Commentary
Advance care planning and the ethical obligation of death literacy as a public health initiative in India
This article highlights the importance of advance care planning (ACP) in good end-of-life care (EOLC). The judgement by the Supreme Court of India legalised Advance Medical Directives in 2018 and in January 2023, amended the procedure to make it easier. The article describes the advantages of ACP, the numerous ethical dilemmas at the end of life that it seeks to address and avoid, the latest legal procedure, the barriers, the need for awareness among healthcare providers, legal professionals as well as the public, and the need for legislation to translate the law into action. Educating citizens about their right to choose the kind of care they want at the end of life, including the right to refuse treatment, is the moral and ethical duty of all health professionals. Making death literacy and ACP a part of a public health initiative would be a major step towards meeting the obligations reflected in the World Health Organization guidelines and National Health Policy 2017, which envisage palliative care and EOLC as an integral part of Universal Health Coverage, requiring support from the government as well as the participation of civil society.
Copyright and license ©Indian Journal of Medical Ethics 2024: Open Access and Distributed under the Creative Commons license ( CC BY-NC-ND 4.0), which permits only non-commercial and non-modified sharing in any medium, provided the original author(s) and source are credited.
This article covers a sensitive yet pertinent topic of Advance Care Planning (ACP) in a simple and detailed manner. The first quarter of the article introduces ACP and End of Life Care to the reader. India’s abysmal ranking in the world in overall healthcare of patients requiring palliative care does not come as a surprise. The reader finds that these topics are rarely discussed during the course of management of a patient. It provides some startling statistics on the increasing cost of treatment and healtcare burden on caregivers. The article further discusses possibility of cutting down on these expenditure and empahsises on legislative changes.
It goes on to define ACP and Advance Directives, which are slowly becoming a part of the legal framework in which healthcare is delivered in the country. Autonomy of the patient is the first pillar of ethical medical practice. The West has incorporated this concept a long time ago while India remains lagging. The article describes the process of ACP and its relevance to the Indian scenario.
In conclusion, the attention is drawn towards the concept of death literacy and reiterates the judgement of Supreme Court on this important matter.
Overall, this article is very informative, relevant and thought provoking.