THIRUVANANTHAPURAM: The living will, or advance medical directive, has become increasingly popular among individuals in the state who wish to avoid prolonged life through intensive care, despite challenges in its implementation.
Amid ongoing disputes over communist leader M M Lawrence’s body, those familiar with a living will believe that such a document could have facilitated the medical college’s handling of the veteran leader’s remains according to his wishes.
A living will serve as a written expression of a person’s preferences, enabling designated individuals or family members to honour those wishes without guilt or conflict at a critical time.
Kochouseph Chittilappilly, an industrialist and philanthropist, created a living will five years ago to ensure he could “leave peacefully”. In his directive, he specified that he did not want any major medical interventions, particularly surgery or ventilation, if he became permanently ill after the age of 70. He also expressed his desire for his body to be donated for medical research.
He emphasised that individuals should draft such a will while in good mental health.
“This way, your family and friends can understand your decision. I’ve made a digital copy of my will and shared it with them,” he explained. “Without a living will, my children might feel pressured to pursue treatment due to societal expectations. I want to avoid that, having lived my life fully.”
Creating a living will has been simplified to include filling out a form that expresses the desire to discontinue medical treatment, which must be witnessed and attested by a gazetted officer.
Anyone over 18 can prepare this document while in good health and sound mind. If it’s determined that a patient is in a terminal condition or a persistent vegetative state with no hope of recovery, the will can be enacted to halt further treatment.
Since the Supreme Court recognised living wills in 2018, many elderly and terminally ill patients feel more empowered to make healthcare decisions. A subsequent ruling in 2023 streamlined the process. However, experts warn of lingering procedural challenges.
Dr M R Rajagopal, Chairman Emeritus of Pallium India and an advocate for a dignified death, noted that while more people are drafting living wills post-ruling, their execution remains complex. It requires approval from two medical committees: one from the hospital and another from the district medical officer.
“This process can take days, which is particularly cruel for conscious patients. Additionally, the wording of the judgment seems to suggest it could apply to patients in home care as well. Consequently, these individuals must be admitted to a hospital to undergo the necessary procedures in order to benefit from the law,” he said.
Dr Rajagopal stressed the importance of living will being discussed and agreed upon with the next of kin to prevent an execution dilemma. In the real world, doctors are generally guided by the decisions of the family rather than the patient who does not have a voice.
Boris Paul, a lawyer based in Kollam, highlighted disputes among family members as a frequent issue, sometimes necessitating intervention from the High Court.
What is a Living Will?
The “living will” is a written record of a person’s wishes that will help the nominated person(s) or family to carry out the person’s wishes at the appropriate time without any guilt or angst. The “living will” will provide people the opportunity to think about, talk about and write down their wishes, preferences, priorities and refusals. They can make their own decisions on how they would like to be cared for and what they prefer to have and have not towards the end of their life.
Requirements
Age: 18+ years
Sound mind
Free consent
Document should be:
In writing
Signed
Witnessed
Attested
Challenges/limitations
Awareness and acceptance
Cumbersome procedures
Disagreement among family members
Lack of clarity on directives
People opt for a living will for various reasons:
Personal reasons
Autonomy: Control over medical decisions
Dignity: Maintain quality of life
Peace of mind: Knowing wishes are respected
Family protection: Reduce the burden on loved ones
Self-determination: Choose own end-of-life care
Medical reasons
Terminal illness: Manage symptoms and pain
Chronic conditions: Limit life-sustaining treatments
Disability: Ensure quality of life
Old age: Clarify medical preferences
Serious injury: Specify treatment wishes
Emotional reasons
Fear of suffering
Fear of loss of dignity
Fear of burdening family
Desire for control
Spiritual or philosophical beliefs
Financial reasons
Avoid unnecessary medical expenses
Reduce financial burden on family
Prioritise quality over quantity of life
Social reasons
Respect for family’s wishes
Avoid conflict among family members
Community or cultural values
Common scenarios leading to living will creation
Serious health diagnosis
Advanced age
Chronic illness progression
Disability or incapacitation
Family history of prolonged illness
Benefits of having a living will
Ensures autonomy
Reduces family stress
Prevents conflicts
Guides healthcare providers
Provides peace of mind