ICHHAMARAN

(THE LIVING WILL)

Society For The Right To Die With Dignity

(Mahaprasthana Medi-Ethics Foundation)

Registered office: 46/A, Hanuman Building, 308, Perin Nariman Street, Fort, Mumbai 400001

The Living Will

The introduction to The Living Will by Louis Kutner in 1969 is a seminal contribution
to the concept of voluntary euthanasia.
The Living Will (also referred to at times as Advanced Health Directive) is a document
which specifies contemporaneous or future circumstances of severe ill health when all
further remediable measures are futile, when you would prefer not to have the process
of dying unduly prolonged with a directive to withdraw or withhold all life supports and
medications and request the physician to aid towards an easier and quicker passage to
death. It is expression of one's right to choose refusal of any treatment offered under the
circumstances.
It can be executed by any mature adult in full possession of his decision-making
capacity, and without any element of duress or coercion.
The declaration is made so that if one is not in a state to convey one's final decision, it is
taken as your expressed wish and direction.
It is preferable to make out the Living Will when one is in a fit state of health, so that no
doubts can be cast that it was made under a stress of illness.
The declarant reserves the Right to withdraw the document at any time if he so desires,
witnessed by two individuals attesting to oral or written withdrawal.
It absolves the physician, paramedical personnel or institution, and family members of
any responsibility for the act of termination of one's life and takes full responsibility for
the act upon oneself.
The Living Will may be considered as a sort of 'insurance policy' against the
malfeasance of the undignified process of dying which may be imposed on an
individual by misuse of modern medical technology.
Though the totality of the Living Will may not have legal sanction as yet in our country,
it is well to remember that the part of the Living Will enunciating the acceptance or
otherwise of any treatment is the legal right of the individual. The Society for the Right
to Die with Dignity is a co-petitioner in an appeal before the Supreme Court in India for
making such a Living Will legal. Even in the absence of legal sanction, it still does not
detract from its value as a moral force for the family and the physician. In the absence
of the document, futile treatment may be continued by the family out of a misplaced
sense of duty, and by the physician out of a misplaced confusion of ethics.
Custody of the Living Will and Desirable Power of Attorney
(1)
Original documents must be kept in a place known to members of the family,
your physician and those who carry your Power of Attorney.
(2)
Each of the above individuals should have Xerox copies of the documents in
their possession.

ICHHA MARAN
A DECLARATION WILLING THE MODE OF MY
DEATH
To,
My family, my close friends, my medical attendants and all other persons
who may be concerned with my medical treatment and care.

I accept death as a natural and inevitable consequence to life and do not

fear it. But I fear the process and mode of dying which may be
accompanied by undue pain, suffering and the indignity of mental and
physical deterioration, causing distress not only to myself but also to my
family. I have given deep considerable thought to this and based on our
philosophy of "ICHHA MARAN, I make the following declaration.
DECLARATION
I, ______________________________________________________________
normally residing at ______________________________________________
_______________________________________________________________
make this declaration when I am in full possession of my decision making
capacity, and after due and careful consideration, without being under any
coercion or duress, enunciating the condition of my health under which, it should
be deemed that I do not desire to prolong my life.
I declare that if at any time the under mentioned conditions of my health exist
and the opinion of physicians there is no reasonable prospect of recovery viz.,
1. Stoppage of heart function for more than three minutes;
2. Cessation of brain stem functions;
3.

Severe and lasting brain damage from any cause;

Any irreversible or irremediable disease or impairment causing severe physical

or mental distress or which renders me incapable of rational, purposeful and
useful existence or when my vital bodily functions are incapable of independent
functioning;
4. Any form of illness such as advanced malignant disease, severe immune
deficiency disease or advanced degenerative disease of the nervous
system or any other incurable illness which has a limited expected
life-span.
Then and in those circumstances, my directions are as under:
1. I request and implore that I be allowed to die with dignity.

I am not to be subjected to any medical or surgical treatment or other heroic or

extra ordinary means aimed at merely prolonging or sustaining my life.
I do not wish to be subjected to any form of life support treatment such as
artificial ventilation, intravenous infusions including blood transfusions or
antibiotics or pacemakers or chemotherapy or dialysis and if such have been
instituted, to withdraw them.
I direct that only those medications which are likely to give me relief from pain
and suffering be administered in appropriate doses, and to employ any other
measures to ease my passage to a dignified death, and with full realisation that
they may shorten my life.
I further empower attending the physician to seek opinion from another
colleague/colleagues if he so desires or feels it necessary to do so.
Further, I request the physician to ask me for my final confirmation of this
Declaration in the presence of a witness if I am still manifestly in a state to
convey the same. If not, then this declaration must be deemed by my family and
attendant physician as a final expression of my legal right to refuse any medical
treatment. Further any such decision may be executed in consultation with the
individuals to whom I may have assigned the Power of Attorney, if deemed
necessary.
I hereby absolve attending physicians and other persons concerned with my
medical care of any liability arising out of any act performed to meet the above
directions and accept unreservedly the responsibility and consequence resulting
from any action to carry out these directions.
I also reserve the right to revoke this Declaration at any time before two
witnesses either in writing or orally.
This Declaration is signed and dated by me in presence of the 2 under
mentioned witnesses present at the same time who, at my request, in my
presence, and in the presence of each other, have hereunder subscribed their
names as witness.
Name :
Address
Signature
Place and Date

WITNESSES:
We testify that the above Directive was signed in our presence, the purpose
of which was made clear to us. We believe that the Declaration has been
made voluntarily without any duress and was made when the Declarant was
in full possession of his/her decision making capacity.
We further testify that we are not members of the Declarants family nor

related by blood, marriage or adoption to the Declarant. We have no claim

against any portion of the estate of the Declarant upon his/her death.

Witness No. 1

Witness No. 2

Name

Name

Address:

Address:

Tel No.
Signature

Tel No.

Place
Date:

Place
Date:

SPECIAL POWER OF ATTORNEY

A Power of Attorney given this________________________ day of
____________________ by me _______________________________
__________________________________________________
Whereas
1)
I have executed a Declaration dated _______________ stating that in
circumstances there set out, 1 should be deemed to decline to receive artificial
medical treatment or any other treatment and to ask to be kept free from pain and
distress.
2)
I seek to ensure that the wishes expressed will be fully respected.
NOW THIS DEED WITNESSES THAT I appoint _______________

who have expressed their acceptance to act as such, jointly or severally, to be my

attorneys for the purpose of securing compliance with terms of my declaration
and I vest in my attorneys, jointly or severally, power to interpret, make
decisions and take action on my behalf with regards to my declaration
notwithstanding any contrary views held by any other person.
I declare that this Power of Attorney shall remain in force during my lifetime or
until notice of its revocation is received by my attorneys
AS WITNESS my hand this day.
SIGNED SEALED AND DELIVERED
BY ME
IN THE PRESENCE
OF
SIGNATURE
PLACE & DATE

DECLARATION BY EXECUTOR OF POWER OF

ATTORNEY
We testify that we are not members of Declarant family, nor related by blood, marriage
or adoption to the Declarant and are not entitled to any part of the estate of the
Declarant and have no claim against any portion of the estate of the Declarant upon
his/her death.

Executor 1

Executor 2

Name

Name

Address:

Address:

Tel No.
Signature

Tel No.

Place
Date:

Place
Date:

Issued by the SOCIETY FOR THE RIGHT TO DIE WITH DIGNITY (Mahaprasthana
Medi-ethics Foundation, Registered office: 46/A, Hanuman Building, 308, Perin Nariman Street,
Fort, Mumbai 400001.
This is a specimen copy on the basis of which you are advised to draw your copy of the
Living Will. You may alter the content without nullifying the objectives of the original
work.