A surgeonDr. I. P. Yadav, a Surgeon from Kerala, had one of his life’s toughest choices in 2010. Terminal cancer patient, his father had verbally indicated his wish to quit all therapy and terminate his agony. As a son, Dr. Yadev believed it was his obligation to do all within his power to extend his father’s life.
“This made him miserable, and he ended up dying alone in an intensive care unit,” Dr. Yadev said. “His ribs were broken in the last attempts the doctor made to revive him using CPR. There was a terrible death.
The encounter profoundly affected Dr. Yadev and helped him see the need for living wills. Suppose a person over eighteen develops a fatal illness or condition with little hope of recovery and is unable to make decisions themselves. In that case, a living will is a legal instrument allowing that person to decide on their medical treatment.
Describe a living will and explain its significance?
A living will lets people indicate whether they want painkillers or to be on life-support devices. India’s Supreme Court lets individuals draft living wills and choose passive euthanasia, in which case medical treatment can be stopped under tight criteria to speed death. Still banned in the nation is active euthanasia, the deliberate act of taking a life.
Though approved legally, living wills have not become very popular in India. Experts believe that this is mostly related to the cultural resistance to addressing death. Many people view death as a taboo topic; hence, discussing it is supposed to bring ill luck.
Under what initiatives are living wills being promoted?
Public opinion is being changed with effort right now. In November, Yadev and his colleagues started India’s first awareness campaign on living wills at the Kollam area Government Medical College in Kerala. With volunteers running awareness campaigns and providing will templates, the effort offers personal and phone information.
“Making a living will call for honest death-related talks among family members. Notwithstanding some opposition, organizations and activists are acting to increase awareness,” notes Dr. Yadev.
Kerala is leading the way in these debates. Organizations providing end-of-life care and the greatest palliative care system in the nation have also initiated awareness campaigns on living wills. About thirty Pain and Palliative Care Society members from Thrissur signed living wills in March to help legitimize the concept.
“Most people have never heard of the term, so they have many questions, like whether such a direction can be misused or if they can make changes later on,” says group founder Dr E. Divakaran.
Whose interests are served by living wills?
Most questions concerning living will come from adults in their 50s and 60s, notes Dr Yadev. ” Right now, the facility is being used by educated upper-middle-class people. But we expect the population to increase with grassroots awareness initiatives,” he says.
The Supreme Court ruling mandates that one create a living will, sign it before two witnesses, and have it attested by a notary or gazetted authority. The living will then be turned into a state government-appointed custodian, a duplicate of which. Many state governments, meanwhile, still need to create systems for application.
Mumbai-based gynaecologist Dr Nikhil Datar discovered this problem two years ago, making his living will. “There was no custodian to whom I could turn it in,” he says. He brought the case before the court, which led the Maharashtra government to name over 400 people to oversee living wills across local administrations.
Goa followed directives issued by the Supreme Court in June, and a high court judge registered a living will first in the state. Similarly, Karnataka recently directed district health officials to name candidates for a vital medical body that certifies living wills. Before medical practitioners can act on a living will, two medical boards must confirm that a patient satisfies the required criteria.
What Difficulties Exist in Using Living Wills?
Dr. Datar is pushing for a centralized digital living repository that is available anywhere. On his website, he has also made his Living Will free template accessible for download. “When a patient is in a vegetative state and beyond recovery, a living will help prevent issues for both families and doctors,” he advises.
“Very often, family members keep the individual in the hospital even though they cannot care for the sick at home and do not want them to endure more treatment. Medical ethics bind doctors not to stop therapy. Hence, the patient suffers without means of expression.”
Living will go beyond the simple selection of passive euthanasia. Dr Yadev remembers a case when someone wanted his living will to say he should be put on life support should he require it. “He said his only child lived overseas, and he didn’t want to die until his son came to see him. You are free to decide the manner of your death. One of our most important rights, thus why not make use of it?”
How may doctors help to facilitate discussions on living wills?
Advocates of palliative care feel that conversations about it are progressively growing in India, motivating living wills. The All India Institute of Medical Sciences’ Dr. Sushma Bhatnagar from Delhi claims the institution is starting a section to inform patients about living wills.
“Although living wills should ideally be discussed with patients, there is a communication gap,” she notes. “Training doctors for these conversations helps ensure a person dies with dignity.”
“Through our lives, our decisions are shaped by the wishes of our loved ones or by what society believes to be right,” says Dr. Yadev. At least in death, let us choose entirely our own and in our best interest.
