ADVANCE MEDICAL DIRECTIVES – A GUIDE
- INTRODUCTION
An Advance Medical Directive (AMD) is a written legal document that allows a person to specify their preferences for medical treatment in case they become too unwell or incapacitated to communicate their choices.
Essentially, it’s a way to plan for your future healthcare when you might not be in a position to speak for yourself.
Imagine a scenario where someone has an accident and slips into a coma. In such a situation, the doctors and the family might not know what the person would have wanted.
Should they continue life support? Is there a point where the treatment should stop?
An AMD provides clear instructions for such scenarios, helping doctors and loved ones make the right decisions based on the individual’s wishes.
The AMD usually includes decisions about:
- Whether to use life-support machines.
- Whether to attempt resuscitation if the heart stops.
- Preferences about feeding tubes or hydration through drips.
- And other similar scenarios about treatment and care that the individual concerned wishes to (or not) receive.
II. AMD – IS IT FOR YOU?
An AMD is a very helpful tool for both you and your family because it takes the uncertainty out of difficult situations and it helps you make decisions about the kind of care you would like to receive in emergency situations.
Here are some key advantages of having one:
- An AMD Ensures that your wishes are followed during emergency or end of life care.
With an AMD in place, you can be sure that medical treatments align with your beliefs, preferences and choices e.g., if a person has strong feelings about not being kept alive on machines when there is no hope of recovery, the AMD will instruct doctors to follow that preference.
Illustration:
Raj, a 60-year-old man, is concerned about his future health as he ages. He does not want to be kept alive on life support if there’s no chance of recovery. Raj creates an AMD that clearly states this. A few years later, Raj suffers a severe stroke and cannot communicate. Thanks to his AMD, the doctors and his family know exactly what to do, avoiding prolonged medical treatments he wouldn’t have wanted.
- Reduces stress and anxiety for your family.
During emergencies, families can struggle with deciding what is best for a loved one, and it may lead to conflict, anxiety and stress. One of the biggest benefits of an AMD is that it spares your family from making very difficult decisions about your care especially when you are not in a position to state your preferences. Having an AMD takes away this burden from your loved ones, as they can simply follow your pre-determined wishes.
Illustration:
Priya’s grandmother was admitted to the hospital with a terminal illness. The doctors said her condition would not improve, but Priya’s family couldn’t agree on whether to continue with aggressive treatments. If Priya’s grandmother had made an AMD earlier, the family would have known exactly what she wanted, avoiding confusion and stress.
- Gives you control over medical decisions and treatment choices.
An AMD gives you the power to decide the extent of medical intervention you want, rather than leaving those decisions entirely to doctors or family members who may not be aware of your true preferences.
Illustration:
Meera was diagnosed with an early-stage disease but was thinking ahead. She created an AMD stating that she would prefer comfort care (palliative care) over aggressive treatments if her disease progressed to a late stage. Several years later, when Meera’s condition worsened, the doctors respected her AMD and provided the comfort care she requested, instead of treatments she wouldn’t have wanted.
Thus, by having an AMD in place, you maintain control over your care and dignity.
III. THE POSITION UNDER INDIAN LAW
In 2018, the Supreme Court of India laid down detailed guidelines to safeguard the rights of patients with respect to AMD’s. However, the implementation faced practical difficulties, leading to a revision by the court in 2023. The updated guidelines aimed to simplify the process of executing AMDs while maintaining essential safeguards to prevent abuse.
Key Updates from the 2023 Judgment:
- Who Can Make an AMD? Any adult, who is of sound mind and capable of making an informed decision, can create an AMD.
- Content of the AMD: The AMD must clearly specify the type of medical treatment the individual wishes to refuse or accept in case of terminal illness, permanent vegetative state, or any situation where recovery is unlikely. For instance, the document can state whether life-support measures, such as ventilators or feeding tubes, should be used or withdrawn.
- Execution of the AMD: The AMD must be signed by the individual in the presence of two witnesses and it must be attested by a notary or a gazetted officer.
- Executor: The AMD should appoint a guardian or close relative as the executor who will have the authority to make medical decisions on the person’s behalf if they become incapable. The executor will work with the treating doctors to ensure that treatment decisions are taken in line with the AMD.
- Integration with Digital Health Records: The executor of the AMD has the option to include the directive in their digital health records, allowing for easy access by treating physicians when required.
- Revocation and Amendments: An individual can revoke or alter their AMD at any time. This ensures that the directive remains up to date with the individual’s preferences.
- Medical and Legal Safeguards: When an AMD is invoked, the treating physician must confirm its validity by checking health records or contacting the person designated as the executor. The decision to withdraw life support must be approved by a medical board, ensuring that the directive is followed ethically and in the patient’s best interest.
- Role of Courts: In case of any dispute, refusal, or ambiguity regarding the directive, family members, treating doctors, or the hospital can approach the High Court for an expedited resolution.
IV. MAKING AN AMD
How to Prepare an AMD?
You should seek assistance from a qualified legal professional with experience in medico-legal matters when drafting an AMD.
When drafting an AMD, individuals should keep the following considerations in mind:
- Clarity of Instructions: The document should clearly outline the medical treatments to be refused (e.g., life support, resuscitation) and under what conditions these instructions are to be followed.
- Choice of Executor: Select a trusted person (or persons) as the executor who will act in your best interest.
- Medical Professional and Lawyer: Consult a medical expert about the type of scenarios that may need to be addressed when recording choices in your AMD. Consult with a legal professional who has experience with preparing and enforcing AMD’s.
- Attestation: The document must be signed in the presence of two witnesses and attested by a notary or a gazetted officer.
- Communication with Family: It is crucial to inform family members and, if possible, provide a copy of the AMD to your family physician to avoid confusion or conflicts during medical emergencies.
- CONCLUSION
In conclusion, an AMD empowers you to have control over your future healthcare decisions and ensures that your wishes are respected when you may not in a position to express them yourself.
It also provides peace of mind to your family by removing the burden of making difficult decisions during a crisis.
Taking the time to draft an AMD is a crucial step in planning for unforeseen medical situations, and it’s a simple way to ensure that your voice is heard.
Act now by consulting with a legal professional and healthcare provider to prepare your AMD and secure your medical future.