The Government of Tamil Nadu on July 31, 2026, issued the Tamil Nadu Advance Medical Directive Guidelines, 2026.
These Guidelines governing the execution and implementation of Advance Medical Directives (AMDs) — commonly known as living wills — enabling adults to specify in advance their wishes regarding withdrawal or refusal of medical treatment in end-of-life situations. Every adult has the right to execute an AMD (Form-A), which takes effect only when the executor becomes incapable of making or communicating informed medical decisions. The AMD must be voluntary, free of coercion or undue influence, unambiguous, and must demonstrate that the executor understood the consequences of executing it. It must name guardian(s) or close relative(s) authorized to give consent on the executor's behalf, and where multiple valid AMDs exist, the most recently signed one prevails. Execution requires the signature of the executor before two attesting witnesses, preferably independent, and attestation before a Notary or Gazetted Officer, all of whom must certify the document was executed voluntarily and with full understanding. A copy must be given to the nominated person(s) and family physician, and deposited with the Joint Director of Health Services (or notified officer) as custodian, with the option to incorporate it into digital health records. The AMD can be withdrawn or altered at any time by the executor while competent, following the same procedural safeguards.
The implementation process centers on a two-tier medical board system. When a terminally ill executor with no reasonable hope of recovery loses decision-making capacity, the treating physician verifies the AMD's authenticity and the treating institution constitutes a Primary Medical Board (the treating physician plus at least two specialists with 5+ years' experience), which forms a preliminary opinion — ideally within 48 hours — on whether to certify withdrawal/refusal of treatment (recorded in Form-B). If the Primary Board certifies this course of action, a Secondary Medical Board is constituted, comprising a practitioner from a panel maintained by the Joint Director of Health Services plus two additional specialists (not part of the Primary Board), who independently visit the patient, ascertain the executor's wishes if possible (or the nominated person's consent if not), and issue their own opinion within 48 hours. Before treatment is withdrawn, the treating institution must inform the jurisdictional Judicial Magistrate First Class (JMFC) of both boards' decisions and the nominee's consent.
If the Secondary Medical Board refuses permission to withdraw treatment, the nominated person(s), treating physician, or institution staff may petition the High Court under Article 226, triggering formation of a Division Bench (which may further constitute an independent three-doctor committee across specialties with 20+ years' experience) to adjudicate expeditiously, guided by the "best interests of the patient" principle. The Guidelines also address situations with no existing AMD: similar Primary/Secondary Board safeguards apply, but require consultation with the family physician and the patient's next of kin, with their written consent needed before certification, and disputed cases likewise escalate to the High Court. Other provisions clarify that an AMD won't apply if unforeseen circumstances arise that would have changed the executor's decision, and that ambiguous AMDs are treated as if no AMD exists.
Finally, the Guidelines require that any withdrawal of life support be reported by the JMFC to the High Court and preserved digitally by the High Court Registry (with the hard copy destroyed three years after the patient's death). Notably, these Guidelines are stated to remain in force only until Parliament enacts formal legislation on the subject, indicating their interim/transitional nature.
[G.O.(MS).No. 221, H & FW (M2)]
