What is a Living Will and should you take it?

An elderly father suddenly falls ill, and his children take him to a hospital for immediate medical attention. After a battery of tests and a detailed examination, the doctors ruled that he should be put on a ventilator and explained different modes of treatment. The treatment is risky, and the family members have to make a call after weighing the options. The children are in a quandary, and they can’t even take the opinion of their ailing father because of his medical condition.

Nowadays, these kinds of situations are very common, but a ‘Living Will’ could make a marked difference. A Living Will or Advance Medical Directive (AMD) enables you to mention in advance the course of medical treatment you want to take if you are in a vegetative or coma state.
In November, the Parippally Government Medical College opened a Living Will information counter under the hospital’s Palliative Care Unit in a bid to educate the public about living wills. People from across the state are coming to the facility to learn about its nuances. The Karnataka Government recently issued an order to execute Living Wills in the state.

What’s in store?
Terminally ill patients and those in a vegetative state won’t be able to decide on their treatment preferences in consultation with doctors. Living Wills or AMD provide a platform whereby a person can state in advance in a will the kind of treatment he or she prefers. The document can also give a clear picture of treatment for older people and their care.

Is it possible to foresee ailments?
Road accidents are quite common, and in such situations, the will can mention ICU, ventilator, and tube-feeding facilities beforehand. Meanwhile, if a person contracts an unexpected disease, that could be later incorporated and provisions added for the requisite treatment in the declaration.

Who are witnesses to will?
The will should be signed by the patient, a close relative (surrogate decision maker: wife, husband, parents), and two witnesses. A gazetted officer/notary should also sign it.
Which treatments can be included?
The treatments included are intravenous medicines, dialysis, ventilator, chemotherapy, radiotherapy, surgeries, nutrition and cardiopulmonary resuscitation (CPR).

Solely based on the patient’s decision?
The patient's decision will be reviewed by an expert committee of doctors, and a final call will be made after that. Life-saving procedures will definitely be followed over and above the patient's directions.
What’s the duration of treatment?
Once the patient mentions availing treatment in the Living Will, it will be legally binding until that person’s death. You can revise and change the will as many times as you need.

What if treatment is not needed?
Like stating the intention to avail yourself of treatment, you can also mention it in the will if you don’t want any benefits. According to Article 21 of the Indian Constitution, no person shall be deprived of their life or personal liberty. Importantly, the patient would be fully responsible for the written will. The terminally ill also have the right to back out of painful courses of treatment. You can also renege on Living Will.

What’s the role of doctors?
The medical board, constituted within 24 to 48 hours of the patient’s admission to the hospital, will meet twice to take a final call before starting treatment, even if there’s a Living Will. The primary board will have at least three doctors out of which one will be the doctor treating the patient, and the others should have five years’ of relevant experience in the departments concerned. The secondary medical board should also have three doctors as members with at least five years of experience. One member of the secondary board should be a registered medical officer appointed by the district medical officer.

Presently, the Parippally Government Medical College is the only institution in Kerala that boasts a permanent medical board. It is a matter of concern that precious time will be lost while constituting a temporary medical board within 48 hours of a patient's admission to consider the clauses of a Living Will. The solution to the problem is to constitute permanent boards in all hospitals in the state.

What’s the legal validity of Living Will?
The Supreme Court gave the nod for Living Wills with strict guidelines in 2018. However, the apex court streamlined and simplified the process of creating and implementing Living Wills in 2023. Now, hospitals across the country have to provide treatment according to the clauses of Living Wills.

How to prepare Living Will?
The will can be downloaded from sites such as https://www.compassionatecare.in/living-will-in-malayalam and https://www.compassionatecare.in/living-will-form-in-english. The form should be filled with requisite signatures and its copies should be in the custody of the persons concerned. Living Will should be produced at the hospital whenever needed.
For more information, contact: 80757 45498 (Living Will Information Counter, Parippally Medical College).