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

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.