Guardianship In Limbo: India's Legal Silence On Patients In Comatose And Vegetative States
India's legal and policy landscape concerning disability rights has undergone significant transformation in recent years, most notably with the enactment of the Rights of Persons with Disabilities Act, 2016 (RPwD Act), which marked a shift from a medical to a social model of disability[1]. Aligned with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) 2006, this legislation emphasizes autonomy, dignity, and inclusion of persons with disabilities in all spheres of life. Complementing this are statutes such as the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 ((hereinafter, 'National Trust Act'), which provides for guardianship for persons with specified 'intellectual' and 'developmental disabilities', and the Mental Healthcare Act, 2017, which establishes provisions for the appointment of a 'nominated representative' for persons with mental illness.
Despite notable legislative advances, a critical legal vacuum remains. As Disability Pride Month encourages reflection on disability rights and inclusion, it is imperative to acknowledge that India's guardianship framework—fragmented across multiple statutes—fails to address the needs of individuals in vegetative states, comas, or total medical incapacity. This is not merely an administrative lapse but a significant constitutional omission warranting urgent legislative reform. Families navigating such incapacities face complex legal hurdles and are often forced to seek ad hoc judicial relief under the courts' parens patriae jurisdiction, highlighting the absence of a codified mechanism for this vulnerable population. Against this backdrop, this article interrogates the limitations of the existing guardianship regime, examines its practical implications, and advocates for a rights-based, structured legal response. .
Current Legal Guardianship Framework in India and Its Critical Gaps
The legal framework is underpinned by four key statutes, none of which adequately provide for guardianship in cases of medical incapacity resulting from catastrophic health events such as strokes or traumatic brain injuries.
The Guardians and Wards Act, 1890 [2] remains the foundational secular statute governing guardianship, but its applicability is expressly limited to minors under Section 7, thereby excluding incapacitated adults. This statutory limitation was explicitly acknowledged by the Law Commission of India[3], which observed that “the Guardians and Wards Act, 1890 deals with appointment of guardians for minors only. There is no comprehensive legislation that deals with guardianship of elderly persons who are incapacitated to take decisions or manage their affairs”.
The National Trust Act, 1999 [4] provides guardianship mechanisms only for persons with specific disabilities such as autism, cerebral palsy, mental retardation, and multiple disabilities, excluding those rendered incapacitated by other medical conditions.
Similarly, the Rights of Persons with Disabilities Act, 2016[5] allows for "limited guardianship" under Section 14, but only for individuals with recognised disabilities who can participate in joint decision-making. This model of guardianship—predicated on mutual understanding—renders it inapplicable to patients who are non-communicative due to coma or vegetative states.
Lastly, the Mental Healthcare Act, 2017 [6], which superseded the Mental Health Act, 1987, significantly reoriented its focus towards promoting patient autonomy and reducing stigma associated with mental illness. However, the Act's scope remains limited to individuals with diagnosed mental illness, leaving a substantial gap for those incapacitated by medical conditions without formal psychiatric diagnoses.
Moreover, even for individuals who meet the statutory definition of mental illness, the protections provided under the Act remain limited. While it allows for the appointment of 'nominated representatives' to assist with healthcare decisions, it falls short of offering comprehensive guardianship over property matters, legal proceedings, and broader aspects of daily life. This limitation creates a dangerous dichotomy where individuals may receive appropriate healthcare support while their financial and legal affairs remain unprotected.
The cumulative effect of these legislative limitations is a critical legal void, leaving families without recourse to access financial resources, manage affairs, or make essential decisions on behalf of incapacitated loved ones. The absence of a legal mechanism for adult guardianship in cases of medical incapacity poses significant ethical, financial, and administrative challenges and urgently necessitates legislative reform.
Judicial Response: Parens Patriae in Practice
In response to a legislative vacuum concerning the guardianship of individuals in comatose states, Indian High Courts have invoked the 'parens patriae' doctrine under Article 226 of the Constitution. This doctrine, meaning "parent of the nation," empowers the state to act as a guardian for those unable to care for themselves. While delving upon the concept, the Constitution Bench of Supreme Court in Charan Lal Sahu V. Union of India 1989[7] defined the doctrine as:
“Parens patriae is the inherent power and authority of a legislature to provide protection to the person and property of persons non sui juris, such as minor, insane, and incompetent persons, but the words parens patriae meaning thereby 'the father of the country', were applied originally to the King and are used to designate the State referring to its sovereign power of guardianship over persons under disability. Parens patriae jurisdiction, it has been explained, is the right of the sovereign and imposes a duty on the sovereign, in public interest, to protect persons under disability who have no rightful protector.”
A landmark moment in this context came in the case of Shobha Gopalakrishnan v. State of Kerala 2019[8], where the Division Bench of the Kerala High Court, comprising Justices P.R. Ramachandra Menon and N. Anil Kumar, addressed the urgent pleas of two families whose breadwinners were in comatose conditions. The Court noted that such patients did not fall under the scope of "multiple disabilities" as defined in the National Trust Act, 1999, and that no statutory mechanism existed for the appointment of guardians for individuals in such conditions. Exercising its 'parens patriae' jurisdiction under Article 226, the Court laid down a detailed 14-point guideline[9] to serve as an interim measure until comprehensive legislation could be enacted to fill the legal void.
Further, Bombay High Court in Rajni Hariom Sharma v. Union of India 2020[10] reinforced this judicial trend, observing that patients in vegetative states have fundamental rights to live with dignity and that spouses have "legal, moral, familial and societal obligations" to care for them. The court highlighted the absence of statutory provisions and noted that people have no option but to approach courts under Article 226 for relief.
Similarly, Madras High Court in S. Sasikala v. State of Tamil Nadu 2024[11] not only appointed a wife as guardian but specifically permitted property disposal for medical expenses, recognising the financial burden of long-term care.
In Mayuresh Dipak Nadkarni vs. Union of India & Ors. (Writ Petition No. 140 of 2024)[12], the Bombay High Court (per G.S. Kulkarni, J.) addressed similar issues. It considered the Mental Healthcare Act, 2017; the Rights of Persons with Disabilities Act, 2016; the National Trust Act, 1999; and relevant Supreme Court judgments (Charan Lal Sahu and Shafin Jahan) and noted:
“It is thus quite clear that in the circumstances as in the present case, the Courts have consistently taken a view of the legal vacuum created by non-availability of adequate provisions under the Mental Health Care Act, 2017 as also under the Hindu Minority and Guardianship Act, 1956 and the other laws as discussed hereinabove. The High Courts in such cases have exercised jurisdiction under Article 226 to appoint legal guardian of a person who is suffering with serious medical disabilities also in the interest of the very survival of such person who is completely dependent on others”.
Recently, the Orissa High Court in Epari Sushma v. State of Odisha 2025[13] delivered a culturally nuanced judgment drawing upon ancient Indian philosophical concepts of "Ardhangini" (the wife as the other half) to justify comprehensive guardianship appointment. Justice Sanjeeb Kumar Panigrahi observed that,
"when a husband falls into a comatose or vegetative state, losing the ability to exercise reason, make decisions, or act on his own behalf, there can be no person more naturally, morally, or legally suited than the wife to act as his guardian"
While these judicial interventions have provided necessary interim relief, they also underscore the pressing need for a coherent, codified legislative framework to ensure consistent and comprehensive protection for medically incapacitated individuals
International Approaches: Comparative Models of Guardianship
Several jurisdictions offer clear, structured responses to medical incapacity through dedicated legislation:
The Mental Capacity Act 2005[14](UK) is widely regarded as comprehensive model for mental capacity legislation[15]. The Act provides a complete statutory framework for decision-making on behalf of adults who lack mental capacity. Notably, Section 2 defines incapacity as an inability to make decisions caused by an impairment of the mind or brain, regardless of whether the condition is temporary or permanent. Specifically, Sections 16-20 establish the 'Court of Protection' with comprehensive jurisdiction to appoint deputies for personal welfare and property affairs. The Act explicitly covers all persons aged 16 and over who lack mental capacity for specific decisions, including those in comatose or vegetative states.
The UGCOPAA, finalized in 2017 (USA)[16], represents modern American best practices in guardianship law. The Act emphasizes person-centered planning and least restrictive alternatives, requiring courts to consider supported decision-making before imposing guardianship. Section 301 provides for the appointment of guardians only when, due to an identified condition, the individual is unable to meet essential health and safety needs and guardianship is necessary for ongoing care. Section 310 allows courts to appoint emergency guardians without prior notice when urgent action is required to prevent serious harm to an individual's health or welfare —such as in cases of coma resulting from trauma or stroke.
Some states have embraced a much broader 'protective arrangements' framework under Article 5 (UGCOPAA) as alternatives to full guardianship, allowing courts to address specific problems with limited interventions. The Act explicitly covers individuals in persistent vegetative states and comas under its broad functional definition of incapacity.
Canada: Provincial Adult Guardianship Frameworks
Ontario's Substitute Decisions Act, 1992[17] provides comprehensive coverage for mentally incapable adults. The Act distinguishes between guardianship of the person (personal care decisions) and guardianship of property (financial affairs), allowing tailored appointments based on individual needs.
British Columbia's Adult Guardianship Act 1993[18], incorporates Statutory Property Guardianship under Part 2.1, enabling the Public Guardian and Trustee to assume financial management for incapacitated adults. The Act's Section 2 principles emphasize least restrictive intervention and presumption of capacity.
These international examples illustrate that comprehensive guardianship frameworks can be effectively designed to uphold both the autonomy and dignity of individuals with medical incapacity, while also providing robust legal protection and support.
Proposed Constitutional and Legal Framework
To address the legal void in guardianship for adults incapacitated by catastrophic medical events, targeted amendments should be introduced across the relevant statutes. The Mental Healthcare Act, 2017 should be revised to allow for the appointment of representatives not only for those with diagnosed mental illness but also for individuals who are medically incapacitated and unable to make or communicate decisions, with provisions for managing both personal and property matters. Further, the Rights of Persons with Disabilities Act, 2016 should broaden the scope by expanding Section 14 to include temporary or permanent medical incapacity resulting from catastrophic health events, and permit the appointment of full guardians where joint decision-making is not possible. Similarly, the National Trust Act, 1999 should be amended to encompass all forms of medical incapacity, ensuring that guardianship mechanisms are available for adults incapacitated by conditions beyond the currently specified disabilities. These amendments should incorporate safeguards such as judicial oversight, periodic review, and adherence to the least restrictive alternative principle, thereby protecting the dignity and rights of incapacitated individuals while providing families with essential legal recourse.
Conclusion and Call for Immediate Action
The absence of a statutory framework for guardianship of persons in vegetative, comatose, or completely disabled states exposes a critical gap in India's disability rights regime. Though courts, invoking the parens patriae doctrine, have offered interim relief—as seen in cases from Shobha Gopalakrishnan (2019) to Epari Sushma (2025)—they have repeatedly underscored the temporary nature of such measures and the pressing need for legislative clarity.
Comparative jurisdictions like the UK, US, and Canada offer instructive models that safeguard both the dignity and autonomy of incapacitated individuals. India's constitutional commitment to equality (Article 14), the right to life with dignity (Article 21), and the Directive Principle under Article 41—which urges the State to provide public assistance to persons with disabilities—demands a similar response.
The burden of prolonged legal ambiguity continues to fall on families already grappling with immense emotional and financial strain. Urgent and coordinated legislative intervention is not merely a policy necessity—it is a constitutional imperative. Parliament, guided by judicial precedent and informed by global best practices, must enact a comprehensive and compassionate guardianship law. The judiciary has illuminated the path; it is now for the legislature to act decisively and ensure that no family is left without legal recourse in their time of greatest need.
Atul Rana is a Ph.D. Scholar Faculty of Law, University of Delhi. Saurabh is a practicing Advocate at Delhi High Court
Views Are Personal.
List of References:
Cases
Shobha Gopalakrishnan v. State of Kerala and Ors., 2019 SCC Online Ker 739
Epari Sushma v. Ministry of Health and Family Welfare & Ors., W.P.C No. 24656 of 2024, Orissa High Court 2025
Rajni Hariom Sharma v. Union of India & Ors., 2020 SCC OnLine Bom 880 (Bombay HC)
Charan Lal Sahu v. Union of India, 1990 1 SCC 613
Mayuresh Dipak Nadkarni v. Union of India & Ors., Writ Petition (L) No. 140 of 2024, Bombay HC (Coram: Kulkarni & Pooniwalla, JJ), decided 12 January 2024
S. Sasikala v. State of Tamil Nadu, W.A. No. 1538 of 2024, Madras HC (23 May 2024)
Statutes:
The Mental Healthcare Act, 2017 No. 10 of 2017
The Rights of Persons with Disabilities Act, 2016 No. 49 of 2016
The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 No. 44 of 1999
The Guardians and Wards Act, 1890 No. 8 of 1890
United Nations Convention on the Rights of Persons with Disabilities CRPD, 2006
Mental Capacity Act 2005 (United Kingdom)
Adult Guardianship Act, S.B.C. 1993, c. 35 (British Columbia, Canada)
Report
Law Commission of India. (2009). Need for protection of interests of the elderly (Report No. 222, para. 3.3). Government of India.
Journal Article
Bhambhani, A. (2018). Legal rights of persons with disabilities in India: A shift from charity to rights. Indian Journal of Law and Human Behavior, 4(1), 1–10
Series, L. (2015). Relationships, autonomy and legal capacity: Mental capacity and support paradigms. International Journal of Law and Psychiatry, 40, 80–91
Bhambhani, A. (2018). Legal rights of persons with disabilities in India: A shift from charity to rights. Indian Journal of Law and Human Behavior, 4(1), 1–10. ↑
The Guardians and Wards Act, 1890 No. 8 of 1890 ↑
Law Commission of India. (2009). Report No. 226: Legal provisions for the elderly (¶ 3.3). Government of India ↑
The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 No. 44 of 1999 ↑
The Rights of Persons with Disabilities Act, 2016 No. 49 of 2016 ↑
The Mental Healthcare Act, 2017 No. 10 of 2017 ↑
Charan Lal Sahu v. Union of India & Ors., 1989 SCC (3) 255, para 35 (SC). ↑
Shobha Gopalakrishnan v. State of Kerala and Ors., 2019 SCC Online Ker 739 ↑
Shobha Gopalakrishnan v. State of Kerala, 2019 SCC OnLine Ker 3349, para 43 (Kerala High Court 2019). ↑
Rajni Hariom Sharma v. Union of India & Ors., 2020 SCC OnLine Bom 880 (Bombay HC) ↑
S. Sasikala v. State of Tamil Nadu, W.A. No. 1538 of 2024, Madras HC (23 May 2024) ↑
Mayuresh Dipak Nadkarni v. Union of India & Ors., Writ Petition (L) No. 140 of 2024, Bombay HC (Coram: Kulkarni & Pooniwalla, JJ), decided 12 January 2024. ↑
Epari Sushma v. Ministry of Health and Family Welfare & Ors., W.P.(C) No. 24656 of 2024, Orissa High Court (Dr. S.K. Panigrahi, J.), judgment dated 9 May 2025. ↑
Mental Capacity Act, 2005 (UK), c. 9. ↑
Series, L. (2015). Relationships, autonomy and legal capacity: Mental capacity and support paradigms. International Journal of Law and Psychiatry, 40, 80–91. ↑
Uniform Law Commission. (2017). Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act. ↑
Substitute Decisions Act, 1992 (Ontario, Canada). ↑
Adult Guardianship Act, R.S.B.C. 1996, c. 6 (British Columbia, Canada). ↑