What is a Living Will? Roadblocks in Kerala

The absence of clear rules for drafting a Living Will—a legal document that allows individuals to outline their healthcare preferences at the end of life —is creating significant roadblocks in its implementation in Kerala. As per the Supreme Court verdict, the registration of a Living Will is the responsibility of local bodies, and the district medical officer must lead the formation of medical boards. Although many people are coming forward to draft Living Wills, the concerned departments have not yet received official directions from the government. The lack of rules and guidelines remains the primary hurdle. 

Healthcare and legal experts have urged the State Government to enact legislation based on the Supreme Court verdict. “Death with dignity is a human right. A Living Will is a way to protect that right. Many people are volunteering to draft their Living Wills. However, the absence of proper legislation is a major challenge. Legislation is essential to ensure proper implementation of the Living Will and prevent its misuse, ”  said Dr B Padmakumar, Principal, Government Medical College, Alappuzha, on the matter. 

Living Will guidelines
The guidelines for Living Wills are rooted in the Supreme Court’s 2018 verdict on end-of-life healthcare. The Court further simplified the procedures in a subsequent verdict on another petition in 2023. The government was directed to legislate accordingly. States like Karnataka and Goa have already enacted laws regarding Living Wills. Although counters were opened at Parippally and Alappuzha Medical Colleges for registering Living Wills, the absence of clear rules and guidelines continues to pose challenges.

How does a Living Will help?
When critically ill, a person may be unable to make informed decisions about their treatment. In such cases, relatives make decisions, including on ventilator support. A Living Will allows individuals to anticipate such situations and document their preferred treatments in advance. In addition to the person drafting it, the Living Will must be signed by a close relative, two witnesses, and a gazetted officer.

Will custodian and medical board
According to the Supreme Court guidelines, the local body concerned must register the Living Will and appoint an official as its custodian. However, local bodies in the State have not received any directions in this regard, due to the absence of legislation.

The Supreme Court guidelines state that the directives in a Living Will should be implemented only after review by a medical board. Two medical boards must be formed for this purpose. A three-member primary medical board should be constituted within 48 hours of the patient’s admission to the hospital. 

In addition, a secondary medical board should consist of three doctors with a minimum of five years’ experience, one of whom must be a specialist nominated by the district medical officer. However, neither hospitals nor district medical officers have received instructions regarding the formation of these boards. Legislation is necessary to prevent hospitals from prolonging treatment for their own interests, even when a Living Will exists. Around 40 individuals have submitted their Living Wills at Parippally Government Medical College. However, ensuring treatment in accordance with these Wills requires proper legislation.