India legalizes 'living wills' but few know about them

New Delhi – In a crowded ward at the All India Institute of Medical Sciences (AIIMS), India's leading public hospital, a mother sits quietly beside her 29-year-old son who is dying of stomach cancer. After five rounds of chemotherapy showed no improvement, the family doesn't know what to do next.

Upstairs, a brother from the small town of Auraiya has brought his 40-year-old sibling suffering from oral cancer to AIIMS in despair. Doctors have declared there are no more treatment options. He can only take his brother back to a rented home in Gurgaon with some painkillers, unaware of the concept of palliative care.

India recorded about 1.56 million new cancer cases in 2024. However, according to a 2025 analysis, an estimated 7 to 10 million people need palliative care, but only about 4% have access to it. Many families are unaware of their right to document treatment wishes before a crisis occurs.

From care to court

In 2018, India's Supreme Court recognized the "right to die with dignity" as part of the right to life under Article 21 of the Constitution. The court also allowed patients to record their wishes about life-sustaining treatment if they lose the ability to decide, through a document called a "living will" – a legal document outlining an individual's medical preferences when they cannot express them.

However, this right remains largely on paper. Only in March 2026 did a court first permit withdrawal of life support for a patient who had been in a coma for 13 years at AIIMS. Harish Rana's family has struggled to care for his feeding tube, tracheostomy, and urine bag for 13 years. His father, 63-year-old Ashok, fears: "If something happens to me or my wife, who will care for him?" The family had to go to court to seek permission.

The Rana family's lawyer, Manish Jain, said the case was complicated because there was no living will. He stressed: "Living will clinics don't exist across India." The country has only two such clinics, both in private hospitals, out of reach for most citizens.

Fear of misuse makes procedures complex

Worried about misuse of living wills, the Supreme Court initially introduced a complex process: requiring signatures of two witnesses, approval by a judge, then forming a panel of doctors with at least 20 years of experience, followed by a second medical board constituted by the district collector. Only when both boards agreed could the process proceed.

In 2023, the court simplified it: removing the judge's approval requirement, reducing doctors' experience to 5 years, and allowing appointment of multiple proxies instead of one. Still, lack of awareness remains a major barrier. A 2019 survey across 7 major cities showed 73% of people were unaware of the right to a living will; among those who knew, only 6% actually drafted one.

Lawyer Manish Jain said: "No parliamentary law governs this matter. The Supreme Court asked the government to enact legislation in 2018 and 2023, but so far nothing has been done."

Dr. Saipriya Tewari, a palliative care specialist at Max Hospital in New Delhi, says not just patients but doctors too lack awareness about end-of-life care. "Families are often confused when told there are no more treatment options and asked to take the patient home. Nobody tells them what to do next. Even when the end is near, how to maintain dignity during that time? That's the big question."

Piyush's mother – the stomach cancer patient – still has no answer: "If your child is sick, you must treat them, do something to keep them alive. We can't think of a way out. Nobody gives us advice on where to go."

(Patient and family names have been changed to protect identities)