「 ✦ Content ✦ 」

Key Aspects of a Living Will:
1.        Purpose and Function:

•          Decision Making: A living will specify what types of medical treatments and life-sustaining measures a person does or does not want, such as resuscitation, mechanical ventilation, tube feeding, dialysis, and palliative care.
•          Guidance for Healthcare Providers and Family: It provides clear instructions to healthcare professionals and family members, reducing confusion and stress during critical moments.
2.        Legal Considerations:

•          Validity: The requirements for a valid living will vary by jurisdiction but generally include being of sound mind, creating the document voluntarily, and signing it in the presence of witnesses or a notary.
•          Revocation and Changes: A living will can be revoked or amended by the individual at any time, as long as they are competent to do so.
3.        Content:

•          Medical Treatments: Specific instructions regarding acceptance or refusal of certain medical procedures.
•          End-of-Life Care: Preferences for pain management, hospice care, and other end-of-life considerations.
•          Organ Donation: Indication of whether the individual wishes to donate organs or tissues.
4.        Complementary Documents:

•          Healthcare Proxy (or Durable Power of Attorney for Healthcare): Designates a person (agent) to make healthcare decisions on behalf of the individual if they become incapacitated.
•          Do Not Resuscitate (DNR) Orders: Specific directives to medical personnel not to perform CPR if the individual's heart stops or if they stop breathing.
Benefits of a Living Will:
•          Autonomy: Ensures that an individual's healthcare preferences are respected even when they cannot advocate for themselves.
•          Peace of Mind: Provides clarity and guidance to family members, reducing potential conflicts during emotionally charged times.
•          Prevention of Unwanted Treatment: Helps avoid medical interventions that the individual would not want, which can be particularly important in terminal or irreversible conditions.
How to Create a Living Will:
1.        Consultation: Consider consulting with a healthcare provider, attorney, or legal expert to understand the options and implications.
2.        Documentation: Use standardized forms available through healthcare facilities, legal services, or online resources.
3.        Communication: Discuss your wishes with family members, your healthcare proxy, and your healthcare provider to ensure everyone is aware of your preferences.
4.        Storage and Accessibility: Store the document in a safe but accessible place, and provide copies to your healthcare proxy, family members, and healthcare providers.

Considerations:
•          State Laws: The legal requirements and recognition of living wills can vary significantly by state or country. It's essential to ensure your document complies with local regulations.
•          Review and Update: Regularly review and update your living will to reflect any changes in your health status, personal preferences, or medical advancements.
Resources:
•          Legal Aid Services: Organizations that provide free or low-cost legal assistance for drafting living wills.
•          Healthcare Facilities: Many hospitals and clinics offer resources and counselling for creating advance directives.
Creating a living will is a proactive step towards ensuring that your healthcare preferences are honoured, providing peace of mind for you and your loved ones in times of medical crisis.
 Living wills are valid in India. They are legally recognized documents that allow individuals to specify their preferences regarding medical treatment in case they become unable to communicate their wishes due to incapacitation. In India, living wills are governed by the Indian legal system and are subject to certain guidelines and regulations, including those outlined by the Supreme Court of India in its landmark judgment in the case of Common Cause v. Union of India in 2018. These guidelines provide a framework for the creation and execution of living wills, ensuring that they are legally enforceable and respected by medical professionals and courts.
A petition was brought by Common Cause, a registered society, which sought a declaration that the right to die with dignity formed a part of the right to live with dignity under Article 21 of the Constitution. It further sought directions to the State to adopt appropriate procedures to allow persons who were of deteriorated health or who were terminally ill to execute Advance Medical Directives or living wills.
Issue was:
Whether the right to die with dignity was a fundamental right within the fold of the right to live with dignity guaranteed under Article 21 of the Constitution.
Decision:
The Court reaffirmed that the right to die with dignity was a fundamental right, as declared by a Constitution Bench of the Supreme Court in the case of Gian Kaur.
 WHAT IS EUTHONASIA?
Euthanasia is the act of deliberately putting an end to a person’s life in order to eliminate pain or suffering.
•          Active euthanasia, or assisted suicide, is the act of deliberately and actively doing something, such as injecting a lethal dose of a drug, to end a person’s life.
•          Passive euthanasia as “intentionally letting a patient die by withholding artificial life support such as a ventilator or a feeding tube.”
While the Supreme Court first tackled the question of whether the “Right to Life” includes the “right to die” in P Rathinam vs Union of India (1994) and Gian Kaur V State of Punjab (1996), it wasn’t until 2011 that debate gathered steam in its present form — whether a person who’s in a vegetative state could be euthanised.
WHAT IS A VEGITATIVE STATE?
•          People in a vegetative state cannot do things that require thought or conscious intention. They cannot speak, follow commands, move their limbs purposefully, or move to avoid a painful stimulus. Most people in a vegetative state have lost all capacity for awareness, thought, and conscious behaviour.
LIVING WILL REQUIREMENTS
The process outlined for living wills in India, following the 2018 Supreme Court order recognizing passive euthanasia, is indeed intricate and involves several steps. Here's a detailed summary:
•          Living Will Creation:
According to the law, a living will should be created by the person (referred to as the executor) while they are of sound mind and capable of making decisions regarding their medical treatment. The living will be needed to be signed in the presence of two attesting witnesses. It should also be affirmed by a judicial magistrate.
•         Terminal Illness Occurrence:
If the executor becomes terminally ill and incapable of making decisions regarding their medical treatment, the living will shall become applicable.
•          Constitution of Medical Board:
When the living will become relevant due to the executor's terminal illness, a doctor overseeing the treatment is required to constitute a board of three medical experts.
•          Composition of Medical Board:
The medical experts must be from specific fields, including general medicine, neurology, psychiatry, oncology, cardiology, or nephrology. Each expert must have at least 20 years of experience in the medical field.
•          Medical Board's Decision:
The role of the medical board is crucial. They assess the executor's condition and the instructions laid out in the living will. Based on their evaluation, the medical board decides whether to certify and carry out the instructions specified in the living will.
•          Preliminary Opinion:
The decision of the medical board is considered a preliminary opinion. Once the medical board grants permission to proceed with the instructions in the living will, it moves to the next stage.
•          Permission from Hospital Board:
Following the preliminary opinion from the medical board, permission is sought from the hospital board. This step involves the hospital board reviewing the decision of the medical experts and granting permission accordingly.
•          District Collector's Sanction:
After receiving permission from the hospital board, the appropriate district collector is approached for final sanction. The district collector reviews the entire process and grants the necessary approval for carrying out the instructions specified in the living will.
After the hospital board grants permission for implementing the living will's instructions, the district collector forms a medical board, typically comprising the Chief District Medical Officer and three expert doctors. This medical board, reviews the decision made by the hospital board and evaluates the executor's medical condition. If the medical board agrees with the hospital's findings, signifying a consensus among medical experts, they proceed to communicate their decision to the appropriate judicial magistrate.
WHO CAN MAKE THE LIVING WILL?
As long as the individual is legally considered an adult and is capable of making decisions regarding their medical treatment, they can create a living will.
Anyone who is at least 18 years can make a living will in India. They must name a person, preferably from their family or close relatives as a Guardian to help execute the Living Will. But registering it is a tedious task. The court in a few hearings have mentioned that the stringent requirements currently needed to for the ‘living will’ may not be possible to follow.
However, it is essential to note that the decision to create a living will should be made thoughtfully and responsibly.