MUMBAI:
A recent survey conducted by HCAH guided by End of Life Care in India Task Force (ELICIT),showed that despite having strong opinions about their last moments, only 27 per cent Indians are aware about the concept of Living Will.
The survey asked citizens across India what living well meant for them during last few days of their life. The survey conducted with a sample size of more than 2,400 showed that 88 per cent Indians wished for the independence to decide their line of medical treatment during the last days of their life rather than leave it on their family. The survey was carried almost a year after Supreme Court’s historic verdict on Living Will.
A Living Will, also called a directive to physicians or advance directive, is a document that lets people state their wishes for end-of-life medical care, in case they become unable to communicate their decisions. In March 2018, India’s Supreme Court allowed people to draw up Living Wills, meaning they can seek withdrawal of life support
Commenting on the findings, Dr. RK Mani, head of ELICIT, said “The survey clearly shows that with more awareness around Living Will, many more Indians would be able to take such informed decisions. While only 27 per cent of people surveyed were aware of the concept of living will, but the moment we gave them a background on the subject more than 79 per cent found the concept of Living Will relevant.
While the ‘Living Well’ factor may differ from person to person, most had a wish regarding how they want to live the last few moments of their life. Supreme Court’s verdict on Living Will, withdrawal and withdrawing of life support becomes an important factor enabling people to ‘live well’ their last moments. What we now wish is to have simplified process laid down to help people execute their Living will”.
The objective of this survey was to bring discussions around Living Will out of conference rooms to living rooms of people. The survey highlighted that while people want to make informed decisions for their last moments, awareness around Living Will – an advanced healthcare directive which lets people state their wishes with regards to their last moments even when they can’t – is very poor in India.
Awareness levels around the concept of Living Will were poorest in Jaipur and Chandigarh, while with 36 per cent and 31 per cent respectively, the awareness levels in Delhi and Mumbai were highest. The survey not just gauged the level of awareness around Living Will, it also made people aware about the same in objective terms.
An objective note about Living Will was shared with all respondents in the middle of the survey to raise awareness around the concept. Post understanding the concept of Living Will, 87 per cent respondents found it highly relevant for terminally ill or patients on artificial life support.
The acceptance was at 92 per cent in respondents above 60 years of age. Interestingly, on being asked the relevance of Living Will for self, this number dipped from 87 per cent to 76 per cent. This gave interesting insights in the psyche of Indians.
While the difference was not significant amongst different age groups and regions, respondents in the age group 25 to 35 years and respondents from Delhi found Living Will least relevant for themselves. What was interesting to note was that Chandigarh, which had the poorest awareness about the Living Will concept found it most relevant.
Commenting on the findings, Dr Gaurav Thukral, COO, HCAH said: “Worrying about burden on the family and wanting a suffering free dignified end of life highlights the maturity of the Indian people in dealing with a difficult situation. The Indian values of putting needs of the family before your own was very evident. 96 per cent of senior citizens who thought Living Will to be a relevant concept see it as an important way to reduce financial stress on their family while 93 per cent of respondents in the 25 – 35 years group found it relevant to put an end to suffering of patients on artificial life support.”
Furthermore, of the 76 per cent people who found the concept of Living Will relevant, 91 per cent wished to discontinue any life support system in case they were declared terminally ill on artificial life support with no or marginal hope of recovery. Only five per cent found Living Will concept irrelevant, with few worried about its misuse and while few find it hard to chart the course of their last moments themselves and will leave it on their kin to decide.
