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Conversations ease passing

March 13, 2018


Living will isn’t a document but a process, which can include a conversation about preferring death at home or hospital, writes Dr. Roop Gursahani in ‘The Times of India’.


Living Wills have been used by lakhs of Americans. A living will or an advance medical directive is a legally binding instrument by which individuals can control and influence decision making regarding healthcare in situations in which they cannot make or communicate such decisions.


But these did not exist in India out of an uninformed concern that they can be misused. All of us have the moral and legal right to make our own informed medical decisions under the concept of patient autonomy. Although seemingly obvious it was never spelt out for Indian citizens until last week’s Supreme Court judgment.


But what legal experts do not realise is that a living will is not a document but a process. The most important component of this process is “the conversation”, either one or a series of discussions about how people wish their last days to be. Often the simplest is a choice of place of death: home or hospital! In addition, people at the end of life need a “chance to express their love, their regrets, their apologies, their parting words of advice or forgiveness”.


This seems essential for a peaceful passing but this can happen only when we admit that death is inevitable, not at some vague time in the future, but in the next few months or a year. Medical science is increasingly better at this kind of prediction but the communication of this knowledge requires both empathy and communication skills. These skills are increasingly recognised as a basic tool of the medical profession, except in India.


Quality of death does not depend on high technology and India has been listed as one of the worst countries in the world to die in. In 2015, three national medical associations of neurologists, intensivists and palliative care physicians came together to try and remedy this situation by forming the End of Life Care in India Taskforce (ELICIT) initiative.


Our task is threefold. There is little public awareness of these issues and we need to make conversations about death natural and not forced. India needs enabling legislation for end of life and palliative care. But most importantly, the medical profession by and large is both unaware of and not trained to do what is right.


The default option then is to ‘do everything’ and senior citizens die lonely, tortured deaths on life support, in hospital ICUs. A lucky few escape that fate because the ‘effector community’ of children, friends, nurses and doctors who know, understand and respect the dying person's wishes throughout. Many of us are not going to have that good fortune.


(Dr. Roop Gursahani is on the Steering Committee of ELICIT.)


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