Living Will Definition

During certain types of medical treatments the consent of the patient is required. Here the question arises as to what will be done if the patient is no longer in a position to express his consent in writing. For this there is a provision in which a patient can beforehand detail the option for treatment he wants. Such declaration is a called a living will.

It is thus, an advance health care directive, in which people can state their wishes for their end-of-life care, in case they are not in a position to make that decision such as vegetative state, coma, brain damage with terminal illness etc. Only an adult with a sound healthy mind can make a living will. It should be voluntarily executed and based on informed consent. It should be expressed in specific terms in a language “absolutely clear and unambiguous.”

Growing awareness about terminal as well as mental illness has given credence to the idea of “living wills because it gives primacy to patient autonomy and what kind of treatment they would want to access or avoid. The rationale behind the will is that close relatives of the patient often end up spending a fortune on treatment of the terminally ill patient and there may be plethora of reasons for doing that- attachment, importance, moral pressure, etc.

However, there are various ethical issues to be considered before the idea of living will become more acceptable in the society and is ready to be implemented.

Individual perspective:

• A living will requires a lot information regarding the disease and treatment. Therefore it is not easy for any individual to write such a will.
• Even views of an individual may change over time and he/she may or may not be willing to stick by the declarations made in the living will.
• Only a handful of individuals with access to best research may be able to rationally formulate a living will. For others, it will merely be an exercise in futility because of lack of information.

Social Perspective:

• Does declaration by a person that he/she does not want to be treated beyond a certain extent absolve the moral responsibility of the relatives to not offer the best treatment?
• On the contrary, if a person wishes to prolong life with support systems as long as possible, does it put a legal obligation on the family or doctors or even state to ensure it?

Medical Dilemma: Does it mean an abandonment of a doctor’s obligation to preserve life? If so at what stage.

Legal/ Constitutional dilemma: Some persons believe that in certain cases a living will may amount to a consent for death. Here it is noteworthy that our constitution (Article 21) allows us the right to live but it does not sanction the right to die. Hence, one can say that a living will is basically unconstitutional.

Public Policy related dilemma: Experts believe that a living will might be misused by the society to neglect the elderly patients and let them die at their own will.

In the case of Common Cause v. UOI (Union of India) the Supreme court maintained that the right to life and liberty as led down under Article 21 (f) the Constitution is meaningless unless it covers within its sphere individual dignity. As such, right to die with dignity has been read as part of the fundamental rights. However, it is imperative that legal sanctification of living wills must be accompanied by robust safeguards. As mentioned by the SC, these include formulation of will solely on voluntary basis and certification by a medical board, constituting of senior practitioners, for executing the desired method of treatment or its withdrawal.

GS PAPER IV Ethics UPSC Mains Question

Growing awareness about terminal as well as mental illness has given credence to the idea of “living wills”. What is a living will? Discuss the ethical issues to be considered from an individual as well as social perspective to formulate and implement it.

Approach

• In the introduction define living will and its nature.
• Highlight the advantages of a living will.
• Bring out the ethical dilemmas in their implementation from individual as well as social perspective.

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