All hospitals should help their patients make living wills

Yet, painful as terminal cases are, doctors are duty-bound to serve the patient’s health while few patients seem aware of our legal right to refuse being kept alive artificially. A Supreme Court order in 2018 granted us discretion over this decision if we explicitly say so in a ‘living will’ (or ‘advance medical directive’). 

In this context, it counts as welcome news that Mumbai’s Hinduja Hospital is opening a ‘clinic’ to help draft this legal document so that people can pre-notify their choices on specific forms of support. Anyone anywhere can make a living will, but since such grim options are typically confronted in hospital settings, access to this option would expand where it’s needed most acutely if other hospitals follow suit. 

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Anything that hints of euthanasia has long been controversial. The medical system is mandated to save lives, as it should be, but  this mandate now covers many life-sustaining advances that do not promise a return to any form of health that a patient may be willing to live with. It was therefore a bold call on the Indian judiciary’s part to allow living wills. 

To prevent their misuse, however, it had initially set a very high bar, requiring a judicial magistrate to attest such a will. In 2023, the apex court eased the process. Now all it takes is  two witnesses, whose attestations need to be notarized for the public record. Yet, the idea does not seem to have gotten far. 

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Willy-nilly, this draws the incentive of healthcare services into the picture. Profit-driven private hospitals that bill patients heavily for intensive care, for example, may see no reason to go beyond medical care if they see more of a revenue downside than upside in advising patients to sign  living wills. And with private equity and other return-chasing investors betting big money on healthcare, hospitals would be under pressure to maximize billings. Even so, a combination of ethics and customer orientation should nudge them to set up legal cells for bedside advice. 

Patients with poor recovery prospects need  all the support that can be summoned. This includes the earnest advice of doctors as much as what the law permits. Once this practice starts at a few hospitals and word gets around, perhaps the rest would be pushed to do likewise in their quest for service parity. The force of competition does not always serve a market well if demand exceeds supply, as seen in some urban zones that are short of health facilities. In such cases, a well-rounded conception of ‘care’ should motivate hospitals to act.

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The broad aim should be to maximize the choice of patients as expressed in a way that’s legally valid. Interestingly, Maharashtra seems to have done some work on this front, having set up more than 400 custodians across the state with whom people can entrust their advance medical directives. Just as asset bequests are now routine among the aware, so might living wills come to be if they’re granted publicity. Clarity on what an individual wants can save patients and their families a lot of  tribulation, not to mention expenses, in no-win situations of health failure. A pragmatic legal solution mustn’t languish in obscurity.