The Last Word: How living wills help ensure death with dignity

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When Lopa Mehta, a 78-year-old retired physician from Mumbai’s KEM Hospital, announced her living will, she did more than make a personal choice — she reignited a national conversation on dignity, autonomy, and the deeply human desire for control over life’s final chapter.

By stating her refusal to be admitted to the ICU, undergo mechanical ventilation, or any other aggressive life-prolonging intervention, Mehta raised a question that is both personal and universal: do we have the right to decide how we leave this world?

This is not a debate confined to India. Around the world, heart-wrenching cases have shaped how societies view end-of-life decisions. In the United States, Nancy Cruzan became the face of a legal battle when her family sought permission to remove her feeding tube after a car accident left her in a persistent vegetative state. The case reached the US Supreme Court and underscored the importance of having clear, written directives — what we now call advance medical directives.

Then came the Terri Schiavo case, one of the most publicised end-of-life disputes in America. Schiavo’s husband and parents fought bitterly for years over whether life support should be withdrawn, with courts, politicians, and even the President of the United States intervening. Her case laid bare the emotional and legal chaos that unfolds when a person’s wishes are unknown.

In the United Kingdom, the story of Tony Bland, a young victim of the 1989 Hillsborough disaster, marked another turning point. Left in a vegetative state, Bland became the first patient in British legal history to have life support withdrawn with court approval.

These cases, steeped in both legal complexity and human anguish, remind us why living wills matter: they protect individuals from unwanted interventions and spare families the trauma of making impossible choices.

What is a living will?

“A living will, also known as an advance medical directive, is a document that enables a person to state in advance her / his refusal to receive certain medical treatments if they’re in a terminal condition,” explains Shweta Tungare, Co-Founder of LawTarazoo. “It allows individuals to decline life-prolonging interventions such as ventilators or feeding tubes when recovery is no longer medically feasible. At its heart, it reflects one’s right to die with dignity, which is protected under Article 21 of the Indian Constitution.”

Alay Razvi, Managing Partner at Accord Juris, adds, “A living will comes into effect when a person is terminally ill, in a coma, or permanently unconscious, and doctors certify that there is no chance of recovery. By making one’s wishes clear, it relieves families of the heavy burden of deciding between prolonging life and letting go.”

India formally recognised living wills in 2018 through the Common Cause vs Union of India judgment, which also legalised passive euthanasia. But the framework is mired in procedural hurdles as the directive must be signed by the individual, attested by witnesses, countersigned by a Judicial Magistrate, and approved by medical boards.

“In contrast, countries like the USA, UK, and Australia have far simpler systems,” says Tushar Kumar, Advocate at the Supreme Court of India. “In the UK, the Mental Capacity Act, 2005, makes advance directives binding, while in the USA, all 50 states recognise them — often along with a durable power of attorney for healthcare. India’s complex process discourages people from making a living will, even if they believe strongly in the principle.”

Autonomy vs sanctity of life

At its core, the living will debate asks whether we have the moral and legal right to decline medical treatment when life becomes mere existence. Supporters see it as an extension of personal liberty under Article 21, while critics fear potential misuse, especially among vulnerable seniors or patients without close kin.

“Living wills bring forth ethical debates about autonomy, the right to die, and whether doctors must preserve life at all costs,” says Razvi. “There is also fear of coercion or misuse, especially when instructions are unclear.”

“If a living will’s directives are ignored, the patient’s family can challenge medical decisions as violating the right to die with dignity,” explains Tungare. “But because there is no statutory law backing it, enforcement is weak and judicial relief often comes too late.”

Kumar adds, “Doctors remain hesitant to act solely based on a living will for fear of legal repercussions or institutional pushback.”

Why living wills are rare in India

Despite the 2018 Supreme Court judgment, few Indians have written living wills. Cultural discomfort around discussing death and the complicated legal procedures are major barriers. In countries like the USA, however, advance directives are common, especially among elderly individuals or those battling degenerative diseases.

Mehta’s public declaration joins a global chorus that includes the legacies of Cruzan, Schiavo, and Bland — individuals whose suffering shaped legal reforms worldwide. For India, the path forward lies in creating a clear, compassionate law that makes living wills both accessible and enforceable.