India’s passive euthanasia framework, extended at last to adults, says nothing about terminally ill children. That silence is not an oversight. It is a choice and one that can no longer be defended.
Somewhere in India right now, a child is dying. Not quickly, not painlessly, but in the prolonged, managed way that modern medicine makes possible — sustained by machines, sedated against suffering, their body kept technically alive while any meaningful life has already receded. The parents are present. The physicians are present. The court is not, because there is no legal mechanism for it to be. And the child, who cannot speak, has no one in the room whose sole obligation is to them.
This is not a hypothetical situation. It is the condition that Indian law has structurally produced, and one that the Supreme Court’s recent judgment in the Harish Rana case, however significant in its own right, does nothing to resolve.
The Rana judgment matters. It permitted the withdrawal of life support from a man who had remained in a persistent vegetative state for over 12 years. In doing so, it corrected a formalistic error by the Delhi High Court, which had classified the removal of a feeding tube as impermissible active euthanasia. The ruling reaffirms what Common Cause v. Union of India (2018) had already established: that the right to die with dignity is integral to Article 21 of the Constitution. This is sound law, and it comes not a moment too soon.
But the architecture of Indian euthanasia jurisprudence constructed through Aruna Shanbaug (2011), Common Cause (2018), and now Rana, is built entirely around the adult patient. The 2018 judgment expressly limits advance directives to persons of majority and sound mind. For children, the law provides no structured pathway, no mechanism for judicial oversight, no defined standard for weighing competing claims, and no independent voice for the patient. What it provides is silence.
That silence has a misleading quality. No Indian court has ever received a petition seeking passive euthanasia for a minor. This might seem to suggest that the question does not arise clinically. It does not. What it reflects is that the legal architecture makes such a petition nearly impossible to bring, and nearly impossible to adjudicate if brought. The absence of litigation here is not evidence of an absence of need. It is evidence of structural foreclosure and foreclosure is not the same as resolution.
The United Kingdom confronted this question publicly and painfully in the cases of Charlie Gard (2017) and Alfie Evans (2018), both infants with catastrophic neurological conditions whose parents sought to continue life-sustaining treatment against medical advice. These cases went all the way to the European Court of Human Rights, which declined to intervene in both, finding no arguable violation of the Convention. At every level, UK courts held that withdrawal of treatment was in the child’s best interests. What made this determination possible was not judicial wisdom alone, but the court’s inherent jurisdiction exercised within the framework of the Children Act 1989, and crucially, the appointment of independent legal representation for the child. The child’s interests were adjudicated separately from those of the parents and the hospital. Someone in that courtroom spoke only for the child.
Belgium and the Netherlands have gone considerably further, permitting active euthanasia for minors under defined conditions. These frameworks are not directly transplantable to India, and the piece does not argue that they should be. What they demonstrate, along with the UK model, is a common underlying principle: that a child’s dignity constitutes a distinct legal interest that requires structured adjudication. It cannot simply be absorbed into parental preference or medical discretion and left there.
Article 21 protects the right to life and personal liberty of every person. That word “every” does not exclude minors. The Supreme Court’s own jurisprudence has consistently recognised children as independent rights-bearing subjects: in the right to free and compulsory education under Article 21A, in the juvenile justice framework, in the progressive elaboration of child welfare standards under Articles 38 and 39. Children are not legally invisible in India. They are legally invisible in this one, consequential domain.
India has also ratified the United Nations Convention on the Rights of the Child, which requires that the best interests of the child be treated as a primary consideration in all actions concerning them, and that children of sufficient maturity be afforded the right to express their views in matters that affect them. Neither principle is reflected in the current euthanasia framework. To put it plainly: India has ratified an international instrument that obliges it to hear the child and then built a domestic legal structure in which the child cannot be heard at all.
The Harish Rana judgment creates a moment not a mandate, a genuine opening for Parliament to act. The legislative task is not to resolve the ethics of end-of-life care for children, which are contested and properly so. It is to create a framework within which those ethics can be adjudicated with rigour, consistency and accountability.
That framework requires several things. A distinct judicial pathway for cases involving terminally ill minors, separate from the adult mechanism, with clear procedural steps and defined timelines. A graduated standard for assessing a child’s capacity to participate in medical decision-making drawing, as English courts have long done, on the Gillick competence doctrine, which recognises that older adolescents may possess the understanding to form and express meaningful medical preferences. A codified best interests standard for children who cannot express those preferences, with explicit reference to dignity, relief from suffering, and quality of life, rather than leaving courts to improvise on the basis of general principle. And, most urgently, a statutory requirement for independent legal representation for the child in any such proceeding so that at least one voice in the room belongs to no one but the patient.
These proposals are not radical. They do not advocate for any particular outcome in any individual case. They do not require India to adopt the Belgian or Dutch model, or to go beyond passive euthanasia, or to override parental authority wholesale. They ask only that when a child is dying and the question of how they die must be answered by a court, the court should have a framework to answer it, and the child should have someone to speak for them.
Law’s silence is never neutral. When a statute does not exist, something still happens, decisions still get made, treatments still get withdrawn or prolonged, families still arrive at an outcome. The difference is who makes those decisions, and on what basis, and with what accountability. In the current legal vacuum, end-of-life decisions for children in India are made informally, inconsistently, and without any mechanism for the child’s interests to be independently assessed or independently represented. That is not a situation the Constitution tolerates for adults. There is no principled reason it should tolerate it for children.
The Harish Rana judgment makes plain that the question of dying with dignity is one Indian law takes seriously. The question now is whether it takes it seriously for everyone.
Urvashi Prasad is the Director, PAVANA Centre, Pahlé India Foundation and Ankeetaa Mahesshwari is a Regional Director, West, Pahlé India Foundation, a New-Delhi based think tank.
Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth