Living Will / Advance Directive:
A written document that:
- States your medical treatment preferences
- Applies when you can't communicate
- Covers end-of-life decisions
- Guides doctors and family

Also Called:
- Advance Medical Directive
- Healthcare Directive
- Advance Care Directive

Living Will Specifies:
- Whether to continue life support
- Artificial nutrition/hydration
- Resuscitation preferences
- Specific treatments to avoid
- Pain management wishes
- Organ donation intent

Becomes Active When:
- You cannot communicate
- Terminal illness diagnosed
- Permanent vegetative state
- Irreversible condition
- No hope of recovery

Not For:
- Temporary illness
- Recoverable conditions
- Active euthanasia (illegal)
- Assisted suicide (illegal)

Common Cause vs. Union of India (2018):

Landmark Decision:
- Recognized right to die with dignity
- Allowed passive euthanasia
- Legalized advance directives
- Set out guidelines
- Constitutional basis: Article 21

Passive Euthanasia:
- Withdrawing life support
- Stopping artificial nutrition
- Withholding treatment
- Natural death allowed

Not Allowed:
- Active euthanasia (giving lethal injection)
- Assisted suicide
- Ending life of non-terminal patients

Article 21 Includes:
- Right to live with dignity
- Right to die with dignity
- Extends to end-of-life decisions
- No one can be forced to live in pain

Consider If You:
- Are above 18 years
- Have strong preferences about end-of-life
- Want to avoid prolonged suffering
- Don't want family to make hard decisions
- Have terminal illness
- Are planning for future

Any Adult Can Create:
- Healthy individuals
- Elderly
- Terminally ill
- Those with chronic conditions
- Anyone wanting to plan ahead

Eligibility:
- Adult of sound mind
- Voluntary decision
- Without any coercion
- Informed about implications

Witnesses Required:
- Two independent witnesses
- Should know the executor
- Attest to voluntary nature
- Cannot be beneficiaries

Countersignature:
- Gazetted officer (preferably)
- Or Judicial Magistrate First Class (JMFC)
- After satisfying about genuineness
- About understanding by executor

Original Document:
- Kept by JMFC
- Sealed cover
- Safe custody

Copies:
- One copy to executor
- One to designated guardian
- One to family physician
- Entered in digital database (when created)

Decisions to Consider:
□ Life-sustaining treatment
□ Artificial respiration
□ Artificial nutrition (tube feeding)
□ Hydration (IV fluids)
□ CPR (resuscitation)
□ Dialysis
□ Blood transfusion
□ Antibiotics for terminal illness
□ Pain management level
□ Organ donation

Important Conversations:
- Share your wishes
- Explain your reasoning
- Hear their concerns
- Reduce future conflict
- Identify guardian/proxy

Medical Discussion:
- Understand conditions
- What treatments mean
- Recovery probabilities
- Quality of life issues
- Pain management options

Include:
□ Your full details
□ Date of execution
□ Statement of sound mind
□ Specific instructions
□ Circumstances when applies
□ Guardian/proxy name
□ Doctor's information
□ Witness details

Execution Process:
1. Sign in presence of witnesses
2. Witnesses sign
3. Present before Gazetted Officer/JMFC
4. Countersignature obtained
5. Store with JMFC
6. Keep copies

ADVANCE MEDICAL DIRECTIVE / LIVING WILL

I, [Full Name], [S/o or D/o] [Father's Name],
aged [X] years, residing at [Full Address],
being of sound mind and understanding, make
this Advance Medical Directive of my own
free will, without any coercion.

PART I: DECLARATION

I declare that this document represents my
wishes regarding medical treatment in the
event that I am:

a) In a terminal condition with no reasonable
   medical expectation of recovery, OR
b) In a persistent vegetative state, OR
c) In an irreversible coma, OR
d) Otherwise unable to communicate my wishes

AND where qualified medical opinion holds
that there is no hope of recovery.

PART II: INSTRUCTIONS

In such circumstances, I direct that:

1. Life-Sustaining Treatment:
   [Choose one]
   □ I do not want life-sustaining treatment
   □ I want limited treatment as follows: ___
   □ I want all possible treatment

2. Artificial Respiration:
   □ I do not want mechanical ventilation
   □ I want it only for [X] days/weeks
   □ I want it as long as doctors advise

3. Artificial Nutrition and Hydration:
   □ I do not want tube feeding or IV fluids
   □ I want hydration only, not nutrition
   □ I want both as needed

4. Cardiopulmonary Resuscitation (CPR):
   □ I do not want CPR (DNR order)
   □ I want CPR attempted
   □ I want it only if there's reasonable 
     chance of recovery

5. Pain Management:
   □ I want maximum pain relief even if it 
     hastens death
   □ I want balanced pain management

6. Other Instructions:
   [Any specific wishes]

PART III: HEALTHCARE PROXY/GUARDIAN

I appoint [Name], [Relationship], residing at
[Address], Contact: [Phone/Email] as my
Healthcare Proxy to make decisions on my
behalf if I am unable to do so.

Alternative Proxy: [Name], [Details]

PART IV: REVOCATION

I understand that I can revoke this directive
at any time while I have capacity.

PART V: EXECUTION

Signed on this [Date] at [Place]

[Signature]
[Full Name]

WITNESSES:

Witness 1:
Name: _______________
Address: ____________
Signature: ___________

Witness 2:
Name: _______________
Address: ____________
Signature: ___________

COUNTERSIGNATURE:

[Gazetted Officer / JMFC]
Name and Designation: _________
Seal and Signature: ___________
Date: ___________

Process:
1. Primary Board Opinion:
   - Hospital's medical board
   - Confirms terminal condition
   - Reviews living will
   
2. Secondary Board Confirmation:
   - District level medical board
   - Independent verification
   - Government nominated doctors

Decision Makers:
1. Primary Medical Board:
   - Hospital doctors
   - Attending physician
   
2. Secondary Medical Board:
   - Chief District Medical Officer
   - Three expert doctors
   - Government nominees

Steps:
1. Living will produced
2. Primary board examines patient
3. Confirms no recovery possible
4. Secondary board reviews
5. If both agree, will is followed
6. JMFC informed
7. Family notified

Healthcare Proxy Can:
- Communicate your wishes
- Make decisions you'd approve
- Speak to doctors
- Access medical information
- Implement living will

Cannot:
- Override clear written wishes
- Demand active euthanasia
- Make decisions for personal gain

Select Someone Who:
- You trust completely
- Understands your values
- Can handle stress
- Will advocate for you
- Is accessible
- Is of legal age

Why Important:
- Primary may be unavailable
- May predecease you
- May become incapacitated
- Geographic issues

Regular Will:
- Distribution of assets after death
- Property and possessions
- Guardianship of children
- Takes effect after death

Living Will:
- Medical treatment decisions
- End-of-life care
- Takes effect while alive
- When incapacitated

DNR Order:
- Specific to CPR only
- Hospital document
- Doctor writes it
- Part of medical record

Living Will:
- Broader scope
- Multiple treatments covered
- You write it
- Legal document

Medical POA/Healthcare Proxy:
- Appoints decision maker
- For medical decisions
- Person makes decisions

Living Will:
- States your wishes directly
- Guides the proxy
- Specific instructions

Process:
1. Create new document
2. State it supersedes previous
3. Same execution process
4. Notify JMFC of change
5. Retrieve old document
6. Destroy old copies

Revocation:
- Written revocation
- Or verbal (if recorded)
- While of sound mind
- Notify relevant parties
- Destroy copies

Consider Updating If:
- Medical condition changes
- Values/preferences change
- Proxy becomes unavailable
- New medical options exist
- Family situation changes

Practical Issues:
- Awareness is low
- Execution process complex
- Hospital staff unfamiliar
- Time pressure in emergencies
- Family disagreements

Ensure Success:
- Multiple copies exist
- Family knows location
- Doctor has copy
- Regular discussions
- Update periodically
- Consider medical alert

Discussion Points:
- Your values about life
- Quality vs. quantity
- Suffering tolerance
- What you've witnessed
- What you want/don't want
- Their concerns

Medical Discussions:
- Current health status
- Potential future conditions
- Treatment options
- Prognosis scenarios
- Documentation

Can Include:
- Organ donation wishes
- Which organs
- Research donation
- Override family refusal?

Separate Form:
- Also complete organ donor card
- Register with hospital
- Carry donor card

Creating Living Will:
□ Understand options
□ Discuss with family
□ Consult doctor
□ Draft document
□ Two witnesses
□ Gazetted officer/JMFC
□ Submit for custody
□ Keep copies
□ Inform proxy and family
□ Review periodically

Emergency Information:
□ Carry card indicating you have living will
□ Note where original is kept
□ Proxy contact information
□ Doctor's contact