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Living Wills UPSC NOTE

 Why in news

  • 30 people in Thrissur in Kerala executed living wills.

  • Living wills have been legal since 2018, when the Supreme Court of India created a process to allow terminally-ill patients, with no hope of a cure, to withhold or withdraw treatment and die with dignity.

  • Six years after the judgment, however, the Court’s process is unavailable in most of India.

  • Officials remain unlikely to implement the procedure without direct orders and guidance from State governments.

  • A living will is a legal document that specifies the type of medical care that an individual does or does not want in the event they are unable to communicate their wishes.

  • Since patients may not be able to communicate their wishes for a variety of reasons, including being unconscious or suffering from dementia, living wills allow them to make choices about future medical care.

  • One particular requirement — that living wills must be countersigned by a judicial magistrate — was too much of a burden.

  • Predictably, few living wills were executed in the first five years after the judgment in 2018

  • In 2023, the Court recognised that requiring a judge to countersign each living will ‘impaired, if not completely defeat’ the objective of its judgment, and streamlined the procedure.

  • Under the streamlined procedure, living wills have to be signed in the presence of two witnesses, attested before a notary or a gazetted officer, and handed over to a “competent officer” in the local government who will act as a custodian.

  • If the patient becomes terminally ill and does not have decision-making capacity, the treating doctor is to authenticate the living will against the copy held with the custodian or against digital health records, if any.

  • However, local governments have not generally designated custodians for living wills

  • As for digital health records, the National Health Authority is yet to produce a protocol that will allow living wills to be authenticated through digital health records.

  • Making a living will does not automatically imply that it will be given effect. 

  • The guidelines require that the decisions on withholding or withdrawing treatment are certified first by a primary medical board and then confirmed by a secondary medical board. 

  • The secondary board must have a doctor nominated by the chief medical officer.

  • Practically, this means that hospitals cannot have secondary medical boards unless the chief medical officer has nominated a doctor in the hospital where you are a patient.

  • As a consequence, terminally-ill patients — even those who have made living wills — may not be able to make critical decisions about medical care.

  • Six years after the Supreme Court declared that Indians have the right to die with dignity, our governments have failed to take basic steps to implement it. 

  • Until they implement the judgment, doctors will remain worried about the consequences of giving effect to their patients’ express wishes.

  • Only effective guidance and persistent action at every level of government will give doctors the confidence they need to act in the patient’s best interests.

  • The Central government can bridge the gap in expertise by developing and publishing model orders and protocols which can provide State governments the confidence and the guidance to effectively implement the judgment.



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Learnerz IAS | Concept oriented UPSC Classes in Malayalam: Living Wills UPSC NOTE
Living Wills UPSC NOTE
Learnerz IAS | Concept oriented UPSC Classes in Malayalam
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