What Is A Living Will?

A Living Will is a legal document that specifies a person's wishes regarding the medical treatment they want to receive, or not receive, if they become incapacitated or are unable to communicate their decisions due to a serious illness or condition.

It is particularly relevant in situations where the person is facing end-of-life decisions and is used to guide healthcare providers and family members on how to proceed with medical care based on the individual's predefined choices. doctors  

Key Aspects Of A Living Will

Medical Directives

The document outlines specific medical interventions that the individual does or does not want. This can include instructions about resuscitation, mechanical ventilation, artificial nutrition and hydration, pain management, and other life-sustaining treatments.

Conditions Covered

A Living Will generally comes into effect only under certain medical conditions, such as in the case of a terminally ill person, or when the patient is in a permanent vegetative state and unable to make decisions or communicate.

Purpose

The primary purpose of a Living Will is to ensure that the person’s medical treatment preferences, including the administration of critical care medicine, are followed, thus respecting their autonomy and dignity in medical care decisions when they are no longer able to voice their preferences themselves.

What The Supreme Court Says About Living Wills In India

In India, the Supreme Court has played a crucial role in shaping the legal stance on Living Wills through its landmark judgment on March 9, 2018.

In the case of Common Cause (A Regd. Society) vs Union of India, the Supreme Court recognised the right to die with dignity as a fundamental right under Article 21 of the Constitution, which guarantees the right to life and personal liberty.

The judgement legalised passive euthanasia and the execution of Living Wills under strict guidelines.

Key Points from the Supreme Court's Judgment on Living Wills

Legalisation of Passive Euthanasia

The Supreme Court modified its earlier judgement by allowing passive euthanasia, which involves withdrawing medical treatment with the deliberate intention to hasten the death of terminally-ill patients.

Living Wills Are Permissible

The Court stated that an adult with the capacity to consent can execute a document specifying that if they suffer from a terminal illness and may go into a state of incurable coma in the future, withdrawing life support is permissible.

This document, referred to as a "Living Will" or "Advance Medical Directive", must be prepared when the Executor is in a sound state of mind and must be voluntarily executed.

Guidelines for Executing Living Wills

The Supreme Court laid down guidelines for the execution and enforcement of Living Wills. It specified that the Executor of a Living Will must:

• Be at least 18 years of age, of sound mind, and free of coercion.
• Appoint a Guardian, who is authorised to give consent to refuse treatment.
• Intimate the Guardian and the family physician, if any.
• Hand over a copy to the custodian designated by the municipal corporation.

The Living Will needs to be hand-signed by the Executor in the presence of two independent Witnesses, and attested before a notary or gazetted officer. The Witnesses and notary of gazetted officer must record their satisfaction that the Living Will was executed without coercion. The Executor may also choose to incorporate their Living Will as a part of the digital health records.

Procedure for Giving Effect to Living Wills

When the Executor becomes terminally ill with no hope of recovery and is incapable of making decisions, the treating physician, upon being informed about the Living Will, would constitute a medical board of three experts.

If the board certifies the patient's condition as matching the one specified in the Living Will, further consultation with another medical board set up by the concerned Collector would follow.

Upon confirmation by this second board, the JMFC would then visit the patient and, after examining all medical reports, approve or disapprove the implementation of the Living Will.

Safeguards Against Misuse

The judgement by the Court included several safeguards to ensure that the Living Wills are not misused. For example, the treating physician’s decision is overseen by medical boards and ultimately validated by a judicial magistrate, providing layers of scrutiny.

This judgement is significant as it recognises the autonomy of patients in making decisions about their own bodies and medical treatment, emphasising the importance of dignity and personal liberty until the end of life.  

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