Advocates appeared:
For the Petitioner(s): Mr. Arvind P. Datar, Sr. Adv. Dr. Dhvani Mehta, Adv. Ms. Rashmi Nandakumar, AOR Ms. Shreya Shrivastava, Adv.
For the Respondent(s): Mr. K.M. Nataraj, A.S.G. Mr. Gurmeet Singh Makker, AOR Mr. Mohd. Akhil, Adv. Mr. Adit Khorana, Adv. Mr. Shailesh Madiyal, Adv. Mr. Udai Khanna, Adv. Mr. Vinayak Sharma, Adv. Mr. Anirudh Bhat, Adv. Mr. Sanjay M Nuli, Adv. Mr. Nakul Chengappa K.K., Adv. Mr. Chitransh Sharma, Adv. Mr. Anuj S. Udupa, Adv. Dr. R. R. Kishore, Adv.

Summary of the Judgment

This Supreme Court order addresses a miscellaneous application filed by the Indian Society of Critical Care Medicine seeking clarification and modification of prior guidelines on Advance Medical Directives (AMD) and withdrawal of life support from terminally-ill patients with no hope of recovery, recognizing the right to die with dignity under Article 21. (!) (!) [1000767620001][1000767620005]

Background and Difficulties Noted:
A prior Constitution Bench decision laid down detailed safeguards for executing and implementing AMD, including requirements for attestation by a Judicial Magistrate of First Class (JMFC), multiple medical boards, and Collector involvement. Practical implementation revealed insurmountable obstacles, such as delays due to JMFC countersignature and preservation duties, voiced by numerous doctors, impairing the objective of facilitating dignified death.[1000767620001] (!) (!)

Key Modifications to AMD Guidelines (Paras 198-199):
The Court modifies the procedure to make it more practical while retaining safeguards:
- Execution (Para 198.2.5, 198.3): AMD must specify guardian(s)/close relative(s); signed before two witnesses (preferably independent) and attested by a notary or Gazetted Officer, who records voluntariness. Executor informs nominated persons and family physician; copy to local government custodian (optional digital health integration). JMFC-related clauses (preservation, forwarding, family notification) deleted.[1000767620005]
- Implementation (Para 198.4): Treating physician verifies authenticity via digital records or custodian if patient lacks capacity. Hospital forms Primary Medical Board (treating physician + 2 experts with 5+ years' experience) for preliminary opinion (within 48 hours). If approved, Secondary Medical Board (1 nominee of Chief Medical Officer + 2 experts, not from Primary) concurs (within 48 hours). Convey decision and nominated persons' consent to JMFC (visits deleted).[1000767620005]
- Refusal/High Court Role (Para 198.5): If Secondary Board refuses, nominated persons, doctor, or staff may file writ under Article 226; Chief Justice constitutes Division Bench, possibly with independent 3-doctor committee (20+ years' experience), hearing State counsel expeditiously, deciding on patient's best interests. (!) [1000767620005]
- Revocation/Inapplicability (Para 198.6): Unchanged, allowing revocation in writing; inapplicable if unforeseen circumstances or ambiguity (apply no-AMD guidelines).[1000767620005]
- No JMFC Authorization: Hospital proceeds post-Boards' approval; post-withdrawal, intimate High Court digitally (hard copy destroyed after 3 years). (!) (!)

Guidelines for Cases Without AMD (Para 199):
Similar simplified process: Hospital forms Primary Medical Board to discuss with family/next of kin/guardian (written consent, within 48 hours). If approved, Secondary Medical Board concurs (within 48 hours), intimates JMFC and family (no visit). High Court recourse if refusal, per above.[1000767620005]

Final Directions:
Guidelines remain until legislation; Registry communicates to High Court Registrar Generals, who forward to State/UT Health Secretaries and Chief Medical Officers. Application disposed without costs. (!) (!) (!) (!)