What is a Living Will?

What is a Living Will?

“I will give no deadly medicine to anyone if asked, nor suggest any such counsel”
The Hippocratic Oath

In the field of medicine where doctors are life givers, not takers, the concept of euthanasia has been difficult to legislate. India is no exception to this case.

Amidst the discussions on passive euthanasia, the nation heard about the new concept of “Living Will”, which gets one step closer to euthanasia. Many of us are yet to understand, what this concept is all about and its pros and cons. So, here we get you what “Living Will” is all about.

What is Living Will?

A Living Will is a legal document that allows a person in sane mind and good health to express wishes to the doctor in case incapacitation results. In the living will, people can state whether they want or refuse artificial treatment in case of serious illnesses or injuries. Prolonging life through artificial means may be unwelcome for many. The living will acts as a life support mechanism in such times.

The Pros

1. Why Prolong Suffering?

In India, where monetary and medical resources are restricted, it makes sense to have legally acceptable living wills to avoid creating a hopeless situation. What is the point of prolonging life if there is no chance for recovery? Such treatment only increases the misery of loved ones and relatives who seek a peaceful end for the patient.

2. Right to Die Peacefully

Under Article 21 of the Indian Constitution, the person has a right to die peacefully without suffering and therefore create a living will when illness is incurable. This ensures the fundamental rights of every Indian should be secured.

3. Right to Live With Dignity

Leading a life devoid of pain and suffering, the person also has a right to live (and die) with dignity. Every person facing an option of whether to lead life without pain or suffering should have the right to choose whether she/he wants to end life.

4. Relief for Relatives

A living will would also relieve relatives of taking painful decisions and making life shattering choices, when it comes to withdrawing medical life support for a comatose or suffering patient.

5. Developed Nations Have Living Wills

The Patient Autonomy and Self Determination Act of USA allows a living will. Euthanasia and assisted suicide are acceptable in 10 nations across the globe including Belgium, US, Canada, Switzerland and Germany. Other countries have mechanisms in place to execute living wills. Why should India have outdated medical ethics and safeguards?

The Cons

1. GoI Vs SC

While the government says the religious and cultural conditions in India are not conducive to living wills, a 5 Judge bench of the SC is stressing on the living will as a need, even as it decided not to remove its six year old ruling permitting passive euthanasia. Refusing to entertain doubts on the 2011 case of Aruna Shanbaug, the SC did however concede right to life does not confer right to die on an individual.

2. Greedy Relatives

Another possible pitfall of the living will is that it may be misused by greedy relatives who want to access wealth, property or other benefits following the patient's death. Misuse of the living will is possible, despite safeguards in place to prevent it.

3. The Medical Question

The medical board may thoroughly examine a person but if he has slipped into a condition that is irrevocable, the question arises whether he can also be revived from the apparently hopeless medical conditions. Consider that kidney and liver failures were once lethal. Now transplants are common.

Conclusion

The SC needs to ensure adequate safeguards are in place to protect the patient, when it comes to a living will. The medical board should certify each case before execution of the living will is allowed. While a right to life does not mean the right to take it too, a dignified life includes the right to die with dignity. Life must be preserved, but not prolonged in suffering artificially. The question however arises whether a living will implies the state has to accept the patient's autonomy to the extent of legalising the will to die? Does it mean doctors are not obligated to make efforts to save every life? With changing times and technology, after all, a cure may be around the corner. One thing is certain though. When it comes to the question of a living will, there are no easy answers.