Abstract
A living will also known as an advance decision, is a legally binding document that allows you to specify which medical treatments you wish to forgo, particularly in a future scenario where you are unable to communicate your wishes. While you have mental capacity, you can make an advance decision to refuse certain medical treatments. Your advance decision would become relevant if and when there comes a time when you’re unable to make or communicate your own decisions. The primary objective of this research was to gauge public awareness levels in urban settings, concerning euthanasia, end-of-life (EOL) decision-making, and the right to die with dignity. A secondary objective was to determine the proportion of respondents willing to prepare a living will and to understand the underlying ideologies or reasons for their hesitation. Data was collected via a structured questionnaire and subsequently analyzed by cross-tabulating responses against the demographic variables of age, gender, and educational qualification.
Introduction
“What is worse? Taking the life of a person who wants to live or taking death from a person who wants to die?” – Jo Nesbo.
With the rapid advancement in healthcare technology, human life expectancy has increased by approximately 20 years in the last 50 years, rising from about 52.5 years in 1960 to over 72 years in recent years. The global average life expectancy has increased from roughly 46 years in 1950 to 73.2 years in 2023. These changes also come with their own set of predicaments, when we think about those who are suffering from terminal conditions or are in a persistent vegetative state. In such cases, the person is kept alive by mechanical ventilation or clinically assisted nutrition, which are some popularly known methods. These practices do not take into account the presence of the patient’s willingness to survive by such methods. As per a report of 2020, a 90-year-old citizen of Belgium, on contracting COVID-19 died after she selflessly refused to be on a ventilator and, reportedly, stated to her doctors, “I don’t want to use artificial respiration. Save it for younger patients. I already had a good life”. In another recent case, Filmmaker and French New Wave legend Jean-Luc Godard died at the age of 91 via assisted suicide in Switzerland, a practice legal under specific conditions. This dilemma is not new to India. Aruna Shanbaug’s tragic case made the entire country aware of passive euthanasia in a very emotional way. The Court through this case recognized the “right to die with dignity” as part of the “right to life” under Article 21 and laid down strict guidelines for withdrawing life support from patients in a persistent vegetative state. Such national and international examples bring us to the question as to whether there exists a right as human beings to decide how we want to depart in a developing country like India.
Research Rationale
In India, futile end-of-life care often conflicts with individual autonomy, as decisions are typically made by the patient’s family. While the Supreme Court legalized Advance Medical Directives (AMDs) in 2018, the initial procedures were so complex that the right was practically inaccessible.
A critical legal change occurred in January 2023 when the Supreme Court dramatically simplified the process, removing magistrate approval and making AMDs a practical option.
This reform created a gap in the knowledge due to lack of awareness of this change. Existing literature has not yet analyzed awareness levels after this simplification.
Therefore, this study provides primary data by exploring public understanding of AMDs, their opinion on the right to die with dignity, and their receptivity to creating a living will in this new legal environment.
Research Hypotheses
H1- There is a positive correlation between a person’s educational qualification and their awareness of a living will.
H2– There is a positive correlation between a person’s age and their willingness to prepare a living will.
Data Analysis & Findings
Question 1: Please Specify your Gender
Findings:
Among a sample size of 80 respondents, 55 individuals identified themselves as Males (70.5%), 24 individuals identify as Females (28.2%) and 1 person identifies as ‘Others’ (1.3%).
Hence, majority of the respondents who participated in this study are Males.
Question 2: Please Specify your Age Category
The questionnaire gave the respondents the option of choosing the following age categories:
- 21-35 years
- 36-50 years
- 51years and above Findings:
The analysis of the age demographic reveals that the sample is heavily skewed toward an older
population. A significant majority of respondents, 49 individuals (61.25%), belonged to the ’51 & above’ age group. This was followed by 24 respondents (30%) in the ’21-35′ age group, while the ’36-50′ age group was the least represented, with 7 respondents (8.75%).
Question 3: Please Specify your city of residence.
Findings:
The analysis of respondents’ city of residence reveals a significant geographic concentration. An overwhelming majority of participants reside in Mumbai. The next most frequently cited cities were Pune and Thane. A smaller number of responses were distributed individually across other Indian cities, including Nashik, Porvorim (Goa), Jaipur, Bhopal, Ahmedabad, Vadodara, Lucknow, and Madhya Pradesh.
Question 4: Please Specify your Educational Qualification
Findings:
The analysis of educational qualifications reveals that the sample is predominantly highly educated. The largest cohort of respondents reported a bachelor’s degree as their qualification, with entries such as Graduate, B. Com, B.A, L.L.B and MBBS. A significant secondary group possessed post-graduate qualifications, including MBA, MSc, and MDS.
Some participants identified by their specific profession, many of which also imply advanced education, such as Doctor, Dental Surgeon, and Law Student. In contrast, only a small minority of respondents reported school-level qualifications (for example: HSC, 12th, or S.S.C) as their highest level of education.
Question 5: Have you previously heard about the concept of Assisted Death/ Euthanasia?
The reason behind asking this question, was to first understand if the Respondents are aware of these basic concepts, before moving to living wills.
Findings:
The survey found that a significant majority of respondents, 61 (76.25%), are aware of the general concepts of “assisted death” and “euthanasia,” while 19 (23.75%) are not. This high level of awareness is likely correlated with the sample’s specific demographic profile. The respondent pool is predominantly highly educated (with a large number possessing bachelor’s and post-graduate degrees) and geographically concentrated in Mumbai, a major metropolitan city. This population group has significantly more exposure to the legal, ethical, and media discussions surrounding end-of-life topics, where these specific terms are frequently used. Therefore, this finding reflects a high level of conceptual familiarity within an older, urban, and educated group.
Question 6: Do you believe in the Right to Die with Dignity?
Findings:
A foundational question of the survey assessed respondents’ attitudes toward the “right to die with dignity.” The results show an overwhelming consensus on this issue.
A majority of 70 respondents (87.5%) affirmed their belief in this right. In contrast, only 10 respondents (12.5%) indicated that they did not believe in this right.
Question 7: Are you aware about Living wills/ End of Life Decision Making?
Findings:
A majority of 71.25% (57 people) said “Yes” to knowing about “living wills and end-of-life decision making” which gives an important insight. This number is likely high because the question covered two concepts. Multiple people probably said “Yes” just because they are familiar with the general idea of “end-of-life decisions,” even if they don’t know what a specific “living will” is.
This figure also reveals a gap: we already know 87.5% of the group believes in the right to die with dignity, but fewer (71.25%) are even aware of the basic concepts to make it happen.
Perhaps the most telling finding is the 28.75% (23 people) who said “No.” Given that this survey group was older, highly educated, and from a big city—the very people you would expect to be most aware—it is very worrying that nearly three in ten knew nothing. This strongly suggests that awareness among the general public is dramatically lower.
Question 8: If you are aware about the above-mentioned concepts, please specify your source of information.
This question was specifically included in the survey to understand the major sources through which the 57 respondents who were aware of living wills and end-of-life decision making have gained awareness regarding these concepts.
Findings:
The most common information channel was ‘newspapers and online information sources,’ cited by 27 respondents (47.37%). This was followed by interpersonal and professional networks, with ‘friends, relatives, and professionals‘ being cited by 22 respondents (38.6%). ‘Social media applications’ were the least common source, mentioned by 12 respondents (21.05%).
Question 9: Have you prepared or would be open to prepare a living will?
Findings:
The above question was asked to assess the receptivity of the participants toward the practical execution of a living will. When asked if they have already prepared one or would be open to preparing one, the results show a very high level of willingness.
An overwhelming majority of 64 respondents (80%) indicated ‘Yes.’ In contrast, only 16 respondents (20%) stated they were not open to preparing a living will. This high receptivity (80%) strongly suggests a desire for personal autonomy in end-of-life care. This figure almost directly mirrors the 87.5% of respondents who affirmed a belief in the “right to die with dignity.”
Question 10: If your answer to the above question is “No”, please specify your Reason
This question was asked to gain an understanding regarding the reasons for hesitation or refusal towards preparing a living will among those who responded with “No” to Question 9.
Findings:
An analysis of the 16 respondents (20% of the sample) who stated they were not open to preparing a living will reveals several distinct categories of reasoning for their reluctance:
The most prominent barrier was philosophical or personal beliefs. This included a preference for a “natural death” without human intervention, a belief in destiny or God’s will, and a psychological avoidance of the topic.
A second significant category involved practical and systemic concerns, with respondents candidly stating, “distrust in the proper implementation by Indian systems.”
Finally, a small number of responses indicated apathy or a lack of engagement with the issue (e.g., “NA” or “Do not have any reason to”).
One of the most important findings came from a respondent who said they weren’t interested in a living will because they were “content” with the Portuguese Civil Code in Goa. This response is a perfect example of the exact problem this research is about, as it shows the person is confusing a “living will” with a “normal will.” A normal will is for the division of your assets after you die, which the Portuguese Civil Code in Goa does cover. But a living will has nothing to do with property; it’s a medical document that states your wishes about end-of-life care before you die. The fact that even a legally-aware person made this mistake is a powerful finding, proving the public is not just unaware but actively confused about what a living will actually is. It is highly possible that other respondents also answered the survey questions while operating under a similar incorrect notion.
Inference & Limitation
While 87.5% of the sample believes in the Right to Die with Dignity and 80% showed their willingness to prepare a living will, these affirmations are undermined by a persistent awareness gap. While 71.25% said that they were aware of Living Wills and End of Life Decision making, this number is probably high because the question included dual concepts. A concrete proof of this confusion was seen where one respondent from Goa, mixed up the living will (a medical document) with an inheritance will (a property document). In summary, the quantitative data supports both H1 and H2. H1 was supported, as awareness levels increased with higher educational qualifications. H2 was also supported, since awareness was higher among the older population (61.25% being in the age group of 51 and above).
A primary limitation of this study is its modest sample size (80). This was a necessary constraint due to the limited time frame for data collection. Because of this small sample, which was also geographically concentrated, the findings cannot be statistically generalized to the broader urban Indian population. Instead, this research should be viewed as a preliminary study that provides valuable insights into the awareness levels and conceptual misunderstandings within this specific group.
Conclusion & Suggestions
This study, assesses the awareness of a living will post the 2023 legal reforms, wherein it is found that there is a high public desire for the right to die with dignity (80-87.5%) but a contrastingly low awareness, about the purpose of a living will often mistaking it for an inheritance will. While India still struggles with basic awareness in rural as well as urban areas, nations like Canada, Netherlands and Switzerland have better developed frameworks, for example, the development of the ‘sarco pod’ a capsule like machine for assisted suicide in Switzerland. A collaborative effort is required from NGO’s, media and medical professionals to educate the public, urban as well as rural on the purpose of a living will and the fundamental right of every individual to determine their end-of-life care. Furthermore, hospitals should establish dedicated counseling centers to proactively guide patients and families on passive euthanasia, helping to normalize these sensitive conversations.
References
- S. Batra & A. Kaushik, Living-Will: The Ultimate Right over One’s Life, 22 NAT’L J. PROF’L SOC. WK. 134 (2021), https://doi.org/10.51333/njpsw.2021.v22.i2.280
- O.P. Harsh Singh Munday, The Legal Journey of Living Wills in India, Sᴄᴄ Online Blog (May 29, 2025), https://www.scconline.com/blog/post/2025/05/29/the-legal-journey-of- living-wills-in-india/.
- Akshat Eknath Hegde, Balancing Personal Autonomy and the Right to Life in Euthanasia, 6 (4) IJLSI Page 61 – 80 (2024), DOI: https://doij.org/10.10000/IJLSI.112086
- Tanishi Gola , Consideration of Living Wills among the Indian Population, (January, 2025) https://www.researchgate.net/publication/388414681_Consideration_of_Living_Wills_A mong_the_Indian_Population
