As Maharashtra upholds right to die with dignity, why other states should too
Maharashtra has introduced a mechanism for registration of living wills, allowing citizens to make end-of-life decisions as per their preferences and beliefs
The state, on April 7, introduced a structured mechanism for registration and preservation of living wills across urban and local bodies, including municipal corporations and municipal councils. Accordingly, a digital portal, called MahaULB, was also launched for the registration, verification and storage of living wills.
Jatin Popat, founder of WillJini.com, says that just as people plan for their wealth and estate via a normal will used after death, a living will allows an individual to decide how they wish to die if their medical condition is beyond recovery. Since end-of-life decisions are among the hardest to make, he adds that Maharashtra’s move will facilitate some ambiguities and procedural aspects surrounding the execution part by a Guardian of Living Will. This becomes particularly significant in India where these decisions are often clouded by cultural and familial ties/emotions.
What’s a living will?
A living will is a legal document that allows individuals to set forth their preferences for healthcare professionals on how they want to be treated at the end of life, especially in case they become terminally ill and there is no scope of recovery and also can’t communicate the decision.
Most of the preferences outlined in the living will pertain to life-support interventions, including ventilator support, tube feeding, cardiopulmonary resuscitation (CPR) and surgical procedures.
By setting out these preferences in advance, individuals gain autonomy on their end-of-life phase and can ensure that their medical care remains consistent with personal values, beliefs and priorities.
While India does not have the provision for euthanasia, the Supreme Court, in its landmark judgment in Common Cause v. Union of India (2018), affirmed that individuals possess the right to refuse medical treatment and to determine the nature and extent of medical care they wish to receive.
“This decision marked a significant step towards recognising patient autonomy within Indian constitutional law. Autonomy, in this sense, includes the ability to decide not just how one lives but how one is treated at the end of life,” says Vivek Sadhale, co-founder of law firm LegaLogic Consulting.
Explaining the importance of living will, he explains that the “right to die with dignity” is an extension of the right to live with dignity. In the context of Article 21 of the Indian Constitution, autonomy is not limited to the right to receive treatment; it also includes the right to refuse or limit it, he adds.
Sadhale elaborates on the essentials of a valid living will:
- A living will is a legal document that should be in written form, made by an adult of sound mind out of his or her own will, without any force or duress.
- The living will should mention clear and specific instructions regarding medical treatment preferences.
- The living will have to be signed in front of two adult witnesses.
- The living will should also be reviewed and approved by doctors.
- The executor (person making the living will) must appoint an agent who will be responsible to oversee that the wishes are duly honoured and carried out.
- Once the document is prepared, it may be submitted for registration either through the online portal or by visiting the local municipal office.
- After submission of the living will, physical verification before the designated custodian, as appointed by the state government, is mandatory.
- The maker is also required to submit an application, along with two notarised copies of the living will and an affidavit in the offline process. In either case, the verification is a mandatory step that requires completion.
- Upon successful verification, the living will is formally recorded in the system, and a signed and stamped copy is issued to the individual.
- It is possible to modify or revoke the living will, but this must be done through a formal process before the custodian. Any informal changes may not be legally recognised.
It is also important to understand that registration of a living will does not always determine its implementation as medical practitioners are required to act in accordance with the safeguards laid down by the Supreme Court, including assessment of the patient’s condition, evaluation by medical boards and, where necessary, judicial oversight.
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The state, on April 7, introduced a structured mechanism for registration and preservation of living wills across urban and local bodies, including municipal corporations and municipal councils. Accordingly, a digital portal, called MahaULB, was also launched for the registration, verification and storage of living wills.
Jatin Popat, founder of WillJini.com, says that just as people plan for their wealth and estate via a normal will used after death, a living will allows an individual to decide how they wish to die if their medical condition is beyond recovery. Since end-of-life decisions are among the hardest to make, he adds that Maharashtra’s move will facilitate some ambiguities and procedural aspects surrounding the execution part by a Guardian of Living Will. This becomes particularly significant in India where these decisions are often clouded by cultural and familial ties/emotions.
What’s a living will?
A living will is a legal document that allows individuals to set forth their preferences for healthcare professionals on how they want to be treated at the end of life, especially in case they become terminally ill and there is no scope of recovery and also can’t communicate the decision.
Most of the preferences outlined in the living will pertain to life-support interventions, including ventilator support, tube feeding, cardiopulmonary resuscitation (CPR) and surgical procedures.
By setting out these preferences in advance, individuals gain autonomy on their end-of-life phase and can ensure that their medical care remains consistent with personal values, beliefs and priorities.
While India does not have the provision for euthanasia, the Supreme Court, in its landmark judgment in Common Cause v. Union of India (2018), affirmed that individuals possess the right to refuse medical treatment and to determine the nature and extent of medical care they wish to receive.
“This decision marked a significant step towards recognising patient autonomy within Indian constitutional law. Autonomy, in this sense, includes the ability to decide not just how one lives but how one is treated at the end of life,” says Vivek Sadhale, co-founder of law firm LegaLogic Consulting.
Explaining the importance of living will, he explains that the “right to die with dignity” is an extension of the right to live with dignity. In the context of Article 21 of the Indian Constitution, autonomy is not limited to the right to receive treatment; it also includes the right to refuse or limit it, he adds.
Sadhale elaborates on the essentials of a valid living will:
- A living will is a legal document that should be in written form, made by an adult of sound mind out of his or her own will, without any force or duress.
- The living will should mention clear and specific instructions regarding medical treatment preferences.
- The living will have to be signed in front of two adult witnesses.
- The living will should also be reviewed and approved by doctors.
- The executor (person making the living will) must appoint an agent who will be responsible to oversee that the wishes are duly honoured and carried out.
- Once the document is prepared, it may be submitted for registration either through the online portal or by visiting the local municipal office.
- After submission of the living will, physical verification before the designated custodian, as appointed by the state government, is mandatory.
- The maker is also required to submit an application, along with two notarised copies of the living will and an affidavit in the offline process. In either case, the verification is a mandatory step that requires completion.
- Upon successful verification, the living will is formally recorded in the system, and a signed and stamped copy is issued to the individual.
- It is possible to modify or revoke the living will, but this must be done through a formal process before the custodian. Any informal changes may not be legally recognised.
It is also important to understand that registration of a living will does not always determine its implementation as medical practitioners are required to act in accordance with the safeguards laid down by the Supreme Court, including assessment of the patient’s condition, evaluation by medical boards and, where necessary, judicial oversight.
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