In March 2024, after she turned 76, Helen Thambi signed something that almost no one in India does—an advance medical directive, a document that lists multiple scenarios in which her medical treatment should be stopped if she became seriously ill.

The two-page document says that if Thambi, a homemaker, were to become bed-ridden, she should not be hooked to a ventilator or be fed by a tube, and specific health issues, such as chest infections or low oxygen levels, should not be corrected. The document, however, clarifies that she wants pain relief and palliative care until death.

Thambi is among 42 members of the Thrissur Pain and Palliative Care Society in Kerala who signed advance medical directives or AMDs in 2024. AMDs are meant to be used by doctors where a patient is incapacitated, such as in a coma, and unable to communicate. Nominees are meant to provide consent to stop treatment or disallow invasive, possibly fruitless procedures and medication, in a manner consistent with the AMD.

Though AMDs have been common in several western countries for decades, they became legal in India only after a 2018 Supreme Court judgement. But AMD registration is nearly non-existent in India because state governments have not set up enabling mechanisms.

Yet, across the country, many like Thambi have taken the first steps. Unable to complete the AMD execution process as the Supreme Court envisaged, Thambi has notarised the document so that her son and nominee clearly knows her wishes.

“I signed the document because hospitals often admit patients to the ICU or use ventilators unnecessarily,” said Thambi, a confident, composed woman and a volunteer with the Palliative Care Society for the past 17 years.

Thambi’s husband died in July 2021 at 80, a year after he was diagnosed with cancer. His cancer had been too advanced for any chance of cure, and he rejected intensive care after a previously traumatic experience in an intensive care unit (ICU).




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