Thiruvananthapuram, Jul 27 (PTI) Over a decade ago, a government surgeon in Kerala found himself in a dilemma—whether to honour his cancer-stricken father’s wish to avoid ventilator support in his final days or to provide all futile medical treatment given at the end of life, as any doctor would.
In the end, the surgeon prioritised all medical futility to sustain his life over his father’s wishes, leaving the elderly man suffering in an ICU in his last days.
The permanent regret and pain the incident caused in Dr Induprabha Yadev alias IP Yadev, the doctor-son, has set the path for a silent revolution in the health and palliative care sector of Kerala by popularising Advanced Medical Directives (AMD) or Living Wills based on a Supreme Court verdict in 2018.
According to official records, a “living will” is a legal document that outlines an individual’s right to decide and exercise their health care preferences when faced with a terminal illness or life-threatening disease and unable to make decisions on health care choices and treatments.
Yadev’s constant preoccupation with the matter, his association with his mentor Dr MR Rajagopal, father of palliative care in India, and sincere desire to prevent others from enduring the same mental anguish his father had suffered led to the establishment of the groundbreaking Living Will Information Counter under the Government Medical College’s Palliative Care unit in Kollam district—the first such initiative in the country.
The Counter opened on November 1, 2024 provides information and guidance on drafting ‘Living Wills’.
Though there is no record on how many people have prepared ‘Living Wills’ in the state so far, hundreds of people approached the counter with queries. Many of them are expected to have prepared a Living Will, hospital sources said.
“Every human has the right to make choices on how they should be treated in their old age,” Dr Yadev told PTI.
“Somebody may not want to have any major medical intervention and have a peaceful exit. Others may want to receive all possible medical support to extend their life longer…to spend more days with their loved ones. Both these things can be ensured through a Living Will,” he explained.
With the concept gaining traction in recent years, as many as 65 members of a traditional family in Paravur in Kollam recently signed a Living Will. Around 30 members of a palliative care society in the central district of Thrissur also followed a similar path.
Prominent industrialist Kochouseph Chittilappilly told the media some time back that he created a Living Will to ensure that he does not get surgery or ventilator support if he becomes permanently ill after he turns 70.
Dr Yadev, who signed a Living Will himself, said the document was legally recognised by the Supreme Court in 2018. The concept gained momentum after the apex court simplified the procedures for signing and implementing the Will through its order on January 23, 2023.
The general surgeon, serving as a nodal officer of the model palliative care division of the Kollam Medical College, said they have been imparting grassroots-level awareness about the Living Will during the community classes.
“Not just the people who wish to avoid major medical support want to sign the Living Wills. There are people who clearly want all possible medical support during their old age just to extend their life till their children arrive from abroad. Such people are also approaching the information counter,” he said.
Explaining the procedure, Dr Yadev said once a person decides to write a living will, the individual needs two or more health care attorneys, also known as surrogate decision-makers or proxies.
“A gazetted officer or notary then certifies the will in the presence of two witnesses. This ensures that the person voluntarily wrote the will. A copy of it can be sent to the local government,” he said.
Krishnakumar, a Perumbavoor-based businessman who signed a Living Will recently, said the plight of some of his relatives who had to spend their final days in the ICU and on a ventilator despite having a terminal illness has prompted him to think about signing such a legal document.
Instead of fixing all that medical equipment unnecessarily on the body, it is better to spend peaceful hours with loved ones at our own home if it is a case of terminal illness, he said.
“By signing a Living will, we can make an appropriate decision in this regard much earlier. Now, its procedures are simplified,” he said.
Krishnakumar said his father also signed a Living Will and died some time back without any major medical interventions, as insisted by him.
Dr Yadev, however, made it clear that there are challenges in the implementation of the Living Will.
“Who will decide this particular person has a terminal illness? The doctor who treats the patient is not enough, as per the guidelines. There should be a primary and a secondary board. The primary board should have medical experts with at least 5 years of experience other than the doctor who treats,” he said.
The secondary board should have 3 persons—one from the panel suggested by the District Medical Officer and 2 specialists.
“To overcome the hurdle of forming two boards for each patient, we have created 2 panels of doctors, like the organ donation programme, for the first time in the country,” the surgeon added.
Inspired by the success story at the Kollam Medical College, the Government Medical College in Alappuzha is to open a similar “Living Will Information Desk”, authorities said. PTI LGK ADB
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