What is an Advance Medical Directive/Living will?

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What is an Advance Medical Directive/Living will? Blog Image


Recently, a Constitution bench of the Supreme Court (SC) questioned the utility of executing an advanced medical directive in India when a person is anyway free to refuse invasive treatment and accept death.

About Advance Medical Directive/Living will

  • What is it? It is a document prescribing a person's wishes regarding the medical treatment the person would want if he/she was unable to share his/her wishes or not in a position to make an informed decision by reason of being unconscious or in a coma. 
  • Legality of Advance Medical Directive in India: 
  • Supreme Court in Common Cause vs. Union of India, 2018 recognised that a terminally-ill patient or a person in persistent vegetative state can execute an “advance medical directive” or a “living will '' to refuse medical treatment,and gave sanction to passive euthanasia and living will/advance directives. 
  • The court also laid down principles relating to the procedure for execution of living will.
  • Who can draw up an Advance Medical Directive/Living Will? 
  • An adult who is of a sound and healthy mind and in a position to communicate, relate and comprehend the purpose and consequences of executing the document.
  • It must be voluntary.
  • Elements of a Living will:
  • It should be in writing and should clearly state as to when medical treatment may be withdrawn or if specific medical treatment that will have the effect of delaying the process of death should be given.
  • Instructions must be absolutely clear and unambiguous.
  • It should mention whether the patient may revoke the instructions/authority at any time.
  • It should specify the name of a guardian or close relative who, in the event of the patient becoming incapable of taking decision at the relevant time, will be authorized to give consent to refuse or withdraw medical treatment
  • If there is more than one valid Advance Directive, the most recently signed Advance Directive will be considered as the last expression of the patient‘s wishes and will be implemented.
  • How is living will recorded? It should be signed by the patient in the presence of two witnesses, preferably independent, and countersigned by a jurisdictional Judicial Magistrate First Class (JMFC), so designated by the concerned district judge.
  • When and by whom can it be given effect to? When The person becomes terminally ill and is undergoing prolonged medical treatment with no hope of recovery and cure of the ailment, the treating physician, when made aware about the Advance Directive, has to ascertain the genuineness and authenticity of the document from the jurisdictional JMFC before acting upon the same.

What is active and passive euthanasia?

  • Active euthanasia: It occurs when the medical professionals, or another person, deliberately do something that causes the patient to die.
  • Passive euthanasia: It occurs when the patient dies because the medical professionals either don't do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive.

Q1) What is the origin of a living will?

The history of living wills dates back to 1969 when the American lawyer, Louis Kutner first proposed it. He viewed it as a simple device to allow patients to say no to life-sustaining treatment that they did not want, even if they were too ill to communicate.
Source: Constitution Bench questions utility of an advanced medical directive in India when a person is anyway free to refuse invasive treatment