The Kerala Story:

The Government Medical College Hospital (GMCH) in Kollam, Kerala, has opened India's first Living Will Information Counter close to its outpatient block in a historic gesture supporting the right to pass away with dignity. Subsequently, 30 people in Thrissur signed a living will.

This important healthcare idea is still mainly misunderstood and underutilised, even after the Supreme Court's landmark 2018 decision and the streamlined 2023 guidelines on living wills.

What exactly is a "Living Will" ?

A "living will" is a written document that outlines a person's desires and helps the designated person or people, or their family, carry them out at the right moment without feeling guilty or anxious. People will have the chance to consider, discuss, and document their desires, preferences, priorities, and refusals through the "living will." They are free to choose how they want to be cared for and what they want and don't want as their life draws to a close.

Requirements to be fulfilled in Living Will:

1) >18 years of age

2) Free consent

3) Sound mind

The document should be in written form, signed, witnessed and attested.

Common Man's Views:

To make sure he could "leave peacefully," businessman and philanthropist Kochouseph Chittilappilly made a living will five years ago. He stated in his directive that if he got persistently ill after the age of 70, he would not want any significant medical operations, including ventilation or surgery. Additionally, he stated that he wanted his body given for medical study.

Additionally he said, “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.”

The Law side:

Through significant Supreme Court rulings, the idea of a living will was given legal validity in India. The right to die with dignity was derived from Article 21 of the Constitution in the Aruna Shanbaug case (2011), which legalised passive euthanasia.

The Common Cause v. Union of India ruling (2018) extended that notion and upheld the validity of living wills as an extension of personal liberty and self-governance.

Drafting such directions was complicated at first, but on January 23, 2023, the procedure was made simpler. To ensure voluntariness, two witnesses and certification from a gazetted officer or notary were required.

A proponent of a dignified death and Chairman Emeritus of Pallium India, Dr. M R Rajagopal, said that although more people are creating living wills after death, their implementation is still difficult. Two medical committees—one from the hospital and one from the district medical officer—must approve it.

“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."

The treating physician and two subject-matter specialists with at least five years of expertise comprise this board. To decide whether it is permissible to withhold or discontinue life-sustaining treatments, it assesses the patient's health.

The board makes sure that these choices are made with precision, both ethically and medically.

Lessons and impacts:

Volunteers involved in GMCH's living will awareness campaign have brought attention to the individual stories of people who have chosen to create living wills.

Volunteers said educating people about the distinction between a normal will and a living will is the first step in increasing awareness.

Many describe the agony of witnessing loved ones suffer as a result of choices made without enough direction. Using his own life as an example, Dr. Yadav expressed his deep regret for putting his father on a ventilator against his desires.

(Input from various sources)

(Rehash/Sanika Dongre/MSM)