Advance Care Planning: The Documents Every Adult Should Have Recorded
A well-organised health record with a decade of history is a useful thing. A record that also documents your explicit wishes for what should happen if you cannot speak for yourself is a fundamentally more useful thing. Advance care planning — the specific work of writing down preferences, appointing decision-makers, and communicating them to family — is a conversation Indian families rarely have and one that becomes essential exactly when it is too late to have.
The four documents that constitute advance care planning
- A living will or advance care directive — your specific preferences on aggressive vs comfort-focused care.
- A healthcare power of attorney — who decides on your behalf when you cannot.
- A list of specific preferences on interventions — CPR, mechanical ventilation, artificial feeding, dialysis.
- A statement of what matters to you — the values that should guide decisions the documents did not anticipate.
The legal status in India
Since the Supreme Court's 2018 Common Cause judgment (and 2023 clarifications), advance directives are legally recognised in India. The specific requirements:
- Written by a competent adult.
- Signed in the presence of two witnesses.
- Countersigned by a First-Class Judicial Magistrate.
- Naming a specific person or persons to make decisions.
- Specific about the circumstances in which it takes effect (typically: terminal illness, permanent unconscious state, degenerative condition with no chance of recovery).
The formal legal document is what a hospital's ethics committee will look for. An informal note in a health record is not a substitute; it is a supplement.
What to specifically address in the document
- Situation: Cardiac arrest in end-stage disease · Options to consider: CPR / no CPR
- Situation: Respiratory failure in terminal illness · Options to consider: Ventilation / no ventilation
- Situation: Unable to eat or drink · Options to consider: Feeding tube / hydration only / comfort measures
- Situation: Kidney failure in end-stage illness · Options to consider: Dialysis / no dialysis
- Situation: Persistent vegetative state after months · Options to consider: Continued life support / withdrawal
- Situation: Terminal diagnosis with limited time · Options to consider: Aggressive treatment / palliative focus / hospice
The healthcare power of attorney choice
The person you appoint should meet several criteria:
- Trusted to make decisions aligned with your values, not their own.
- Emotionally capable of making hard decisions in a crisis.
- Physically available — a child living abroad may not be the right choice if reachable only by video call.
- Willing to accept the responsibility.
- Have a backup person named in case the primary is unavailable.
The conversation to appoint someone should be explicit — 'I am naming you as my healthcare decision-maker. Here is what I would want in these situations.' Written wishes plus explicit conversation is what makes the appointment work in practice.
The values statement — the part that is often skipped
A specific scenario the documents cannot anticipate: your appointed decision-maker faces a choice not written down. What guides them? A separate values statement:
- 'I value being at home over being in hospital, when the outcome is the same.'
- 'I want to be conscious to say goodbye rather than sedated for comfort in my last days.'
- 'I do not want to be a burden on my family in a way I would not have wanted for myself.'
- 'Religious or spiritual practices important to me at end of life.'
These are not medical decisions but they guide medical decisions. A page like this in the record is a gift to the person who will one day have to decide for you.
Storing and communicating
An advance directive that nobody knows about is not much use. Specific steps:
- Physical original — with the person appointed as decision-maker, and one backup copy.
- Copy in the health record app, accessible to the family.
- Copy filed with your primary care doctor.
- Copy with any specialist for a chronic condition where end-of-life decisions may come up.
- A note on the emergency page of the health record: 'Advance directive exists. See [decision-maker name] at [phone].'
The conversation itself
An advance directive without a family conversation is a document that will produce arguments at the moment it should produce clarity. Have the conversation — with your spouse, with your adult children, with the person you name as decision-maker. Explain what you have written and why. Answer their questions. The document is legal; the conversation is what makes it liveable.
Nothing about advance care planning is easy to think about. All of it is easier to think about now, in health, than in the middle of a crisis. The family record that includes these documents alongside the medicines and labs is a record that respects the whole arc of a person's life.
References
Free for 90 days, no card needed. After that, keeping the record costs ₹349 for the year.
General information, not medical advice. Always talk to a qualified doctor about your own care. Where this and your doctor disagree, your doctor is right.