Mumbai Hospital Launches First-Ever Clinic to Help Patients Prepare a Living Will
A Landmark Move in Indian Healthcare
In a historic step that could redefine how patients approach end-of-life decisions, a prominent Mumbai hospital has launched India’s first dedicated clinic to help individuals prepare a living will. This groundbreaking initiative is not only the first of its kind in the country but also a critical development in advancing patient rights and medical ethics in India.
The concept of a living will, while widely accepted in many Western countries, remains relatively new and underutilized in India. A living will is a legal document that allows a person to outline their preferences for medical treatment in situations where they may no longer be able to express informed consent. It includes decisions about life support, resuscitation, palliative care, and other life-sustaining treatments.
Launched at a well-known multispecialty hospital in South Mumbai, this clinic aims to offer end-to-end guidance for patients and their families. The facility is staffed with trained doctors, legal consultants, counselors, and ethicists, who work together to help patients understand the implications of living wills and ensure their decisions are legally sound and ethically informed.
Bridging the Gap Between Law and Medicine
The Supreme Court of India recognized the legality of living wills in its 2018 judgment on passive euthanasia. However, in practice, the procedure to create and validate a living will has remained convoluted and intimidating for most citizens. Lack of awareness, bureaucratic hurdles, and cultural taboos around discussing death have all contributed to the concept being largely absent from mainstream healthcare.
This newly launched clinic seeks to address these gaps head-on. Dr. Neelam Deshmukh, the medical director of the hospital, emphasized the clinic’s mission: “We want to empower patients to make dignified choices about their own bodies and treatment pathways. A living will is not about giving up; it’s about having control.”
The clinic provides a structured process: first, an initial counseling session helps individuals understand the nature of living wills. This is followed by one-on-one discussions with a medical consultant who explains various medical scenarios that might occur in terminal illnesses or irreversible coma situations. Legal advisors then help in drafting the document in accordance with the patient’s wishes and ensure it meets the guidelines outlined by the Supreme Court.
Changing the Conversation Around Death
In Indian society, conversations about death are often avoided due to religious, emotional, and cultural sensitivities. This has led to a disconnect between the patient’s wishes and the actual medical interventions administered in critical care settings. Families often face the burden of making life-altering decisions without knowing what their loved one would have wanted.
With the advent of this clinic, a shift in mindset is expected. The clinic has already begun conducting awareness sessions and workshops not only for the public but also for medical practitioners, so that the healthcare ecosystem becomes better equipped to respect patient autonomy.
Several patients and families have already availed the clinic’s services. Seema Gupta, a 63-year-old retired schoolteacher, was among the first to register her living will through the clinic. “I want to reduce the burden on my children to make tough choices if something were to happen to me. I feel more at peace knowing that my voice will be heard even if I can’t speak,” she shared.
Legal Complexities, Cultural Resistance, and the Road Ahead
While the concept of a living will offers immense potential to uphold patient autonomy and relieve emotional burdens on families, its adoption in India faces multifaceted challenges. Chief among them are legal ambiguities, entrenched cultural taboos, and infrastructural deficits in healthcare facilities across the country.
The Legal Labyrinth
Despite the Supreme Court’s 2018 judgment legitimizing passive euthanasia and advance directives, the procedural requirements laid out are notoriously cumbersome. The guidelines demand that the living will be signed before two witnesses and a judicial magistrate, followed by medical board approvals when invoked. This multi-tiered process is not only time-consuming but also intimidating for laypersons.
The absence of a streamlined national framework further complicates matters. State-level differences in interpretation and implementation often leave patients and healthcare providers in a legal gray zone. While the Mumbai clinic’s legal team helps patients navigate these obstacles, the process still remains complex enough to deter widespread adoption.
Legal experts suggest the need for a simplified, centralized digital registry for living wills, akin to the organ donation database. This would ensure accessibility, verification, and enforceability. The Ministry of Health and Family Welfare has hinted at possible policy reforms, but concrete legislative measures are still awaited.
Cultural and Religious Barriers
Indian society’s strong emotional and spiritual connection to life—and death—adds another layer of resistance. For many families, opting out of life-saving treatment, even in terminal cases, is perceived as giving up or inviting bad karma. Religious beliefs often mandate the sanctity of life until natural death, regardless of suffering.
In joint family setups, collective decision-making takes precedence over individual autonomy. A person’s wish to forgo aggressive treatment can be overruled or ignored by family members during emotional emergencies, especially in the absence of legal clarity.
Dr. Meera Balan, a clinical psychologist working with the clinic, emphasizes the importance of family counseling: “We include the patient’s loved ones in the counseling process. Understanding that a living will is about dignity, not death, is key to shifting attitudes.”
Healthcare System Readiness
Another major concern is the healthcare system’s capacity to honor living wills. Many hospitals, especially in semi-urban and rural areas, lack the infrastructure to maintain such directives. Moreover, doctors may be reluctant to follow them due to fear of legal repercussions or institutional liability.
Training medical staff to understand, respect, and execute living wills is crucial. The Mumbai clinic has started conducting CME (Continuing Medical Education) programs on end-of-life care ethics, in collaboration with the Indian Society of Critical Care Medicine.
Path Forward: Awareness and Policy Reform
The success of this initiative will depend heavily on public awareness campaigns, interdisciplinary training, and institutional cooperation. The clinic plans to expand its model across other metro cities, and engage with insurance companies to cover advance care planning under premium health policies.
Activists and NGOs working in healthcare advocacy have welcomed the move and called for a national dialogue on end-of-life rights. “We need to destigmatize death, just as we did with mental health,” said Ananya Rao of the Patient Dignity Foundation. “Living wills are a fundamental part of dignified healthcare.”
As India grapples with a growing geriatric population and increasing burden of chronic illnesses, the demand for advance care planning is only going to rise. The Mumbai clinic, in this context, may well be the spark that ignites a much-needed transformation in how the country addresses the final frontier of life.
The Global Landscape – Lessons from Other Nations on Living Wills and Advance Directives
To fully understand the implications and potential of India’s first clinic supporting living wills, it is essential to look beyond borders and examine how different nations have adopted and adapted the concept of advance care planning. Countries across the globe have developed various models, policies, and educational frameworks to empower their citizens to make informed decisions about end-of-life care—models that India can learn from as it forges its path.
United States: A Pioneering Model in Advance Directives
In the United States, living wills and healthcare proxies are a cornerstone of patient rights. The concept gained legal traction through the Patient Self-Determination Act (PSDA) of 1990, which mandates that healthcare providers inform patients of their rights to make advance directives. Every adult admitted to a healthcare facility must be offered the opportunity to complete such documents.
The U.S. model is notable for its decentralized yet widely accepted use of documents such as the “Do Not Resuscitate” (DNR) order and the “Physician Orders for Life-Sustaining Treatment” (POLST). States like California and Oregon have digital registries for advance directives, enabling real-time access to patient preferences in emergencies. A strong culture of medical-legal cooperation ensures that healthcare providers comply with the patient’s documented wishes.
Moreover, organizations such as Aging with Dignity and Compassion & Choices have played a critical role in raising awareness. Public education campaigns, community workshops, and integration into elder care planning have normalized discussions around death and end-of-life choices.
Europe: Legal Robustness with Cultural Sensitivity
Several European countries have developed robust legal frameworks while tailoring them to cultural contexts.
Netherlands and Belgium, for instance, not only permit advance directives but also legally allow euthanasia under strict criteria. In these nations, the right to die with dignity is considered a fundamental civil liberty. Citizens can register living wills with their general practitioners, and the system is integrated into national health databases.
Germany recognizes advance directives as legally binding under the Third Law on Advance Healthcare Directives (2009). The law enables any adult to issue a legally valid document without the need for a notary or physician. Additionally, German doctors receive training to handle such directives with due diligence.
France employs the concept of “directives anticipées,” which are incorporated into electronic health records accessible by hospital staff. The government has launched public awareness efforts through health insurance platforms and geriatric associations.
United Kingdom provides advance decisions to refuse treatment (ADRT) under the Mental Capacity Act 2005. The National Health Service (NHS) supports these directives with extensive educational material and digital access.
Asia: Emerging Interest, Legislative Diversity
Asia presents a diverse landscape in terms of legal recognition and cultural reception of living wills.
Japan, known for its aging population, has approached advance directives through non-binding “living wills,” promoted by civic groups like the Japan Society for Dying with Dignity. While not legally enforceable, such documents are widely respected by medical professionals due to social consensus and ethical norms.
South Korea passed the “Act on Decisions on Life-Sustaining Treatment” in 2016, allowing individuals to register their advance directives in a national database. The law came into effect in 2018 and is hailed as a landmark in Asian bioethics. Over 2 million South Koreans have registered their directives as of 2024.
Singapore permits Advance Medical Directives (AMDs) under the Advance Medical Directive Act (1996). The process includes registration with the Ministry of Health and requires medical witnesses, ensuring the directives are taken seriously in critical care scenarios.
China lacks a national law on advance directives, but interest is growing, particularly in urban centers. Pilot programs and academic discussions are pushing for clearer legislative frameworks, though traditional beliefs about filial piety continue to influence end-of-life decisions.
Australia and New Zealand: Community-Led and Culturally Inclusive Models
In Australia, each state and territory has its own legal provisions for advance care directives. The documents can be stored digitally in My Health Record, the national electronic health system. Importantly, there is an emphasis on inclusive practices—Aboriginal and Torres Strait Islander communities are engaged through culturally appropriate resources and facilitators.
New Zealand follows a patient-centric model, where advance care planning (ACP) is widely integrated into primary and palliative care services. The government supports this through district health boards and has issued toolkits and training for medical professionals.
What Can India Learn?
The international landscape offers several insights for India as it begins to explore living wills through institutional channels:
- Simplify Legal Procedures: Streamlined processes like those in Germany or South Korea could help India overcome bureaucratic inertia. Removing the need for judicial magistrate involvement could make the system more accessible.
- Create a National Registry: A centralized, digital registry accessible by hospitals and emergency responders would ensure that living wills are honored during critical moments.
- Public Education: Campaigns similar to the PSDA outreach in the U.S. or NHS informational programs in the UK can normalize conversations around death and empower individuals.
- Medical Training: Institutionalizing end-of-life ethics in medical education—as seen in Australia and the Netherlands—will prepare healthcare providers to respect patient autonomy.
- Cultural Inclusion: India’s religious and linguistic diversity demands that materials and counseling services be tailored accordingly, engaging community leaders, spiritual guides, and civil society.
As India watches global best practices unfold, it must adapt them with local sensitivities and infrastructure in mind. The Mumbai hospital’s initiative, while groundbreaking, is only the first step. By learning from the world and listening to its own citizens, India has the opportunity to craft a compassionate, equitable, and efficient approach to end-of-life care.
While policies, laws, and healthcare infrastructure form the skeleton of any medical reform, it is the voices of those on the frontlines—the doctors, nurses, legal experts, caregivers, patients, and families—that bring soul and meaning to these efforts. In this part of our continuing series, we bring forth perspectives from those directly involved with India’s first living will clinic in Mumbai and explore how it is impacting real lives, professions, and moral choices.
Doctors at the Crossroads of Ethics and Duty
For years, Indian doctors—particularly those working in critical care units—have wrestled with the ethical dilemmas of prolonging life versus preserving dignity. Dr. Rajeev Ahuja, a senior intensivist at the Mumbai hospital, reflects on the complexity of his work:
“We are trained to save lives, but there are times when continuing treatment may actually cause more suffering. Until now, we often had to rely on verbal family consensus. With living wills, we finally have clarity and legal protection to align our care with what the patient truly wanted.”
The clinic has also hosted roundtable discussions for healthcare workers, encouraging open dialogue around moral distress. For many junior doctors, the clinic has provided a framework to reconcile their clinical obligations with patients’ rights to refuse aggressive interventions in terminal scenarios.
Dr. Ahuja notes a striking shift in the culture of hospital rounds. “In the past, we’d jump to invasive procedures even in hopeless cases because ‘not doing everything possible’ could invite litigation. But now, when a patient has a living will, the focus moves from intervention to comfort.”
Nurses and Palliative Care Teams: The Unsung Heroes
Nurses, often closest to patients during prolonged hospitalization, are emerging as advocates for patient dignity. Many have expressed relief that structured documentation through living wills alleviates moral burden.
Sister Annabelle D’Souza, head nurse at the palliative care unit, shares her experience:
“I’ve held the hands of dying patients whose families were fighting outside the ICU about whether to continue ventilator support. I’ve seen the pain in patients’ eyes when they’re intubated against their will. This clinic changes that. Patients now have a voice—even in silence.”
She also emphasizes the role of nursing in educating families. The clinic has trained dozens of nurses to be “Living Will Liaisons,” acting as the bridge between technical medical jargon and emotional family decisions.
Legal Experts: From Ambiguity to Advocacy
India’s legal community has traditionally been cautious in its interpretation of passive euthanasia and end-of-life decisions. However, the living will clinic has prompted several legal scholars to re-evaluate their stance and push for more accessible, citizen-friendly frameworks.
Advocate Rina Majumdar, who helped co-develop the clinic’s legal protocol, sees it as a milestone:
“We are finally demystifying what was once a legal black box. We’re showing people that you don’t need to be rich, terminally ill, or legally savvy to safeguard your right to a dignified death.”
She notes that most people who walk into the clinic are not currently ill—they are healthy individuals planning ahead. “That’s where true legal empowerment begins. It’s proactive, not reactive.”
However, Rina warns that until state-level policies are harmonized and a digital archive is established, there will continue to be legal grey zones. She’s now advocating for an e-Living Will registry at the national level, modeled after e-Court filing systems.
Families: Relief, Clarity, and Emotional Closure
Perhaps the most poignant voices are those of families who have experienced the power of a living will firsthand.
The family of Mr. Hari Mohan Mehta, a retired railway officer suffering from advanced-stage pancreatic cancer, shared their journey. His daughter, Neha, recalls:
“He was very clear that he didn’t want invasive treatment. But when the time came, the doctors needed legal proof. Thanks to the clinic, we had a properly registered living will. He passed peacefully, surrounded by family, not machines.”
For the Mehta family, the experience has become a story of peace, not regret. “It was painful, but also beautiful,” says Neha. “We could focus on saying goodbye, not filling forms or making impossible choices.”
Ethical Committees: Institutionalizing Respect for Autonomy
The clinic has collaborated with hospital ethics committees to create review boards for cases where living wills are invoked. These boards include doctors, ethicists, and community members to ensure transparency and adherence to ethical norms.
Dr. Amrita Thakkar, a bioethicist involved in designing the clinic’s review protocol, explains:
“Living wills are not just legal tools. They are ethical declarations. Our job is to ensure they’re honored with the integrity they deserve. We examine whether the conditions for invoking the will are met, and we mediate if there’s disagreement among family members.”
The review board model, if adopted widely, could help other institutions reduce medical conflicts and lawsuits by providing structured mediation.
The Ripple Effect: Academic Institutions, Insurance Companies, and Spiritual Leaders Join the Conversation
- Medical colleges in Maharashtra are now considering integrating modules on living wills into their curriculum, inspired by the clinic’s training methodology.
- Insurance companies are evaluating whether advance care planning can be offered as a value-added service in premium health packages.
- Spiritual leaders from diverse faiths—including Hindu, Jain, Buddhist, Christian, and Islamic backgrounds—have been invited to participate in interfaith dialogues organized by the clinic. Many have expressed support, emphasizing that preparation for death is a sacred, not taboo, act.
Swami Vatsayananda of the Vedic Ethics Council shared his perspective:
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