Living Wills in India

 Dr Smriti Khanna gives you the lowdown on— what they are, why they matter, and how to make one

Why a Living Will Matters – A Real-Life Scenario

Kavita is terrified of dying her father’s death. ‘He had dementia and was bedridden for the last three years of his life. He stopped recognising us, and I could see him suffering. What if something like this happens to me?’ she said as she walked into the Living Will Clinic. ‘I want to tell my children, if I reach a point like that, don’t take me to the hospital. Even if I do go to the hospital, if my doctor feels that treatment is not going to improve my quality of life, what is the use of going on the ventilator?’ Kavita says her family understands her feelings but she does not want to place either guilt or responsibility on them. ‘The decision should be mine and mine alone. That’s why I want to make a Living Will.’ Read on to know why one should make a Living Will.

What Is a Living Will?

A Living Will, also known as an advance medical directive, is a written legal document in which you outline your preferences for medical treatment in case you are ever unable to communicate your wishes. It typically comes into play in scenarios like terminal illness or vegetative state, guiding doctors and family on whether to use or withhold life-sustaining interventions. In essence, a Living Will is your voice during critical medical moments when you cannot speak for yourself

• Living Will vs Last Will and Testament: A Last Will (regular will) deals with your assets and property after your death – it specifies how your estate should be distributed to heirs. In contrast, a Living Will has nothing to do with property or finances; it deals with healthcare decisions while you are still alive but incapacitated. Both are legal documents reflecting your wishes, but one speaks for your belongings after death, whereas the other speaks for your medical care before death.

Living Will vs. Euthanasia: Euthanasia generally means deliberately ending a life to relieve suffering (often called “mercy killing”). It’s crucial to understand that a Living Will does not authorise active euthanasia. In India, active euthanasia (for example, giving a lethal injection) remains illegal.

Why Should Everyone Make a Living Will?

• • Autonomy and Dignity: A Living Will empowers you to direct your own healthcare according to your values. It preserves your autonomy over medical decisions, ensuring your personal wishes are respected even when you cannot voice them. 
  • Clarity for Family and Doctors: It spares your family from potential guilt, disagreements, or second-guessing. Doctors, too, are given concrete instructions, which “dispel many a doubt at the relevant time of need” and give them confidence that honouring your wishes is lawful. 

• Preventing Unwanted Treatments: Modern medicine can sometimes extend life without improving its quality. A Living Will helps prevent unwanted medical interventions that might merely prolong dying. It ensures that you receive only those treatments that align with your idea of dignity. 

What are the key elements of a Living Will?

• • Specific Medical Interventions to Accept or Refuse: Clearly spell out which life-sustaining treatments you do or do not want if you are terminally ill or permanently unconscious. Common interventions addressed in Living Wills are: mechanical ventilation (breathing machine), tube feeding or intravenous nutrition, cardiopulmonary resuscitation (CPR), dialysis, surgeries, or antibiotics in life-ending scenarios.
  • Palliative Care and Comfort Measures: You can state preferences like “I want maximum pain medication and comfort care”
  • Appointment of a Designated healthcare representative: This is a trusted person who will interact with doctors and ensure your wishes are carried out if you cannot speak. You might name a close family member or friend who understands your values. Make sure to talk with whomever you nominate, to confirm they are willing and know your preferences well. 

• Personal Values, Beliefs, or Special Instructions: These may be instructions on place of care (hospital or home), organ donation, funeral arrangement etc.

How to Make a Living Will in India – Legal Steps and Best Practices

1. Check Your Eligibility: Under Indian guidelines, only adults above the age of 18 and of sound mind can create a Living Will, and it must be made voluntarily, without any coercion. 
2. Draft the Document: There are templates available through some hospitals, websites such as acpindia.org, or Living Will Clinics that you can consult as a guide. While not legally required to hire a lawyer, some people consult a lawyer or a knowledgeable doctor to help with phrasing and to ensure nothing important is omitted. 
3. Sign in Presence of Witnesses: After preparing the document, you must sign it in the presence of two independent witnesses (people who are not your beneficiaries or closely interested parties). 
4. Get it Notarised or Attested by a Gazetted Officer: Once your document is ready and witnessed, you take it to a notary (like you would notarise an affidavit) or an authorised official who will attest it. This step gives it legal authenticity. Make sure the notary or officer also stamps the date. This attested document is now your official Living Will.
5. Distribute and Store Copies: Give a copy to your close family members and your designated healthcare representative. Inform your regular doctor or family physician. One copy should be in your hospital medical records. There is a government nominated custodian who will keep a copy of the Living Will, to verify its authenticity when needed in the future. You have to go personally to submit this copy, and the custodian is usually the medical officer of the municipal ward office, panchayat or district. Additionally, if there is a Digital Health ID or electronic health record system you use, consider uploading your Living Will there.  
6. Keep It Updated: Life circumstances (like a new diagnosis, or a change in who you trust as a proxy) might prompt revisions to your Living Will. That’s completely normal and allowed. You absolutely have the right to modify or cancel your advance directive at any time. 

Is It Legal Everywhere in India?

The right to make a Living Will is derived from fundamental rights under the Constitution, and a Living Will executed in any one state is valid anywhere in India.

What did Kavita do?

In Kavita’s case, her Living Will clearly states she does not want to be put on a ventilator or receive CPR, chemotherapy, radiotherapy, or feeding tubes if she is ever diagnosed with an irreversible terminal illness. She named her two daughters as decision-makers (proxies) for her end-of-life care, and has given them copies of the document. 

Further information about the Living Will can be found on the following websites: palliumindia.org and acpindia.org. There is also a WhatsApp channel for updates and interested individuals can follow @HindujaHospital on LinkedIn for updates.