Maharashtra's New Living Will Law: How ICU Decisions Affect Financial Planning

Supreme Court Guidance on Advance Medical Directives in India Takes a Significant Leap Forward

In a landmark judgment in March, the Supreme Court of India allowed a family to withdraw life-sustaining treatment from Harish Rana, a 31-year-old engineering student who had been in a persistent vegetative state since a fall from a fourth-floor balcony in 2013. The court's decision applied India's passive euthanasia framework and laid out a supervised path for end-of-life care.

The judgment brought attention to a crucial question that affects households across India: who speaks for you when you cannot, and what instructions do they carry into an intensive care unit? This is where an Advance Medical Directive (AMD), also known as a Living Will, comes into play.

What is an Advance Medical Directive?

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An AMD is a written record of your treatment preferences for a time when illness or injury removes your ability to decide or communicate. It gives doctors and family a clear statement of your wishes when recovery is medically improbable and life is being sustained through clinical interventions. An AMD also appoints the people you trust to speak with hospitals on your behalf, providing a clear voice in clinical settings.

India's Legal Basis for AMDs

India's legal basis for AMDs came from the Supreme Court's Constitution Bench decision in Common Cause v. Union of India (2018). The court recognised the "right to die with dignity" as part of Article 21, and it accepted that an adult of sound mind may set out advance instructions for end-of-life medical care. The court described how an AMD should be executed: voluntary intent, signatures, two witnesses, and attestation by a notary or a gazetted officer, along with a named representative who can engage with doctors when the time comes.

Recent Developments in Maharashtra

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In an India first, Maharashtra has now put a working administrative spine under the Supreme Court's direction. On April 7, 2026, the state's Urban Development Department issued a Government Resolution appointing Municipal Commissioners and Chief Officers of Municipal Councils and Nagar Panchayats as custodians for the permanent preservation of Living Wills in urban areas. A uniform digital module has been launched on the MahaULB portal (mahaulb.in), built for registration, verification, and storage.

The GR also provides a clear revocation route. The executor submits the original to the custodian, the custodian cancels it on the portal, and the document is returned marked "cancelled".

What to Do in Your Own Life

Start with a conversation, held early and revisited occasionally. Speak with your spouse, adult children, or the person you plan to appoint as your medical representative. Use plain language: what outcomes matter to you, what treatments you consider acceptable, and what you want prioritised in end-of-life care. Then write an AMD that is specific and workable, and register and store it through the Maharashtra custodian framework if you live in an urban local body area.

By taking these steps, you can ensure that your voice is heard when you need it most, and that your loved ones are equipped to make informed decisions about your end-of-life care.