Judge M S Sonak of the Bombay High Court’s Goa Bench recently registered the first “living will” in Goa, which is an advance medical directive for his family if he cannot make decisions for himself.
Living Will
It is a legal document that states the patient’s choices for medical care, especially with relation to end-of-life care and life-sustaining interventions, for terminally ill patients who are unable to express their choices.
What is the current process for carrying out a living will?
1) Simplified process: The Supreme Court has simplified the process to address the issues raised by the previously suggested complex approach.
A) Living wills must be signed before two witnesses and attested before a notary public or gazette officer. Then, they must be given to a “competent officer” in the local administration. The capable officer will act as the living will’s guardian.
B) If the patient is terminally ill and unable to make decisions for themselves, the physician will compare the living will to the copy held by the custodian or to the patient’s digital health information.
2) Medical board certification: A main medical board certifies, and a secondary medical board confirms the choice of treatment withdrawal or withholding. The chief medical officer should designate a physician to the secondary board.
Furthermore, the primary medical board must get the “next of kin’s” written authorisation before discontinuing or delaying treatment if the patient does not have a living will, according to the Supreme Court.
What problems exist with living will execution in India?
1) Absence of living will custodians: State governments have not appointed a living will custodian. For example, in order to designate caretakers throughout the State, a public interest litigation had to be brought in the Bombay High Court recently.
2) Lack of protocol: Digital health records cannot validate living wills since the National Health Authority has not created guidelines.
3) Difficult Procedure: The chief medical officer must designate a physician to the secondary board. This suggests that secondary medical boards are not permitted in hospitals unless a physician is nominated by the chief medical officer who practices where the patient is hospitalised. As a result, even persons who have created living wills but are terminally sick are unable to make crucial decisions regarding their medical treatment.
4) Ambiguous rules: “Next of kin” is not clearly defined under Indian law. There is even more ambiguity when family members dispute the right course of action. Owing to this, officials will abstain from making conclusions regarding a matter this delicate.
5) Lack of desire on the part of state governments: Because this is a complicated field that requires the attention of legal and medical specialists, state governments are hesitant to execute it tenaciously.
What is the best course of action?
The central government can create and publish model directives and procedures to help close the knowledge gap. These procedures can offer state governments the assurance and direction they need to successfully implement the Supreme Court’s rulings.
