Does the hospital have to honour the Living Will?

Yes, where it is produced and where the clinical conditions it contemplates are met. The hospital will constitute a Primary Medical Board and a Secondary Medical Board under the Supreme Court's 2023 order. The Nominees have standing to insist on compliance.

Living Wills in India (2026) — Advance Medical Directive After the 2023 Supreme Court Modification

A Living Will is a document a person writes while of sound mind, telling doctors what medical treatment should or should not be given later, when they are no longer able to decide for themselves. In India, this idea was given constitutional backing by the Supreme Court in 2018. For nearly five years after that judgment, almost nobody actually executed one, because the procedure was so cumbersome that hospitals avoided it. The Supreme Court fixed that in January 2023.

This page explains what a Living Will does, how to make one under the simplified procedure, and what happens when the document is actually invoked at a hospital. The content is informational and is written for the lay reader. For a document that fits a specific family and medical situation, independent legal advice remains necessary.

The legal foundation

The right to execute a Living Will in India flows from Article 21 of the Constitution. In Common Cause (A Regd. Society) v. Union of India, reported at (2018) 5 SCC 1, a Constitution Bench of five judges held that the right to die with dignity is part of the right to life. The judgment was delivered on 9 March 2018 by then-Chief Justice Dipak Misra, with Justices A.K. Sikri, A.M. Khanwilkar, D.Y. Chandrachud and Ashok Bhushan. The Bench recognised two things that mattered for ordinary citizens:

Passive euthanasia, meaning the withdrawal of life-sustaining treatment in defined clinical cases, is legally permissible.
An Advance Medical Directive, often called a Living Will, can be executed by a person of sound mind to govern their own treatment at a stage when they can no longer speak for themselves.

The 2018 judgment set out a detailed procedure. It required a Judicial Magistrate First Class to countersign the directive, and the medical board that invoked it had to include a nominee of the District Collector. Hospitals, doctors, patients and families largely ignored it. Between 2018 and early 2023, documented cases of a Living Will being executed and actually honoured in India could be counted on one hand.

The Supreme Court's clarificatory order dated 24 January 2023 reset the procedure. Attestation now happens before a Notary or a Gazetted Officer. The medical boards that invoke the directive are constituted entirely by the hospital, with the Collector's nominee no longer required. The 2023 order kept the substance of Common Cause while removing the practical blockers. That is what makes a Living Will a usable instrument today, rather than only a theoretical right.

Who can execute a Living Will

The person signing the directive — the "executor" — must be:

An adult, meaning 18 years or above.
Of sound mind, capable of understanding the consequences of the directive.
Acting voluntarily, without pressure from relatives, doctors or anyone with a financial interest in the executor's estate.

The 2023 order does not require a medical certificate of soundness at the time of execution. Mental capacity is presumed in favour of the executor unless it is credibly challenged.

How to make one — the procedure under the 2023 order

Write the directive in clear language.
The content must specify when it takes effect, which treatments the executor refuses, and which treatments are to be continued. Vague wording like "do not keep me alive artificially" invites dispute. A properly drafted Living Will names the treatments by category: mechanical ventilation, cardiopulmonary resuscitation, artificial nutrition, artificial hydration, dialysis, and the like. Each is addressed separately.
Name two Nominees.
Nominees are the people empowered to communicate the executor's wishes to the treating hospital when the executor cannot. The 2023 order encourages, though does not strictly require, that both Nominees sign the document in acknowledgement. They should not be the executor's treating doctors or anyone with a financial interest in the estate.
Sign before two witnesses.
The witnesses must be present at the time of signing. They should be adults who are not Nominees or treating doctors.
Attest before a Notary or Gazetted Officer.
This replaces the earlier requirement of a Magistrate's countersignature. A Notary's attestation, with the Notary's seal and signature on each page, is sufficient. A Gazetted Officer with authority to attest documents is an alternative route.
Hand a copy to the designated local custodian.
The 2023 order asks the executor to file a copy with the local body: the Panchayat Secretary in rural areas, or the Municipal Corporation or Municipality in urban areas. Several State governments are still setting up these registries. In States that have not yet designated a custodian, the practical workaround is to keep multiple attested originals — one with the family physician, one with each Nominee, one with the executor's lawyer.
Inform the family physician and the intended treating hospital.
A Living Will that nobody knows about is a Living Will that cannot be honoured. The 2023 order expects the family doctor and the likely treating hospital to be in possession of a copy.
Keep a digital copy.
The Supreme Court specifically contemplated digital preservation. A scanned PDF with the Nominee contact numbers, stored in a cloud location accessible by the Nominees, has become standard practice.

What the directive should contain

A workable Living Will addresses, at minimum:

Trigger conditions. The precise clinical state in which the directive takes effect. For most people this reads as "a condition where recovery to independent existence is not expected" or "where I am in a persistent vegetative state as confirmed by qualified medical opinion."
Treatments refused. Named by category — mechanical ventilation, cardiopulmonary resuscitation (CPR), dialysis, artificial nutrition, artificial hydration. Each decision is independent of the others.
Treatments to be continued. Palliative care, pain relief and comfort care should always be preserved. Many executors specifically ask for these to continue even when curative treatment is withdrawn.
Clear identification of Nominees. With contact details, relationship to the executor, and alternate Nominees in case the primary Nominees are themselves unable to act.
Statement of understanding. A short paragraph in the executor's own words recording that the executor understands the directive, has had time to consider it, and is acting without pressure.
Revocation clause. A short line confirming that the executor may revoke or amend the directive at any time while competent.

When it is invoked — the medical board process

When a hospital receives a patient who has executed a Living Will and the patient reaches a stage where the directive may apply, the 2023 order sets out a two-board process. Both boards are now constituted by the hospital itself.

Primary Medical Board. Three doctors: the treating physician and two subject-matter experts with at least five years of post-qualification experience. The Board examines the patient and takes a view on whether the treatment contemplated in the directive should be withdrawn or withheld. The Board is expected to decide within 48 hours.
Secondary Medical Board. Three doctors with at least five years of post-qualification experience, with one member drawn from a State-empanelled list. The Secondary Board acts as a check on the Primary Board's view. It, too, is expected to decide within 48 hours.
Nominee consultation. The Nominees are consulted. If the Nominees dispute the Boards' view, or if any party is dissatisfied, the matter may be moved before the Judicial Magistrate First Class for resolution. The post-2023 order retains the Magistrate as a tie-breaking authority rather than an everyday gatekeeper.

The treating hospital is expected to document each step. The Living Will does not override the independent medical judgment of the Boards. It governs the scope of permissible intervention.

Revocation and amendment

A Living Will can be revoked or amended at any time, so long as the executor is competent. A new document executed under the same procedure supersedes the earlier one. The 2023 order does not require the earlier document to be formally destroyed, though it is advisable to withdraw the earlier copies from custodians and Nominees to prevent later confusion.

Common misunderstandings

A Living Will is not a Will. A testamentary Will deals with property after death. A Living Will deals with medical treatment before death. The two documents are drafted differently, attested differently, and operate in different legal spheres.
A Living Will is not a healthcare power of attorney. Indian law does not yet recognise an open-ended healthcare POA. The Living Will works by expressing the executor's own prior wishes. The Nominees communicate those wishes; they do not substitute their own judgment.
A Living Will does not legalise active euthanasia. It only covers the withdrawal or withholding of life-sustaining treatment. Any step that actively ends life remains outside the scope of what Common Cause permits.
A Living Will does not override a court order. In contested matters, where the family or doctors move the Magistrate, the Magistrate's order prevails.

Related statutes

A separate statutory route exists under Section 5 of the Mental Healthcare Act, 2017 for an advance directive regarding the treatment of mental illness. It is procedurally distinct from the Advance Medical Directive under Common Cause, and is relevant where the subject anticipates loss of capacity due to mental illness rather than physical illness. The two can be executed together, with care taken that neither contradicts the other.

Frequently asked questions

There is no central registry. Filing with the local custodian under the 2023 order — the Panchayat Secretary in rural areas or the Municipal Corporation in urban areas — serves the function of registration where that custodian has been designated. No stamp duty is prescribed on a Living Will as a legal instrument.

Yes. The procedural requirements are the same. Notarisation can happen before an Indian consular officer or a Notary of competent authority in the country of residence, with apostille or consular attestation as applicable.

Yes, where it is produced and where the clinical conditions it contemplates are met. The hospital will constitute the two Medical Boards described above. The Nominees have standing to insist on compliance.

A Living Will addresses treatments the executor may wish to refuse in defined clinical states, typically terminal illness or persistent vegetative state. It is not a blanket refusal of treatment while the executor is competent. A competent patient can always refuse any specific treatment in real time, independent of the Living Will.

The 2023 order encourages a majority view among the Nominees and preserves the Judicial Magistrate First Class as the final arbiter in genuinely contested cases. Choosing Nominees who understand the executor's wishes and are willing to act in alignment is the practical safeguard.

Living Wills in India — a practical guide after the 2023 Supreme Court modification.