The Supreme Court′s Constitution Bench has eliminated "insurmountable impediments" to the execution of advance medical directives (AMD) for terminally ill patients who are beyond treatment or hope, allowing them to withdraw medical care and pass away with dignity. This matter was brought back to the apex court, stating that the 2018 judgment′s instructions would be extremely difficult to carry out in practice.

One example is that an advance medical directive (AMD), in accordance with the 2018 judgment, has to be countersigned by a judicial magistrate in addition to the signatures of two independent witnesses. In its current order authored by Justice Joseph, the court stated that it needs to be signed by the executor/patient and independent witnesses in the presence of a notary or gazetted officer who would record his/her satisfaction that the AMD was voluntary and executed without coercion.

According to the judgment, the hospital should form a primary medical board with the treating doctor and two specialists who would verify the patients condition within 48 hours. This board would again ascertain the patient`s condition within 48 hours and give its findings on whether or not to withdraw medical care or life support.

Before implementing the AMD, the hospital should then inform the judicial magistrate of the primary and secondary school boards about their conclusions as well as the approval of the relatives.

If the boards reject the AMD, the individual listed in it, the treating physician, or the hospital may file a complaint with the relevant High Court. A Division Bench led by the Chief Justice of the High Court would be able to assemble an impartial panel of medical professionals with expertise in general medicine, nephrology, neurology, cancer, radiology, and critical care. In these situations, the hospital, which would serve as the primary medical board, may be informed by the treating physician.