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Updated: May 9, 2025

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Enhancing Advance Care Planning in India through a 12-step Pathway.

Anuja Damani1, Arun Ghoshal1, Krithika Rao1

  • 1Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
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Summary
This summary is machine-generated.

This study introduces a 12-step framework for advance care planning (ACP) and advance medical directives (AMDs) in India. The framework simplifies legal procedures to ensure patient autonomy and dignity in end-of-life care.

Keywords:
Advance care planningCultural factors in health careDecision-making capacityEnd-of-life carePalliative care

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Area of Science:

  • Medical Ethics
  • Palliative Care
  • Health Law

Background:

  • Advanced care planning (ACP) and advance medical directives (AMDs) are crucial for aligning medical decisions with patient preferences, especially for end-of-life care.
  • India's 2018 Supreme Court ruling legalized AMDs, affirming patient autonomy.
  • Recent 2023 amendments simplified AMD procedures, replacing judicial magistrate approval with a medical board system.

Purpose of the Study:

  • To propose a practical and culturally sensitive 12-step framework for implementing ACP and AMDs in India.
  • To address procedural and systemic challenges in ACP implementation by integrating legal, ethical, and cultural considerations.
  • To facilitate informed decision-making and enhance patient autonomy in end-of-life care.

Main Methods:

  • A consensus-driven process involving experts in palliative medicine, neurology, critical care, and geriatrics.
  • Incorporation of feedback from legal and medical stakeholders through multiple iterations and public consultations.
  • Development of a framework integrating legal, ethical, and cultural aspects for ACP implementation.

Main Results:

  • A 12-step pathway is proposed, covering living will creation, periodic reviews, and AMD execution.
  • Key components include initiating discussions, appointing surrogate decision-makers, and ensuring legal compliance via simplified procedures.
  • Implementation strategies focus on public awareness, provider training, and institutional policies to normalize ACP.

Conclusions:

  • The framework offers a practical, culturally relevant model for patient-centered, ethical end-of-life care in India.
  • Simplified legal procedures and educational initiatives empower patients, families, and providers in medical decision-making.
  • The approach promotes dignity and autonomy by addressing misconceptions and reducing procedural barriers to ACP.