A living will is a document that prescribes a person's intentions as to the health care provider,
if he could not communicate his preferences. In India, 'living will' follows the case law of
advanced directives, which has its roots in US law. For the implementation of Advance
Guidelines, a certain method must be followed. "A legal document stating your health care
desires if one gets incompetent or is unable to communicate," says Black's Law's Dictionary
in advance directives. In the A Regd. Society against Union of India, the Supreme Court held
that dignified death is a fundamental right guaranteed in Article 21 of the Constitution. This
decision cleared the door for passive euthanasia, commonly called physician-assisted suicide
(PAS). According to the Supreme Court, passive euthanasia is allowed under legislation. The
passive euthanasia is not active euthanasia, as the former does not need an overt act. The
person's desire to treat him/her can be measured by the Advance Directives that a person is
entitled, by a method provided forth in this decision.
ADVANCE DIRECTIVE CAN BE ISSUED BY THE FOLLOWING:
Only a sound and healthy adult with the capability to communicate, relate and
understand the purpose and effects of executing a document can implement the
Advance Directive.
They must be carried out freely and, with complete knowledge or information,
without any obligation or duress.
It should have informed consent features without excessive influence or constraints.
He or she shall make explicit in writing when medical care is discontinued or no
particular medical treatment will occur, simply postponing the dying process which
may otherwise inflict agony, misery and suffering and place him or her further in a
position of indignity.
ADVANCE DIRECTIVES CONTAINS THE FOLLOWING:
The choice on the factors to which medical care can be withheld or withdrawn should
be clearly indicated.
The directions should be clear and straightforward, and should be explicit.
It should be noted that the executor might at any moment rescind the instructions.
The executor should be aware of the ramifications of executing such a document.
It should indicate the name of a guardian or close family member who is permitted to
consent to decline or withdraw any medical treatment in a way compatible with the
Advance Directive in case the executor is unable to make decisions at that time.
If more than one Advance Directive is valid, none of which was cancelled, the later
written Advance Directive will be regarded as the final statement of the patient's
intentions and will take effect.
THE FOLLOWING SHALL RECORD AND PREERVE THE ADVANCE
DIRECTIVES:
In the presence of the two certifying witnesses, preferably independent and counter-
signed by the First-Class Judicial Magistrate (JMFC) chosen by the District Judge
concerned, the document shall be signed by the Executive.
Witnesses and the JMFC jurisdictions should be satisfied that this instrument was
performed freely and without any force or duress, and all essential facts and
implications fully understood.
In addition to maintaining it at digital format, JMFC should save one copy of the
document in its office.
The JMFC shall transmit to the Registry of the District Court for retention one copy
of the document. In addition, a document should be kept in digital format in the
District Judge Registry.
If it is not present at the time of execution, JMFC should advise the immediate family
members of the executor and tell them of the execution of the document.
A copy should be transmitted, as the case may be, to the appropriate local government
authority, to the Municipal Corporation or to the Panchayat. In this respect, the
aforementioned authorities shall propose the custodian of such document for a
competent official.
The JMFC shall cause to handover copy of the Advance Directive to the family
physician, if any.
WHEN AND BY WHOM CAN IT BE GIVEN EFFECT TO?
If the executor becomes terminally sick and undergoes extended healthcare without
the expectation that the malaise will be cured, the therapy physician should verify the
validity and the legitimacy of the Advance Directive before acting.
The doctors should give appropriate weight to the directions in the paper. Only when
it is completely satisfied that the executor is finally sick and undergoes lengthy
treatment or survives on a lifetime basis should it take effect, however, and that the
executor's disease is incurable or there is no prospect of healing it.
If a patient's doctor (document executor) is satisfied that the directions given in the
document need to be followed, the executor or his close relationship, as appropriate,
shall inform the executor or his guardian about the nature of the disease, the
availability of medical treatment and the consequences of alternatives and the
consequences of non-treating. He must also guarantee that he or she feels, for
reasonable reasons, that the information supplied is understood, coagulates about the
alternatives and considers that the best option for medical treatment is the decision to
withdraw or to refuse.
A medical board composed of head of treatment, at least three expert specialists from
the fields of general medicine, cardiology, neurology, nephrology, psychiatry and
oncology with a medical care experience and a general standing of at least twenty
years in medically advanced medicine shall be the executive doctor admitted to the
medical department for medical therapy. It is a preliminary view that this decision
shall be seen.
Should the Hospital Medical Board confirm that it is appropriate to carry out the
instructions set out in the Advance Directive, the physician/Hospital should promptly
report the plan to the Collector's authority. The Collector is then immediately
appointed as the Chairman of the Medical Officer of the district concerned and three
expert doctors from general health, cardiology, neurology, nephrology, psychiatrics or
oncology with at least twenty years of experience in critical care and an overall
medical profession (who were not members of the previous Medical Board of the
hospital). They shall be admitted to the hospital together and can endorse the
certificate to follow the directions included in the Directive if they agree with the first
judgement of the Medical Commission of the Hospital.
The Collector's Board should first discover the executor's desires if he is able to
communicate and understand the repercussions of medical withdrawals. In case the
performer is unable to decide or has deficiencies in the ability to make decisions, it
should be agreed to obtain, in accordance with the clear instructions given in the
Advance Guidance, the consent of the guardian appointed by the executive in the
Advance Guideline to deny or withdraw medical treatment to the performer.
A decision of the Council to be forwarded to the JMFC before giving effect to the
decision to withdraw the medical treatments given to the executor will be
communicated by the President of the Medical Committee appointed by the Collector
(i.e. the Chief District Medical Administrators). Once the patient has examined all
elements, the JMFC shall allow the execution of the decision of the Board as soon as
possible.
It is open to the executor at any time before the document is executed. It is revoked.
IMPORTANCE OF A LIVING WILL
The best feature of a living will is that it protects you in the future, where you can no
longer convey your intentions. The physicians responsible for treatment will explain a
bit about what is going on after you're in a condition where you don't know what you
want to do.
Having a living will eliminates heated discussions among members of the family if
the choice is not the responsibility of the medical experts. Your family members are
the others who have a voice in what goes on with you. If you differ about what you
should do, it may lead to ending disputes in the connection between your family
members. In such terrible and challenging times, this is the last thing you would like
to happen. It is your choice and nobody else with a live will. This will eliminate any
discussion or dispute about what you should do.
A willingness to live also offers you control of medical treatments and procedures in
cases where you are so unwell that you cannot communication. A live person instructs
physicians to follow your desires in writing in this circumstance. You take the
decision from their hands in this way.
If you slip into a coma or vegetative condition, a live will decide exactly what you do.
Many individuals want to die instead of another 20 years of supporting their lives.
The rationale is that, if they support their lives, the family would have to pay huge
medical expenses. You can leave your family with insurmountable medical charges if
you do not specify this. If you want anything like this not to happen, you need to have
a living will that states exactly what you want in a specific circumstance to happen.
Last of all, it gives you peace of mind to live. They are meant to control you in order
to prevent more harm in catastrophic situations. Tragic events are sufficiently difficult
and you want to know that you and your family are appropriately treated in these
instances. The last thing you want to do is be pitiful and finally give people beyond
the authority of your family what's going on under horrible conditions. Make your
living today. It's so simple to postpone, yet definitely one of your finest choices.
CONCLUSION
In Indian law, the notion of living will have been given a position through judicial activism
instead of international practice. The notion is evolving just as the Vishakha directives by
which women are protected on the job and the right to die with dignity is acknowledged
through living will. It is a significant step and the land law is till the legislature clearly
succeeds.
