Health and Me

Dr Rajeev Jayadevan

Harish Rana Case Highlights Why Planning For A Living Will Is Important

Recent legal developments have highlighted the importance of advance planning for end-of-life care.

A Living Will is something every adult should consider discussing and creating at some point.

Conversations within families about individual preferences in the event of a terminal illness are an important first step, and these discussions should take place while everyone is still in good health.

Individuals may have very different views about how they wish to be treated if they develop a terminal illness or certain severe, irreversible conditions. For instance, some may not want ventilator support, while others may choose to avoid ICU care.

Some might accept ICU care but prefer not to undergo CPR. Others may prefer not to receive artificial feeding through tubes. Yet others may wish for every possible treatment to be attempted. A few may prefer to spend their final days at home.

It should be noted that a Living Will does not impose any limitation on treatment for common medical conditions such as infections, surgery for curable illnesses, or routine hospital care. 

These preferences apply only to situations such as terminal illness—for example, advanced cancer—or irreversible conditions such as a persistent vegetative state.

Creating a Living Will is now relatively straightforward. It must be signed in the presence of two witnesses and attested by a notary or a gazetted officer. 

The earlier requirement of countersignature by a Judicial Magistrate has been removed to make the process easier. Templates are also available online that individuals can use as a basis for drafting their own. Before preparing one, it is helpful to discuss the pros and cons of their choices with the family doctor. 

It is important to again emphasize that a Living Will is NOT about refusing all treatment, hospitalization, or ICU admission for routine medical care. Rather, it addresses only specific situations.

When such preferences are clearly documented in advance, important decisions about withholding or withdrawing treatment in select circumstances become less contentious. 

Doctors and hospitals will no longer be hesitant to withhold unnecessary treatment measures in such situations, as it will already be documented in the patient’s own Living Will. Relatives also will not face the difficult decision of withholding or withdrawing futile medical treatment on behalf of their loved one. 

Essentially, the Living Will protects the patient’s wishes when they are no longer able to speak for themselves.

<h2>What Happens Without A Living Will</h2>

In a terminally ill patient who is unable to communicate, the absence of a Living Will often leads to differences of opinion among family members about what the patient might have wanted. 

This uncertainty frequently results in a collective decision to “do everything possible,” just to be on the safe side. 

Doctors are reluctant to override the wishes of relatives, even when they believe that further treatment measures are unlikely to be beneficial. 

As a result, the patient may receive prolonged medical interventions that neither improve the underlying condition nor enhance quality of life. Once started, these treatments may continue indefinitely until the patient dies naturally.

This may take months, years, or even decades, and also incur huge costs. In the absence of a Living Will, complex legal procedures are required to withdraw these treatments — even if all the relatives are convinced that they should be withdrawn.

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Recent legal developments have highlighted the importance of advance planning for end-of-life care.A Living Will is something every adult should consider discussing and creating at some point. Conversations within families about individual preferences in the event of a terminal illness are an important first step, and these discussions should take place while everyone is still in good health.Individuals may have very different views about how they wish to be treated if they develop a terminal illness or certain severe, irreversible conditions. For instance, some may not want ventilator support, while others may choose to avoid ICU care. Some might accept ICU care but prefer not to undergo CPR. Others may prefer not to receive artificial feeding through tubes. Yet others may wish for every possible treatment to be attempted. A few may prefer to spend their final days at home.Creating A Living WillIt should be noted that a Living Will does not impose any limitation on treatment for common medical conditions such as infections, surgery for curable illnesses, or routine hospital care. These preferences apply only to situations such as terminal illness—for example, advanced cancer—or irreversible conditions such as a persistent vegetative state.Creating a Living Will is now relatively straightforward. It must be signed in the presence of two witnesses and attested by a notary or a gazetted officer. The earlier requirement of countersignature by a Judicial Magistrate has been removed to make the process easier. Templates are also available online that individuals can use as a basis for drafting their own. Before preparing one, it is helpful to discuss the pros and cons of their choices with the family doctor. It is important to again emphasize that a Living Will is NOT about refusing all treatment, hospitalization, or ICU admission for routine medical care. Rather, it addresses only specific situations. When such preferences are clearly documented in advance, important decisions about withholding or withdrawing treatment in select circumstances become less contentious. Doctors and hospitals will no longer be hesitant to withhold unnecessary treatment measures in such situations, as it will already be documented in the patient’s own Living Will. Relatives also will not face the difficult decision of withholding or withdrawing futile medical treatment on behalf of their loved one. Essentially, the Living Will protects the patient’s wishes when they are no longer able to speak for themselves. What Happens Without A Living WillIn a terminally ill patient who is unable to communicate, the absence of a Living Will often leads to differences of opinion among family members about what the patient might have wanted. This uncertainty frequently results in a collective decision to “do everything possible,” just to be on the safe side. Doctors are reluctant to override the wishes of relatives, even when they believe that further treatment measures are unlikely to be beneficial. As a result, the patient may receive prolonged medical interventions that neither improve the underlying condition nor enhance quality of life. Once started, these treatments may continue indefinitely until the patient dies naturally. This may take months, years, or even decades, and also incur huge costs. In the absence of a Living Will, complex legal procedures are required to withdraw these treatments — even if all the relatives are convinced that they should be withdrawn.