My father was the eldest of four surviving siblings — three brothers and a sister. In truth, he was the fifth child born to my grandparents, but the first to survive. The four before him died either during childbirth or shortly thereafter. He was born in 1917, the year of the Russian Revolution, when India was still a British colony. In 1990, the average life expectancy in India was a shocking 22 years.

Thanks to advances in medical science, the average life expectancy in India has crossed 70, and in my home state of Kerala, it is well over 75. Diseases that once wiped out entire communities are now preventable, treatable, and often curable. Today, it is no longer unusual to meet people in their 90s or even centenarians living active lives.

All this progress owes itself to the relentless march of medicine — better hospitals, widely available antibiotics, improved maternal and child healthcare, awareness about nutrition, and preventive care. A child born today has a fighting chance to outlive the Biblical span of "threescore and ten" — 70 years — and possibly live well into their 90s. But the 21st century has rewritten those odds.

And yet, one certainty remains unchanged: death. You can delay it with pills and procedures, bypasses and transplants, tubes and wires. But you cannot escape it.

It is said that one day science might master the art of reversing ageing — that a person could be restored to their physical prime and remain there indefinitely. While that may seem like the stuff of science fiction today, many serious thinkers and technologists are investing in that very future. Personally, I find the idea both terrifying and absurd. If death were abolished, wouldn't life lose its urgency, its meaning? A society without death would become, paradoxically, unliveable.

Few of us like to talk about death. We prepare for childbirth, weddings, careers and retirement, but we rarely prepare ourselves or our loved ones for death — our own or theirs. I was reminded of this during a recent visit to a leading hospital in India, where a dear friend of mine was in the Intensive Care Unit (ICU). He was on a ventilator, and even a layperson could see that he was surviving only because of machines. If the wires and tubes were removed, he would pass on — peacefully and swiftly.

Knowing him as I did, I was certain that this was not how he would have chosen to go. He was a man of dignity and fortitude, not one to cling to life at any cost. But in a hospital setting, the wishes of the patient often take a back seat to protocol, legal caution, and the emotional paralysis of family members.

It reminded me of another story — of one of India's richest men. He, too, was kept alive on machines, technically alive but completely dependent on the elaborate life-support infrastructure his immense wealth could afford. But they made a conscious decision not to prolong his life artificially. After discussions among close family members, they chose a suitable day and time, disconnected the machines, and let nature take its course.

I don't think the family did anything wrong. On the contrary, I believe they showed great maturity and compassion. They respected his dignity, and in doing so, accepted death not as defeat but as a natural closure.

Contrast this with another story I know only too well — of a young boy, my son's friend, who met with an accident and was admitted to a private hospital in Delhi. He was on a ventilator, and it was clear to the doctors that they could do little more. The family was asked to shift him to another hospital to free up the ventilator for a patient with better chances of survival. The father, anguished and helpless, could not find an alternative in time. The ventilator was withdrawn, and the boy died.

Over four decades ago, I visited a cousin at a newly opened hospital in Chengannur, Kerala. He was in the ICU, and visitors were not allowed inside. I saw him through a glass window, and our eyes met. He tried to say something — perhaps a goodbye, perhaps a request. I couldn't tell. A few hours after I returned home, I got the news that he had died. Would it not have been more humane to let him spend his final hours at home, among his loved ones, rather than in a sterile room behind glass?

I've thought often about that incident, especially since I myself had a short stint in an ICU recently after a cardiac procedure. Unable to sleep, I observed everything around me — the beeping monitors, the anxious nurses, the suffering patients. One elderly man refused to eat or drink. He shouted at the nurses and kicked them away. But the next morning, when the doctor declared him fit to go home, a miraculous transformation occurred — he ate everything he was given and was suddenly cooperative. Was he fighting death or the indignity of being imprisoned in the ICU?

Then there was the grandmother of one of my relatives. A nonagenarian, she had lost her ability to eat or drink. Food in liquified form was pushed into her through a nasal tube. She lived like that — neither dead nor fully alive — for months. There was nothing left of her quality of life, only a routine of feeding, cleaning, and waiting.

Another elderly relative was bedridden and suffering from a neurological problem. Doctors recommended brain surgery. Since the treatment was covered by government insurance and the family feared social stigma if they refused, they consented. The operation was done, but he did not survive. Was that surgery necessary? Was it meaningful? Or was it merely a ritualistic battle against the inevitable — a costly and futile act of denial?

These experiences have led me to one conclusion: while modern medicine has given us tools to extend life, we must also have the wisdom to know when not to use them. The question is not only how long we live, but how — and more importantly, how we die.

In every story I shared, one thing stood out starkly: none of the persons concerned was in a position to decide their course of treatment. The decisions were made on their behalf — by families unsure of what to do, or hospitals driven by fear, profit, or protocol. But were these informed decisions? Were they aligned with the wishes of the dying? From my perspective, many of these choices were deeply flawed — influenced by misplaced family pride, social expectations, institutional greed, or sheer helplessness.

There is, however, a solution — one that our legal system has slowly come to recognise, but which remains woefully underused. I am talking about the Living Will, also known more formally as an Advance Medical Directive. While most people are familiar with the traditional will — a legal document that outlines how one's property or assets should be distributed after death — a living will deals not with property, but with life itself.

The first will I ever read was that of Jawaharlal Nehru, written in prose but imbued with such lyricism and depth that it read like poetry. I remember reading it more than once, enchanted by its poignancy and clarity. Yet a living will is more grounded, more utilitarian — perhaps less poetic, but no less profound in its moral and legal significance.

A living will allows individuals to state, in clear and legally enforceable terms, what kind of medical treatment they wish to receive — or not receive — if they become incapacitated or enter a vegetative state. It gives voice to a person when they can no longer speak for themselves. I do not wish to dwell on the technicalities of drafting a living will, for those can be found elsewhere. Instead, let me share what my own living will would look like, if I were to prepare one today.

God forbid that I am ever diagnosed with a terminal illness — one with no reasonable hope of recovery — I would like my family to refrain from pursuing expensive, aggressive treatments, even if they are covered by insurance. I would prefer palliative care that manages pain and ensures comfort, as I confess that my tolerance for pain is quite low. I do not need the plush facilities of a five-star hospital. A well-run mission hospital, with compassionate caregivers and a human touch, is more than enough.

I believe that human beings were meant to eat through the mouth. If my body no longer accepts food or water the natural way, I would prefer not to be artificially fed through nasal tubes. Nature, in such cases, is sending its own signals. I would like those signals to be respected.

Some years ago, I stayed in a luxurious seven-star hotel in Istanbul. But I found myself longing for the simplicity and familiarity of my own bed back home. Likewise, I would prefer not to be confined to a hospital bed for longer than necessary. Home, or the closest approximation of it, is where I would like to be during my last days — provided, of course, it does not impose undue strain on my family.

ICUs are not places of healing for people at the end of their lives. At best, they delay the inevitable; at worst, they strip the patient of privacy, comfort, and dignity. I would prefer to spend no more than a day or two in an ICU, and only if strictly necessary. The prolonged stay — and the mounting bill — is not something I want to impose on those I leave behind.

Today, we hear of drugs that cost ?1 lakh a shot, or injections that promise miraculous extensions of life. I do not want such drugs. The money can be better used — for someone's education, for a cause that outlives me, for something meaningful. I have already pledged my organs for donation, except the skin.

I do not believe in dialysis-dependent life, especially at an advanced age. If a condition arises that requires regular dialysis to sustain life, I would rather skip the treatment altogether.

As for what happens to my body after death, I would like it to be donated to a medical college — ideally, Maulana Azad Medical College in Delhi or Believers' Church Medical College in Thiruvalla, Kerala. Let it serve one final purpose: the education of young doctors, who may one day save others.

Once the studies are over, the college may cremate or bury the remains — I leave it entirely to their discretion.

I am a Marthoma Christian by birth and conviction. I have not hesitated to critique certain practices in the Church, but I remain committed to its core doctrines. I would like to have a Marthoma funeral — a service marked by solemnity, simplicity, and substance. Christian funerals, when conducted well, are moving and dignified events. They offer comfort, not only to the grieving family but also to those who attend.

There is a particular prayer in the Marthoma liturgy, recited just after the body is lowered into the grave. It never fails to move me to tears:

"If this is the end of human life, why do kings and Lords hoard up gold?
If this is our end, why should the rich take pride in their riches?
If this is our end, why should the wise take pride in their wisdom?
If this is our end, why do the beautiful exult in their beauty?
If this is our end, why are those in authority proud of their power?
If this is our end, why should the young be proud of their youthful strength?"

These lines are a powerful reminder of our shared mortality, stripping away illusion and ego in the presence of death. Since my body would be sent to a medical college and would not receive a traditional burial, I hope the priest may consider saying this prayer at the church, before the handover.

I am reminded here of my grandfather — a practical man, who made a special outfit for his body to be dressed in, so his children wouldn't be burdened. He even built a modest tomb with a marble slab brought all the way from Rajasthan. He prepared sliced wood for a quick coffin. To spare his family the cost and logistics of a funeral feast, he invited the villagers for a "birthday feast" during his lifetime.

That, I think, is dignity — not just in dying, but in planning one's departure with grace, foresight, and compassion. The living will is not just a document. It is a declaration of one's autonomy, one's values, and one's deepest hopes for a meaningful end. We prepare for every major event in life. Why should death — the final chapter—be any different? In the end, no matter what decisions we make or avoid, it is God who remains the final arbiter of life and death.