In Karnataka, a Primary Medical Board for executing a living will must include the treating physician and at least 2 senior medical experts.
Published Aug 25, 2025 | 11:49 AM ⚊ Updated Aug 25, 2025 | 11:49 AM
Representational image. Credit: iStock
Synopsis: A healthcare professional amongst the audience explained how a patient’s spouse, also her DHR, wanted to withdraw her life support (as discussed between the two during early stages of her illness), but the hospital staff did not pay heed to their wishes.
Even though Karnataka this year achieved the feat of becoming the first state in India to implement the Supreme Court order on legalised will and Advanced Medical Directive (AMD), its implementation has been choppy.
From procedural hurdles to hospitals refusing to honour a patient’s final wishes, caregivers and dependents still face the brunt of lack of awareness within the healthcare system—undermining the very intent of dignified end-of-life care.
At the two-day Death Literature Festival in Bengaluru called ‘Good to Go’, caregivers, healthcare providers, and senior citizens came together on Sunday for a workshop on writing a living will as part of the Advanced Medical Directive (AMD). The one-of-a-kind festival held panel discussions and workshops on the right to die with dignity and how to prepare for the same.
“Making a living will is the best way for someone to initiate a conversation with their loved ones about how and when they would want to be let go. It is also a doctor’s responsibility to listen to the patient’s wishes, so the will communicates these wishes to healthcare professionals when a patient can’t speak for themselves anymore,” said Dr Roop Gursahani, a neurologist at Mumbai’s PD Hinduja Hospital.
The Supreme Court in 2018 outlined procedures, guidelines and a structured framework for the execution of living wills to ensure that individuals could exercise their right to die with dignity in a legally recognised manner. So far, only Karnataka, Maharashtra, Goa, and Punjab have issued implementation orders.
In a workshop moderated by Dr Gursahani, alongside festival director Smriti Rana from Pallium India, Shireen Yachu and Rituparna Padhy from the Vidhi Centre for Legal Policy, participants were guided through the often misunderstood concepts of withholding and withdrawing medical care, and how to clearly lay out their wishes in a living will.
Giving an example of a patient with dementia, who is not able to recognise their family members anymore, Gursahani said administering IV fluids or artificial feeding to this person would only prolong their and their family’s misery.
“It is easier to withhold such a treatment rather than withdraw it at a later stage. Palliative care can make their journey comfortable, and would be much less emotionally taxing for family and doctors as well,” he said, urging that people document these wishes in their living will that only kicks in when the patient can’t make decisions.
A template of a living will was passed around to the audience. Apart from basic personal details, the template detailed directions relating to life-sustaining treatment – including CPR, dialysis, chemotherapy, ventilation or other kinds of artificial-life support. The patient can note down which of these treatments they do not wish to receive during their illness, which is then required to be followed by the designated healthcare representatives and treating team.
Since there is no nationally-accepted template of a living will that has been mandated by the top court, doctors at the event explained that it could be adjusted to make it as suitable as possible for the patient.
“We had one patient who mentioned in their will and even verbally to us that he wanted to be kept alive with whatever means until his sons arrived from abroad. It could be as specific as that,” Gursahani said.
An AMD has two parts; the living will which outlines treatment choices and a Designated Healthcare Representative (DHR) who is a trusted person nominated to act if the individual loses capacity. Experts at the workshop recommended that an individual appoint at least two DHRs who they trust to keep emotion aside while making decisions at the end.
Despite the legal framework, real-world cases reveal gaps in awareness and compliance.
A healthcare professional amongst the audience explained how a patient’s spouse, also her DHR, wanted to withdraw her life support (as discussed between the two during early stages of her illness), but the hospital staff did not pay heed to their wishes.
“The family was told that they would be killing their own daughter when they demanded that their wishes be heard,” the healthcare professional said.
In Karnataka, a Primary Medical Board for executing a living will must include the treating physician and at least two senior medical experts. This board is responsible for evaluating whether the patient is in a terminal condition and if continued treatment is viable. If the board doesn’t agree that life support be withdrawn—despite the wishes outlined in the living will and supported by the DHR—a Secondary Medical Board must be formed.
Legal experts at the workshop advised that if both boards refuse to act, the DHR or the family has the option to petition the High Court. “This could bring up more trauma for the family,” Padhy pointed out.
Once the AMD is made, doctors and legal experts at the workshop recommended that it be handed over to the nominated health care representatives and a custodian who is appointed by the local authority.
A custodian in this case, is a competent officer of the local government or the municipal corporation or municipality or panchayat who has been nominated to receive and store AMDs. While it is not compulsory to hand it over to a custodian, experts at the event suggested it as a ‘best practice’ to ensure that every party is kept aware.
Another member of the audience however pointed out that questions still remain on whether officials who have been appointed as custodians know of their role.
Gursahani said that he noticed this problem in Maharashtra. “People who have been appointed as custodians didn’t know of their appointment or what they had to do.”
“They must know. Unawareness is not an excuse,” countered Padhy.
(Edited by Amit Vasudev)
