While the Supreme Court has allowed India’s first case of passive euthanasia for 32-year-old Harish Rana, in a vegetative state for over 12 years, the debate over withholding or withdrawing life-sustaining treatment dates to the 2011 Aruna Shanbaug case. It is about the nurse who spent 42 years in a vegetative state following a sexual assault.In 1973, a hospital janitor at Mumbai’s KEM Hospital sexually assaulted her, strangling her with a metal dog chain. She remained in a vegetative state until dying of pneumonia in 2015 at age 66.Journalist Pinki Virani filed a petition before the Supreme Court, requesting that life support given to Shanbaug be withdrawn, arguing that she had the right to die with dignity.In its 2011 judgment in Aruna Ramchandra Shanbaug v Union of India, the apex court rejected the plea as hospital staff opposed it. Yet it issued a landmark ruling, recognising passive euthanasia under strict safeguards and judicial approval.Dr Sandeep Dewan, Senior Director of Critical Care and Chairman of ECMO Programme at Fortis Gurgaon, commented: “This judgment could significantly impact end-of-life care in Indian ICUs. Many patients linger in prolonged vegetative states with no quality of life, sustained only by artificial support. The ruling balances life preservation with dignity, offering clearer pathways for families and doctors to make compassionate decisions.”Dr Niraj Tyagi, consultant at Institute of Critical Care Medicine, Sir Ganga Ram Hospital, noted that while some countries permit active euthanasia under regulation, India allows only life-support withdrawal in limited cases with strict oversight.Citing the Netherlands, Belgium, Canada, and parts of the US — where euthanasia or physician-assisted dying is legal under frameworks — he explained: “India adopts a cautious model reflecting social realities, permitting only passive euthanasia via withdrawal or withholding of support under court-established safeguards. Active euthanasia remains illegal.”In other countriesSwitzerland legalised assisted dying in 1942 on the condition the motive is not selfish, making it the first country in the world to permit the practice. In the US, assisted dying is legal in 10 states: California, Colorado, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington, plus the District of Columbia.In the Netherlands, the “Termination of Life on Request and Assisted Suicide (Review Procedures) Act” came into effect in 2002. Here, a doctor cannot be punished for euthanasia in cases where patients are experiencing “unbearable suffering with no prospect of improvement”.