Many classic literature works have made several things clear about life. But the most important among them is that "The only certainty in life is Death". Every living thing, and most certainly human beings, have a definite death that comes as their possession and baggage with the birth itself. Sri Krishna has given the essence of this in this Shloka of Srimad Bhagavadgita (Chapter 2.27):
जातस्यहि ध्रुवो मृत्युः ध्रुवं जन्म मृतस्य च |
तस्मादपरिहार्येSर्थे न त्वं शोचितुमर्हसि ||
Death is certain for one who is born, and rebirth is inevitable for one who has died. Therefore, you should not lament about the inevitable.
Some people are ready to discuss the issue of death at any time, though it comes only when it wants. Many people are not willing to discuss about it either for fear of death or a feeling that why should it be discussed when we do not know when it will come. But the issue often haunts some individuals or their families and friends every day. We keep reading about either patients or their family members requesting for "Merciful Death". Whether such a thing should be legally allowed has been discussed since a long time and there are instances when judicial intervention have been sought in cases where no useful purpose is served in keeping the person alive as there are absolutely no hopes of nursing back to good health. There is also the issue of donating organs of the body for use of someone elsi who is waiting for a donor.
There are issues about decisions to be taken about treatment to a patient when the patient himself or herself is unable to take decisions about hospitalisation and continuation of treatment. There are also concerns about the real wishes of the particular person as to how treatment should be given, end should come and later dispose off the mortal remains.
In the blog post titled "To Be Or Not To Be (in ICU)" of January last year (Please click here to read it), there was a discussion on this issue. In the background of directives by the Supreme court of India, Ministry of Health and Family Welfare, Government of India had come out with "Guidelines for Intensive Care Unit Admission and Discharge Criteria" in January last year. Details are available in the above blog post.
Yesterday (31st January 2025) Karnataka State Government has become the first state that issued a formal order defining the appropriate authority under the Transplantation of Human Organs and Tissues Act, 1994 to give effect to the supreme court directives.
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That was about taking decisions regarding treatment in hospitals, continuation or termination of life support systems and dignified end to a human being. Then there is also an issue about what were the desires of the person in respect of non-medical issues at the end of the life. Whether he or she would like to receive visitors or not, whether some post-death ceremonies or service should be done and finally how the mortal remains are to be disposed.
In the year 2016, an interesting case "Anstey V Mundle & Anor" came up before the England and Wales High Court. A person born in Jamaica in 1935 came to England in 1960 to work as a transport engineer and died there in the year 2016. Two daughters wanted him to be buried in England whereas another daughter and niece wanted to take the body to Jamaica for burying it by the side of his mothers grave there.
The details of the case and connected issues are discussed in the blog post titled "Who Owns Your Body" of January 2019. Please click here to read it. Should not those left behind value the wishes of th deceased? If so, how to know what were they and having methods of making them formal and clear to all concerned? This is indeed important especially in the context of present day civilised society.
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Even if someone desires to record his thoughts and plans for covering such an eventuality, given that this day will certainly come in everyone's lives one day, how to go about it? Is there some method where such wishes can be recorded, trusted by others, and could be legally acceptable? If so, what are the areas covered by such a recording of the wishes? When should such a recording be done? Is it necessary that when such recording be done all the concerned persons and witnesses should be present in one place? Do hospitals or care giving organisations trust and accept them? These are indeed valid and important questions.
There are many websites that provide answers to these questions. One can open an account by paying a small fee, record their wishes, designate persons who can take decisions on their behalf, and get it attested by witnesses. One can check before recording their wishes as to whether your hospital or care provider accepts them. The designated persons and witnesses need not be physically present in the same place at the time of recordings. They can confirm their assent by electronic means wherever they are on earth. (Persons living in Moon and Mars are not covered for the time being!).
The recordings can be made by any adult irrespective of age. This is so because when the requirement for its use will come, no one knows. Elderly people should naturally do so immediately.
What are the broad areas covered by these wishes of the declaring person?
They include:
- Persons who can make health care decisions when the declaring individual is unable to decide for self.
- Persons can be designated in the order of preference. Usually three persons can be identified.
- The preference may be decided by considering personal choice, most likely availability for taking decisions, etc.
- Type of Medical Treatment desired or not desired.
- Making medical tests, scans, etc.
- Admission to hospitals, nursing homes, rehabilitation centres etc.
- Handling and releasing medical records for research etc.
- Moving to a different place or location.
- Donate organs or not.
- Apply for medical insurance, care and other similar programs.
- The extent to which the designated person can act.
- Starting, keeping on or discontinuing life support systems.
- Giving consent for surgical operations etc.
- Comfort level one wants when the end is nearing.
- Administering pain killers etc.
- Help by way of placing moist cloth, giving warm baths, etc.
- Other care like giving shaves, massaging etc.
- Reading of spiritual texts, poems, prayers etc.
- Having near ones chant a particular song, stotra or prayer as desired.
- Treatment expected by other people in those final moments.
- Having people around or being left alone etc.
- Holding hand or being talked to etc.
- Having pictures of loved ones or objects around.
- Playing of favourite music.
- Whether end should come at home or hospital etc.
- How one would like to be addressed at that time.
- How one would like to be remembered by the loved ones.
- Seeking forgiveness for past actions.
- Communicating thoughts about relatives and friends.
- Message to family members who may not be in good terms.
- To be buried or cremated.
- How ashes should be disposed, if cremated.
