Cherylann Mollan
BBC News, Mumbai
Getty images
Health activists help defend the idea of living wills in India
In 2010, IP Yadev, a surgeon from the state of southern Kerala, was faced with one of the most difficult decisions of his life.
He had to decide between keeping his father – a patient in the terminal cancer phase – living and honoring his wish, expressed verbally, to stop all treatments and put an end to his suffering.
Warning: This article contains painful details
“As a son, I felt that it was my duty to do everything I could to prolong my father’s life. This made him unhappy and he ended up dying alone in an intensive care unit. The ribs.
Experience, he says, deeply affected him and helped him achieve the importance of advanced medical guidelines (AMD), also known as living will.
A living will is a legal document which allows a person over 18 to choose the medical care he wanted to receive if they develop a terminal disease or condition without hope of recovery and are not able to Make decisions by themselves.
For example, they might specify that they do not want to be on survival machines or insist that they want to receive adequate pain medication.
In 2018, the Supreme Court of India allowed people to write living will and thus choose passive euthanasia, where medical treatment can be removed according to strict guidelines to accelerate a person’s death. Active euthanasia – any act that intentionally helps a person committed suicide – is illegal in the country.
But despite the legal green light, the concept of living will has not really taken off in India. Experts say that it has a lot to do with the way Indians speak, or rather, do not talk about death. Death is often considered a taboo subject and any mention of it bring bad luck.
But there are now any efforts to change this.
In November, Dr. Yadev and his team launched the first program of India – at the Kollam District Kerala Mollge Mollge College – to educate people on life testaments, offering information in person and by phone. Volunteers also carry out awareness campaigns and distribute models.
IP Yadev
Volunteers at the news counter on living will at the hospital managed by the Kollam government, Kerala
The creation of a will be life forces family members to have open and honest conversations on death. Despite some resistance, activists and institutions take measures to raise awareness, and there is a growing interest, although cautious.
Kerala opens the way in these conversations. Currently, it has the best palliative care network in the country, and organizations that offer end -of -life care have also launched awareness campaigns around life testaments.
In March, around 30 people from the Thrissur City Care Society Palliative Society signed living wills. Dr. E Divakaran, founder of society, says that the gesture aims to make the idea more popular among people.
“Most people have never heard of the term so that they have many questions, as if such a directive can be used to unscathe or if they can make changes to their will later,” said M .
“Right now, it is the educated and upper average class that uses the establishment. But with the basic awareness campaigns, we expect the demography to widen,” he said.
According to the ordinance of the Supreme Court, a person must write the will, sign it in the presence of two witnesses and attested it by a notary or a gas officer. A copy of the will must then be subject to a goalkeeper appointed by the government of the State.
Although the directives exist on paper, many governments of the States have not yet set up mechanisms to implement them. This is what Dr. Nikhil Datar, a gynecologist of Mumbai City, realized that when he earned his life two years ago because there was no guardian to whom he could submit it.
Nikhil Datar
Dr. Nikhil Datar (right) handing over his living will to the goalkeeper
He therefore went to court and this led to the appointment of the Maharashtra government around 400 civil servants in local state organizations to serve as living guardians.
In June, the state of Goa implemented the orders of the Supreme Court around the living will and a high court judge became the first person in the state to register one.
On Saturday, the state of Karnataka ordered the district health workers to appoint people to sit on a key medical advice required to certify living wills. (Two medical commissions must certify that a patient meets the criteria necessary for the implementation of a living will before doctors can act.)
Mr. Datar also pleads for a centralized digital standard for life testaments, accessible nationally. He also made his own will available for free on his website as a model. He thinks that a will helps prevent problems for families and doctors when a patient is in a vegetative state and beyond the recovery.
“Very often, family members do not want the person to undergo more treatment, but because they cannot take care of the patient at home, they keep them in the hospital. Doctors, linked by Medical ethics cannot remember from treatment, so the patient ends up suffering without any means of expressing his wishes, “explains Mr. Datar.
Living will are not only to choose passive euthanasia. Dr. Yadev remembers a case where a person wanted his will specifies that she should be placed in life if his condition never needed it.
“He explained that his only child lived abroad and that he did not want to die until his son could meet him,” said Mr. Yadev. “You have the freedom to choose how you want to die. It is one of the greatest rights at our disposal, so why not exercise it?” he said.
Defenders of health care say that conversations around palliative care are slowly developing in the country, giving momentum to living will.
Dr. Sushma Bhatnagar of the All India Institute of Medical Sciences in Delhi says that the hospital is launching a department to educate patients on living wills. “Ideally, doctors should discuss living will with patients, but there is a communication gap,” she said, adding that doctors by training for these conversations can help guarantee a person who dignes with dignity.
“Throughout our lives, our choices are colored by the wishes of our loved ones or by what society thinks is fair,” explains Mr. Yadev.
“At least in death, let’s make choices that are in our interest and to us.”
