Challenges in Implementing Living Wills in India

The Supreme Court of India's 2018 judgment recognized living wills, allowing terminally-ill patients to make informed decisions about their end-of-life care. Despite this landmark ruling, the actual implementation of living wills remains fraught with challenges across most of India, largely due to bureaucratic complexities and lack of clear guidelines.

Key Issues and Developments:

• Complex Initial Process: Initially, the Court's process for executing living wills was deemed too complex, involving cumbersome bureaucratic procedures aimed at preventing potential misuse.
  

• 2023 Streamlining: Recognizing these issues, the Supreme Court simplified the process in January 2023, reducing the need for judicial magistrate countersignature and introducing a system where living wills are attested by notaries or gazetted officers and managed by local government custodians.
  

• Lack of Custodians: Despite the streamlined process, the designation of custodians for living wills by local governments is rare, with Maharashtra being a notable exception following a High Court directive.
  

Implementation Hurdles:

• Medical Board Certification: The guidelines require the certification of treatment decisions by primary and secondary medical boards, complicating the immediate application of living wills in hospitals.
  

• Ambiguities and Legal Uncertainties: Ambiguities in the guidelines and the absence of clear definitions for key terms like 'next of kin' add to the reluctance of officials to enforce living will protocols.
  

Government Inaction and Recommendations:

• Need for Direct Orders and Protocols: Officials seek explicit directives and detailed procedures from State governments to confidently implement living will provisions.
  

• Role of State Governments: While some states like Odisha are taking steps towards formulating detailed orders, a uniform approach across India is lacking.
  

• Central Government's Potential Role: The Central government could play a pivotal role by developing model orders and protocols to guide State governments in implementing the judgment effectively.
  

Implications for Patients and Medical Professionals:

• Barrier to End-of-Life Decisions: The lack of clear legal and procedural guidelines has made doctors wary of legal consequences, hindering their ability to honor patients' end-of-life wishes.
  

• Call for Action: For terminally-ill patients to truly exercise their right to die with dignity, concerted efforts and clarity in implementation are crucial at all government levels.
  

Additional Information to Remember:

• This situation highlights a broader issue of navigating the delicate topics of death, mortality, and end-of-life care within India's legal and medical framework.
  

• Effective implementation of living wills is not just a legal challenge but also a moral imperative to respect individual autonomy and dignity in death.

Keywords to Remember:

• Living Wills: Legal documents allowing individuals to outline their preferences for medical treatment in terminal conditions.
  

• Supreme Court Judgment: The 2018 ruling that legalized living wills in India, recognizing the right to die with dignity
  

• Medical Boards: Bodies required to certify decisions on withholding or withdrawing treatment as per the guidelines for living wills.

Reason it's important : Living wills implementation lags in India

Published in : The Hindu

Date appeared in newspaper : 04 April 2024

Link to the article (might require a paid subscription) : https://www.thehindu.com/todays-paper/2024-04-04/th_international/articleGNDCKH4DL-6349732.ece