Educating people about 'living will', a way to die with dignity

Nobody wants to die but it is the harshest reality of life. But at least with the ‘living will’ rule being passed by the Supreme Court on March 9, 2018, one can choose to pass away in a dignified manner.

HealthCare atHome (HCAH), a home health care service provider in India, took the opportunity to launch a print campaign to inform the citizens of India about living will, which, not known to many, is an important document that a person can execute in advance under strict guidelines.

Through this document, such a person can choose not to remain in a vegetative state with a life-support system. If that person comes to that state, and when it will no longer be possible for him/her to express their wishes in spoken words, the document will be presented to hospital authorities for appropriate action. Thus, in a living will, a person can make a statement in advance that their life should not be prolonged by putting them on a ventilator or an artificial support system.

The print campaign on the subject was put in place by McCann Health. The campaign describes the story of a woman, Aruna, who suffered for quite a long time due to being in a vegetative state and till the last days of her life. Alongside, it also has a format of the ‘living will’ form, to provide better guidance to the readers. The creative copy in the campaign urges readers to prepare a living will while them still being in a state to do so.

Bhavesh Doshi

Discussing about the brief that was given by client, Bhavesh Doshi, Executive Creative Director, McCann Health, said that there was no particular brief as such. “So this was when we were discussing their services and that’s when the discussion went into living will. The Supreme Court had come with something like a living will. The discussion went into the fact that not many people are aware of it, though it is all there. And as an agency we thought that something on this can be done and should be done about it,” he pointed out.

“It can be looked at from two points of view — one, if God forbid, something happens to us, we don’t have the chance to do it. And secondly, if we look at it from the family’s perspective, the family might be going under debt for keeping their family member in the hospital for a long period of time. And it is also a burden on the family,” Doshi said.

Kush Anand

Talking about the strategy of the campaign, Kush Anand, Strategy Planning Director, McCann Health, said that the strategy was simple in a way. “The concept of living will is already present in the Supreme Court, as the rule had been passed last year. But nobody had taken notice of this ground-breaking judgement. Because till people are not in the state of having a family member in a vegetative or non-communicative state, nobody thinks of something like a living will,” he emphasised.

Anand said the main objective was to popularise living will, because the action has to be taken before the patient goes into a non-communicative state. To get people to recognise that there is a concept like this and in which non-communicative patients can communicate their wishes to their loved ones. Because most of the times, the loved ones don’t know what the person wants because he/she is in a vegetative or non-communicative state. So there is a lot of emotional turmoil within them — what decisions to take, should they continue giving them life support or should they restrict their economic burden because everybody cannot afford to have people in that state and to maintain life support that comes with it.

“And therefore this idea was to get people to communicate with those non-communicative people in a way that can ease the burden on their heads. At the end of the day, the official statement lies with the caregiver or the loved one who is taking care of that person, they know what their loved one has wished for. Therefore, they can make a simpler decision,” mentioned Anand.

In the home health care services that HCAH provides, it operates in a niche area called ICU set-ups at home. They do step-down care and do ICU set-ups at home, right from managing patients on ventilator, etc. Out of these, there is a subset of patients which are largely end-of-life care, where the doctor knows that now nothing more can be done. The only thing that the family wants is that the patient can breathe his last in his home, and in the vicinity of his loved ones rather than being in a hospital ICU where his/her loved ones can’t even be with him/her.

So that is where the problem statement is — when do you call it off? Before HCAH offered this organised care, one of the things that happened was that people would save the person in the hospital, and would illegally pull the tube off in the ambulance. The patient was dying a very bad death, as everybody knew that nothing could be done, because legally you can’t pull off the support system.

With HCAH also, sometimes they have to step out of the patients’ home, because the family doesn’t want to continue the care. And at the end of the day, it is the right of the family to decide what they want to do.

“In all these scenarios, if somebody already has a living will, then it’s an easier decision for the family and medical team. We believe that everybody has the right to a dignified death at the place that the person wants,” specified Dr. Gaurav Thukral, COO, HealthCare atHome.

Given the circumstances, Thukral said they had a lot of debate on this — how do we solve this problem? They had a discussion with industry experts also. “But nobody has the right answer because of the mistrust with hospitals on unnecessary charges made to patients; there is a fear in the minds of the doctors that they cannot do anything which is not permitted by law. The family has a lot of emotional problem deciding whether they should take a call or not — so the only document which the Supreme Court allows and that can say that we can discontinue the treatment because the patient cannot be saved, is the living will. Hence this idea of living will came up,” he said.

Also, the Supreme Court has said that you can give a living will, having a living will is a fundamental right. But what after that? How does the doctor come to know that there is a living will in place by the patient? How does the doctor honour that living will? What is the procedure of getting the living will executed? All these guidelines are not mentioned. It is obvious that for any other will, it would have to be executed by the magistrate and in the court. “But in this case, it is a very tedious process and is simply not practical, and also the people are not very conversant with it, neither the public nor the medical authorities are conversant with it,” said Thukral.

Talking about the campaign’s purpose, Thukral pointed out that it’s about building awareness. “Through our campaign, once people say that they want to do a will, then the end of life task force in India, and one of its heads, who is working with us in this campaign, would again approach the authorities to say that these many people want to do a living will. Let’s have some suggestions or a defined protocol how to execute it, how to honour it and how to deliver it. That’s what the whole campaign objective is,” he added.

The brand could have advertised about a lot of other subjects, why particularly a living will?

“The aim was not to promote the brand or the services with respect to the brand. HCAH takes care of people who are in their recovering phase at home, and that is the main prerogative for the brand. But hearing so many stories of post hospital care, the marketing team had also told us about this concept which was not popular in India,” said Anand.

HCAH told McCann Health that it’s not only about selling the brand’s services, but they actually want to position the brand as someone who takes care of people who are in a suffering state. At the end of the day, they can provide life support to those people, but the nurses and caregivers have also seen the kind of emotional turmoil the families go through. That is why the brand wanted to take this step in that direction. It’s more for social awareness and empathy towards people and their families.

There are a lot of home health care providers in the market — Portea, Nightingale, Apollo HomeCare, Max HomeCare, etc. But these provide mostly staffing solutions. HCAH provides managed care, they manage the patients end to end, from manpower support, to doctor support, lab support, infrastructure support and they manage the care and treat the patients as they are treated in the hospital.

Home health care is a $3 billion market in India. And organised players comprise 5% of the entire market.

HealthCare atHome (HCAH) is a leading home healthcare service provider in India. HCAH has served over 400,000 patients across India and has helped them recover safely and comfortably in the place they know best, i.e. their home. Some of the key services offered by HCAH include setting up an ICU at home, providing cancer care at home, nursing care and physiotherapy services along with providing a plethora of clinical procedures at home thereby delivering almost 70% of all clinical services at home.

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Credits:

Chairman McCann Worldgroup, Asia Pacific. CEO &CCO McCann Worldgroup, India: Prasoon Joshi

Senior VP and Country Head, McCann Health, India: Daleep Mahnas

Senior VP and Executive Creative Director, McCann Health, India: Rajesh Rai

Executive Creative Director, McCann Worldgroup, Mumbai: Abhinav Tripathi

Associate VP and GM, McCann Health, Mumbai: Preetha Vasanji

Associate VP Planning: Siddharth Dutt

Strategic Planning Director, McCann Health, New Delhi: Kush Anand

Executive Creative Director, McCann Health, Mumbai: Bhavesh Doshi

Executive Creative Director, McCann Health, Mumbai: Dinesh Ghosalkar

Associate Creative Director (Art), McCann Health, Mumbai: Jayant Dethe

Associate Creative Director (Art), McCann Health, Delhi: Prasenjit Chowdhury

Group Head Copy, McCann Health, Delhi: Simee Ghazal

Group Account Director: Manisha Das

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