition and hydration ultimately turns on whether its continuation serves a therapeutic purpose or merely sustains biological existence. Where intervention ceases to offer curative or palliative value and functions only to prolong the physiological process of dying, its legal character begins to shift from care to medical treatment.

What appears to be a technical legal question is in fact one of the most profound dilemmas created by modern medicine.

When Medicine Outruns Law

For most of human history death arrived with a certain inevitability. Illness ran its course and life came to an end. Families gathered around the dying and rituals were performed. Advances in medical science have altered that reality in ways earlier generations could scarcely have imagined. Ventilators, feeding tubes and intensive care technologies can sustain biological life long after the possibility of recovery has disappeared.

Modern medicine can prolong the mechanics of life. The law must decide whether it can also protect the meaning of life.

It is important to distinguish between three related but distinct concepts: the withdrawal of life-sustaining treatment, the refusal of treatment, and euthanasia. Indian law has cautiously recognised the first two under constitutional safeguards, while continuing to prohibit the third. The present question concerning artificial nutrition and hydration falls within the first category.

In Indian constitutional law, a critical distinction has emerged between “active euthanasia” (an affirmative act to end life) and “passive euthanasia” (withdrawal or withholding of life-sustaining treatment). The latter has been judicially recognised under strict safeguards, particularly where continuation of treatment serves no therapeutic purpose and merely prolongs biological existence.

The Supreme Court of India has approached this question slowly, cautiously and sometimes reluctantly. The constitutional conversation about the right to die began in P. Rathinam v Union of India [2], where the Court briefly held that the criminalisation of attempted suicide under Section 309 of the Indian Penal Code violated constitutional liberty. That reasoning was soon reconsidered in Gian Kaur v State of Punjab [3], where a Constitution Bench rejected the existence of a fundamental right to die. Yet even while rejecting that claim, the Court observed that the right to life under Article 21 includes the right to live with dignity, and that dignity cannot be entirely separated from the process of dying.

The issue resurfaced dramatically in Aruna Ramachandra Shanbaug v Union of India [4]. In that case the Court cautiously recognised passive euthanasia under strict safeguards, allowing the withdrawal of life-sustaining treatment in exceptional circumstances subject to judicial oversight. A more decisive step came in Common Cause v Union of India [5] when a Constitution Bench recognised the legality of advance medical directives, or living wills. Individuals were permitted to declare in advance that they did not wish to be kept alive through artificial medical intervention if they lost decision-making capacity.

Taken together, these decisions suggest that the Court has moved from rejecting a “right to die” toward recognising a limited right to refuse life-sustaining medical treatment.

The reasoning in Common Cause drew strength from the Court’s broader articulation of personal autonomy and privacy in K.S. Puttaswamy v Union of India [6], as well as earlier recognition of bodily autonomy in Suchita Srivastava v Chandigarh Administration [7]. Article 21 jurisprudence has increasingly located dignity at the intersection of autonomy, bodily integrity, and decisional control. End-of-life choices lie precisely at this intersection, where the individual’s interest in self-determination must be balanced against the State’s interest in preserving life.

Even this framework proved difficult to implement in practice. Hospitals struggled with procedural requirements and families often found the process cumbersome. In 2023 the Supreme Court simplified the procedure governing living wills by allowing them to be attested by a notary or gazetted officer rather than requiring certification by a judicial magistrate [8]. The proceedings in Harish Rana therefore represent another step in this evolving constitutional conversation.

India’s Cautious Middle Path

India has chosen a cautious middle path. Passive euthanasia, understood as the withdrawal of life-sustaining treatment under strict safeguards, is permitted. Active euthanasia remains unlawful.

Unlike jurisdictions that have adopted statutory regimes, India continues to rely primarily on judicially evolved safeguards in this area.

The question whether artificial nutrition and hydration constitutes treatment has been directly examined in comparative jurisprudence. In Airedale NHS Trust v Bland [9], the House of Lords held that the withdrawal of artificial feeding from a patient in a persistent vegetative state could be lawful, treating such intervention as medical treatment rather than basic care. The underlying principle is that the law does not require the continuation of treatment that confers no meaningful benefit on the patient.

Ancient Questions, Modern Dilemmas

Indian philosophical traditions have long reflected on the meaning of death. Jain thought recognises the practice of Sallekhana, a voluntary fast undertaken at the end of life as a form of spiritual discipline. Before embracing it the practitioner traditionally seeks forgiveness from all beings and grants forgiveness in return. Hindu traditions recognise Prayopavesa, while Buddhist philosophy speaks of liberation from suffering in Mahaparinirvana. These traditions cannot simply be translated into constitutional doctrine, yet they remind us that the ethical questions surrounding death are neither new nor uniquely Western.

The tension between religious practice and criminal law surfaced in Nikhil Soni v Union of India [10], where the Rajasthan High Court characterised the Jain practice of Sallekhana as suicide before the Supreme Court stayed that ruling [11].

The Question That Remains

The Supreme Court’s evolving jurisprudence suggests that the Constitution is slowly confronting a difficult truth: preserving biological life and preserving human dignity are not always the same thing.

In such situations, decision-making shifts toward a “best interests” standard, requiring an assessment of whether continued intervention serves the patient’s welfare in any meaningful sense.

Yet law alone cannot resolve this dilemma. India still struggles to speak openly about death. Families avoid discussing end-of-life decisions, hospitals lack clear institutional frameworks and doctors often fear legal consequences if life-sustaining treatment is withdrawn.

For practitioners, the issue is no longer abstract. Hospitals, families, and legal advisors increasingly confront questions of consent, substituted decision-making, and institutional liability. The classification of artificial feeding will directly shape clinical protocols and legal risk.

The Law Commission of India, in its 196th and 241st reports [12], recommended legislation governing passive euthanasia and advance directives. Comprehensive legislation has yet to emerge.

When forgiveness was sought beside Harish Rana on the morning of 16 March, the moment carried a quiet dignity that no statute can fully capture. In that quiet room the law encountered a question older than any constitution: what does dignity require when life itself has already departed?

There is a growing recognition that dignity may, in certain circumstances, require allowing the process of dying to proceed without artificial prolongation. The resolution of this question will likely shape the future contours of dignity under Article 21 in its most fragile and contested application.

Endnotes

*Rishabh Gandhi Advocate, Bombay High Court. Former judge. His doctoral research examines the ethical and legal dimensions of religious death practices and euthanasia. He can be reached at rishabh@rgaa.co.in

[1] Harish Rana v Union of India, Writ Petition (Civil) – pending before the Supreme Court of India.

[2] P. Rathinam v Union of India, (1994) 3 SCC 394.

[3] Gian Kaur v State of Punjab, (1996) 2 SCC 648.

[4] Aruna Ramachandra Shanbaug v Union of India, (2011) 4 SCC 454.

[5] Common Cause v Union of India, (2018) 5 SCC 1.

[6] K.S. Puttaswamy v Union of India, (2017) 10 SCC 1.

Suchita Srivastava v Chandigarh Administration, (2009) 9 SCC 1.

[8] Common Cause v Union of India (clarification on advance directives), (2023) SCC OnLine SC 373.

[9] Airedale NHS Trust v Bland [1993] AC 789 (HL).

[10] Nikhil Soni v Union of India, 2015 SCC OnLine Raj 2612.

[11] Union of India v Nikhil Soni, SLP (C) No. 18889/2015 (Supreme Court, stay order dated 31 August 2015).

[12] Law Commission of India, Report No. 196 (2006), Medical Treatment to Terminally Ill Patients (Protection of Patients and Medical Practitioners); Report No. 241 (2012), Passive Euthanasia.