Overview
Advance Care Planning (ACP) is a process that allows you to reflect on, discuss, and document your preferences for future medical care in the event that you are unable to make or communicate decisions yourself. It is not limited to end-of-life situations—ACP can be relevant at any stage of life, particularly for people living with serious, chronic, or life-limiting conditions. At its core, ACP ensures that the care you receive aligns with your personal values, goals, and medical realities.
The ACP process involves open conversations with healthcare providers, trusted family members, and legal representatives. It may include writing down one’s wishes in a Living Will (also known as an Advance Medical Directive) and appointing a Medical Power of Attorney—someone who can make decisions on your behalf. This allows you to stay in control of their medical journey and protects your loved ones from having to make difficult choices in times of crisis or uncertainty.
Key Terms Explained
Advance Care Planning (ACP):
The process of thinking about, discussing, and documenting your preferences for future medical care in case you are unable to express them yourself.
Living Will / Advance Medical Directive (AMD):
A legal document that outlines the kinds of medical treatment you would or would not want in specific health situations, particularly if you are facing a terminal or irreversible illness.The Indian Living Will is applicable only in case of terminal illness or vegetative state.
Medical Power of Attorney (MPOA):
A person legally appointed by you to make healthcare decisions on your behalf if you lose the capacity to do so. This person is expected to act in accordance with your stated wishes and values.
Do Not Resuscitate (DNR) Order:
A medical order stating that if your heart stops beating or you stop breathing, you do not wish to undergo cardiopulmonary resuscitation (CPR). This order is usually given in hospitals.
Withdrawal / Withholding of Life-Sustaining Treatment:
Withholding refers to the decision not to start a treatment that could prolong life (like a ventilator or dialysis), while withdrawal refers to stopping a treatment that has already been started. These decisions are made when the treatment is unlikely to benefit the person or is not aligned with their goals and values.
Persistent Vegetative State (PVS):
A medical condition in which a person loses cognitive neurological function and awareness of the environment but may still have sleep-wake cycles and basic bodily functions. Recovery is extremely rare, and decisions about continuing life support in such situations are part of ACP discussions.
Terminal Illness:
An incurable condition that is expected to lead to death within a relatively short time.
Decision Making Capacity:
The ability to understand relevant medical information and make informed decisions about one’s own care. If a person loses capacity, decisions are guided by their Living Will or their nominated MPOA.
ACP in India
Advance Care Planning (ACP) is gaining ground in India, as more people live longer and deal with chronic or serious illnesses. In a landmark judgment in 2018 which was then modified in 2023, the Supreme Court of India confirmed that every individual has the right to make a Living Will—a legal document that records your choices about future medical treatment. A 2023 modification of the judgement eased out the administrative process of making a living will. The Court also clarified that people have a constitutional right to refuse life-sustaining treatments in certain situations, such as during a terminal illness or if they are in a permanent unconscious state. This means you have the legal right to say “no” to medical interventions that you feel would not be helpful or would go against your wishes.
Since then, efforts have been made to make Living Wills a practical reality. Some hospitals and doctors are now encouraging these conversations and offering support to patients and families. Living Will Clinics and awareness campaigns are helping people learn how to plan ahead. But there’s still a long way to go—many people don’t know about their rights, and even some healthcare providers are unsure about the process. Talking openly about illness and death is not easy in our culture, but with the right support and information, more Indians can take control of their future healthcare and make choices that are right for them and their families.