CHENNAI: The Tamil Nadu government has notified guidelines for withholding or withdrawing life-sustaining medical treatment both for patients who have executed an Advance Medical Directive (AMD) and for terminally ill patients who have not made such a directive, laying down a detailed medical and legal procedure to be followed by hospitals.
The Health and Family Welfare Department issued the Tamil Nadu Advance Medical Directive Guidelines, 2026, through a GO dated July 31, 2026, following the Supreme Court’s directions on advance medical directives and passive euthanasia.
Under the guidelines, any adult of sound mind can voluntarily execute an AMD for a treatment they wish to refuse or withdraw if they subsequently become incapable of making or communicating informed decisions. The directive can include refusal of mechanical ventilation, cardiopulmonary resuscitation (CPR), or artificial nutrition and hydration when these would only prolong the process of dying.
The AMD has to be signed in the presence of two witnesses and attested by a Notary or Gazetted Officer. The person can nominate guardians or close relatives, in order of preference, to act on their behalf if they lose decision-making capacity.
A copy has to be handed over to the nominated persons and the family physician, if any, and deposited with the Joint Director of Health Services, who will act as its custodian. The directive can also be incorporated into digital health records and can be withdrawn or altered by the person at any time while they retain decision-making capacity. The guidelines also prescribed procedures to be followed by the treating institution on how to act on the AMD.
The new guidelines also prescribe a separate process for patients who have not executed an AMD. Where such a patient is terminally ill, undergoing prolonged treatment for an incurable condition with no hope of recovery, the treating institution will constitute a Primary Medical Board. It will discuss the case with the family physician, if any, and the patient’s next of kin, next friend or guardian, and record the proceedings.
If the Primary Medical Board recommends withdrawal or refusal of further treatment, a Secondary Medical Board will review the case. In case of disagreement, the concerned family member, nominee, treating physician or hospital staff can approach the High Court for permission to withdraw life support.
The guidelines provide for a High Court Division Bench to decide such cases expeditiously. The court can also constitute an independent panel of three doctors from specified specialities, including General Medicine, Cardiology, Neurology, Nephrology, Psychiatry and Oncology, with at least 20 years’ professional experience.
An AMD will not be acted upon if circumstances arise that the person had not anticipated when executing it and which could have affected their decision. An unclear or ambiguous directive will also not be given effect.
The government has prescribed separate formats for executing an AMD and recording the recommendations of the Primary and Secondary Medical Boards. The guidelines will remain in force until Parliament enacts legislation on the subject.