Maharashtra’s Living Will Push Brings ICU Decisions Into Financial Planning

For years, financial planning in India has followed a predictable script. Secure your family with life insurance, protect against hospital bills with health cover, and, eventually, write a will. But there is a situation that slips through all three — when a person is alive, critically ill, and unable to say what they want.

It is not a rare scenario anymore. With advances in medical care, more patients are kept alive through intensive support systems. Machines can keep the body going long after the outcome is no longer clear. Patients may remain in intensive care for days or even weeks, with little certainty of recovery. At that point, the situation moves beyond medicine alone, drawing families into difficult emotional choices along with mounting financial pressure.

When Silence Forces Families To Decide

When there is nothing on record about the patient’s wishes, families are left to take the call. Doctors can explain the options, but deciding whether to push on with treatment or scale it back usually falls on relatives, often at a time when they are already overwhelmed.

These decisions are rarely straightforward. There is hope, fear, guilt, and, often, disagreement. In many cases, treatment continues because no one wants to take the responsibility of stopping it.

At the same time, the financial meter keeps running.

Private hospital ICU costs can climb rapidly, sometimes exhausting insurance cover within days. Beyond that, families may have to draw from savings, break investments, or take on debt. What makes this harder is the uncertainty — continuing treatment does not necessarily mean recovery.

A living will attempts to address this exact situation. It allows a person, while still capable, to state what kind of medical care they would or would not want if they reach a point where recovery is unlikely. It can also identify someone who can speak on their behalf, according to a recent report by Moneycontrol.

This does not make the situation easy, but it removes guesswork. Families are not left trying to interpret silence.

From Courtroom Recognition To Ground Reality

The legal basis for living wills in India has existed for some time. In 2018, the Supreme Court recognised the right of individuals to refuse life-sustaining treatment under specific circumstances, linking it to the broader idea of dignity in life and death.

Yet, on the ground, very few people have acted on it.

Part of the reason lies in the process itself. Drafting a living will has involved formalities that many find difficult to navigate. There has also been little public conversation around it. Unlike insurance or investments, it is not something financial advisors routinely bring up.

Recent efforts in Maharashtra to streamline how living wills are recorded and accessed could change that, at least incrementally. Making the document easier to register and retrieve addresses a practical gap — because in medical emergencies, paperwork that cannot be quickly verified is of limited use.

The Gap In How We Plan

Most financial plans are built around two clear outcomes — survival or death. But modern medicine has created a third space, where a person may survive physically but lose the ability to make decisions.

It is in this space that both emotional and financial pressures tend to peak.

A living will does not solve every problem. It cannot reduce the emotional weight of a critical illness. But it can bring a degree of clarity at a time when clarity is scarce. It sets boundaries around medical intervention and, by extension, around spending that may not improve outcomes.

Despite this, the idea remains on the fringes. Conversations around end-of-life care are still avoided in many households. Planning tends to focus on accumulation and protection, not on difficult choices that may arise later.

That hesitation has a cost.

As healthcare becomes more advanced and more expensive, the absence of clear instructions can leave families navigating both uncertainty and financial strain at the same time. A living will, in that sense, is not just a medical document. It is a way of deciding in advance how far one wants treatment to go — and relieving others of having to make that call in the middle of a crisis.