Implementation & Future Outlook: Living Wills in India
Pursuant to Supreme Court judgments that provided the legal foundation, Maharashtra Government in December 2024, issued a Government Resolution (“GR”) to operationalize the Supreme Court’s 2023 guidelines[1]. The GR required hospitals to constitute both Primary and Secondary Medical Boards, headed by the Dean or senior-most physician, to review cases involving Living Wills. Each board is expected to render its opinion within 48 hours, ensuring that end-of-life decisions are made promptly and transparently
In March 2025, Maharashtra expanded this framework by appointing 417 custodians across municipal bodies and nagar parishads. These custodians are tasked with maintaining and retrieving Living Wills, thereby creating an institutional system for safe storage and quick access when needed[2]. This step is crucial for bridging the gap between patients’ rights and the practical realities of healthcare delivery.
Further, in April 2025, the state informed the Bombay High Court, during the matter of Prof. Dr. Nikhil D. Datar v. State of Maharashtra (PIL 3/2024), that it was building a dedicated web portal for online registration and retrieval of Living Wills. This portal will allow citizens to create and register their directives digitally, while also enabling hospitals and custodians to access them instantly in emergencies. To ensure uniformity, Standard Operating Procedures (“SOPs”) are being finalized for custodians and medical professionals, guiding them on how to handle Living Wills consistently across the State[3].
Practical Implications
These initiatives carry significant practical implications. Hospitals will now be mandated to form medical boards, reducing delays that often accompany critical decisions at the end of life. Citizens of Maharashtra will soon be able to register Living Wills online, bypassing cumbersome paper processes and making advance care planning more accessible. Custodians across municipalities will act as the formal custodians of these documents, ensuring that they are securely stored and retrieved without conflict or confusion.
For doctors, this framework provides legal clarity and protection. With a duly registered Living Will in hand, medical practitioners can act in accordance with the patient’s wishes without fear of liability, a concern that has often deterred doctors from acting even when families urged withdrawal of futile treatment. For families, the system provides assurance that decisions are guided by the patient’s voice, reducing emotional burdens and avoiding disagreements in moments of crisis.
The Road Ahead
Maharashtra’s framework could become a model for other States to emulate. If adopted nationwide, it could lead to the creation of a centralized digital registry of Living Wills, ideally integrated with India’s National Health Record system, ensuring uniform access across hospitals and states. Such a registry would give patients confidence that their directives will be respected wherever they are in the country, while also giving doctors the legal certainty they need to act promptly and compassionately.
Living Wills are more than legal instruments, they are expressions of dignity and compassion. They empower patients to make decisions about their end-of-life care, protect families from the agony of uncertainty, and give doctors the assurance to act responsibly. With Maharashtra leading the way, India now has the beginnings of a practical framework that can transform Living Wills from theory into reality.
Conclusion
Through this three-part series, we have traced the journey of Living Wills from their conceptual roots to their global evolution, and finally, to their implementation in India. The first article introduced the idea of a Living Will and highlighted its importance for patients, families, and doctors. The second explored how different countries shaped their frameworks, offering lessons that India can adapt. This final article has shown how these principles are now being translated into practice, with Maharashtra pioneering custodians, medical boards, and a forthcoming digital registry.
Taken together, these developments suggest that India is on the cusp of a transformation—where Living Wills are no longer abstract constitutional rights but practical, accessible tools that ensure autonomy, dignity, and compassion at the end of life.
Download File:
[1] https://archive.org/details/in.gov.maharashtra.gr.202412121646008713/page/n1/mode/2up
[2] https://timesofindia.indiatimes.com/city/mumbai/maha-govt-appoints-417-custodians-across-state-directs-spread-of-awareness-of-living-wills/articleshow/108307690.cms
[3] https://mercurydocs.sgp1.digitaloceanspaces.com/docs/BombayHC_C_RPIL_32024_17-04-2025.pdf
