As the number of senior citizens continues to rise in our country, so do the challenges of ageing. One critical aspect that often needs to be addressed is planning for end-of-life care. As people reach their 70s, decision-making wanes. Crafting a will when you reach the age of 60 is vital. Seniors usually detail asset inheritance and funeral plans in the will they prepare but often neglect hospital care preferences.
V George Mathew, Former Head of the Department of Psychology at the University of Kerala, shared a story about his close friend who passed away recently. The friend had consistently expressed his desire never to endure his final days in a hospital, hooked up to tubes and machines, but in his own home. But sadly, his passing away occurred the same way he wished to avoid.
George recalls when hospitals sent elderly patients home from the ICU if recovery seemed unlikely. Today, the situation is markedly different, he says, adding that ICU coupled with support from a ventilator can be very expensive.
For instance, private super-speciality hospitals in Delhi charge daily rates ranging from Rs 11,000 to Rs 15,000 for ICU stays. Ventilator support in the ICU adds another Rs 2,500, which can go up to Rs 20,000 per day depending on the hospital.
"What's more, the fear of societal judgment often pushes family members to admit their parents to expensive hospitals. Those in the ICU may bear the heavy mental weight, in the fear that their treatment is pushing their family into pits of debt," George adds.
Geroge says, "Verbal discussions about end-of-life care preferences with family members may prove futile when critical decisions must be made. During moments of crisis, your children may be influenced by societal expectations and extended family opinions. That's why it's imperative to commit your wishes to writing in a will. You can state in your will that you do not wish to remain in the ICU for an extended period when you are beyond a certain age. You can say if you want to remain alive in ventilator support and for how long. Such written instructions serve as a valuable reference and proof of your desires during critical moments."
"When business interest is involved, hospitals may propose organ replacement even for individuals over 80 years old by offering a slim chance of survival. A will can mention your priorities about organ replacement after a certain age."
Says Sudheer M, a Registered Investment Advisor (RIA), "It is almost impossible to make such critical decisions for a person who has entered an ICU or when in ventilator support. I usually advise clients to outline how their assets should be divided among heirs and include instructions for funeral expenses. Given the business interests intertwined with healthcare, specifying medical expenses or care in the will can also be considered."
But he also acknowledges that enforcing such a will presents its own challenges. "During a critical circumstance, your children may not have the capacity to read the document, making verbal communication essential. Additionally, seniors often hide their wills to prevent disputes over asset distribution. It's crucial to convey the location of the will to ensure your wishes are known," he said.
There is no legal challenge in enforceability except on practical grounds. Says Ankur Mahindro, Managing Partner of Delhi-based legal firm Kred Jure, "Legal enforceability of a Living Will is limited to areas where the Testator limits the treatment to be administered upon him or elaborates upon the stage of withdrawing life support. Essentially, passive euthanasia is covered by the permissibility of a living will.
Mahindro says, "The will must appoint a guardian or close relative as an executor, be signed by two independent witnesses, and be attested by a notary or gazetted officer. The copy shall be sent to the guardian, family physician, or the authorised officer of the local municipality."
"The enforcement is still relatively complicated, which involves a go-ahead by the physician, two levels of medical board approval of hospital, consent of guardian and Magistrate," he adds.