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Advance care planning in colon cancer: putting your wishes on record | CION Cancer Clinics
Advance care planning means deciding, while you are well enough to choose, what care you would want if you later became too unwell to say. It covers what matters most to you, who should speak for you and which treatments you would or would not want. It does not mean giving up treatment. This page explains what to cover, how to start the conversation at home and where a living will fits in India. At CION Cancer Clinics, a multidisciplinary team plans colon cancer treatment for your stage, from surgery to chemotherapy and follow-up.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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The short answer
What is advance care planning, and why do it now?
Advance care planning is a set of conversations about what matters to you and what care you would want if you became too unwell to say. It is best done early, while you are well and thinking clearly. The result is a plan your family and doctors can follow when you cannot speak for yourself.
It is not signing away treatment
A plan does not stop chemotherapy, surgery or any other treatment you are having now. It only comes into use if you lose the ability to make decisions. Until then, you decide everything yourself, and you can change your mind at any time.
Why colon cancer makes it worth doing early
Advanced colon cancer can bring sudden problems, such as a blocked bowel or a serious infection during chemotherapy. Decisions then have to be made quickly, often at night, by whoever is in the hospital corridor. A plan made in advance means that person is not guessing.
It is for people aiming at long-term control too
Some people with spread to the liver are potentially curable with surgery, as our page on when liver metastases can be removed explains. Planning ahead does not close that door. Anyone facing a major operation benefits from having named who speaks for them.
Planning ahead is about keeping your voice in the room. It is not about expecting the worst.What goes into a plan
What does an advance care plan usually cover?
There is no single form. Most good plans answer four questions, in the person's own words.
What matters most to you
Start with values, not machines. Some people most want to be at home. Others want to stay alert enough to talk to family, or to reach a particular wedding or festival.
Questions to think about
- What would make a day worth living for you?
- What worries you most about being unwell?
- What would you not want to go through again?
Who will speak for you
Name one person to speak to doctors if you cannot. In a joint family this matters, because the eldest son, the spouse and the daughter who does the caring may all expect to decide. Choose one, and tell the others why.
Treatments you would or would not want
Your oncologist can explain which situations might realistically arise. These usually include a return to intensive care, a breathing machine, a feeding tube, or attempts to restart the heart if it stops.
You can say yes to some and no to others. It is not all or nothing.Where you would prefer to be cared for
Home, a hospital near home, or a hospice. For families in a district town this is practical as well as personal. It affects medicines, equipment and who will be nearby at night.
Not sure whether this applies to you?
Ask an oncologistGetting started
How do you actually make a plan?
Think it through on your own first
Spend a little time with the four questions above. Write down anything that comes to mind, even if it is incomplete. A few honest lines are more useful than a perfect document.
Ask your oncologist what lies ahead
Ask which problems could realistically come up with your cancer and your treatment. Your doctor will answer as honestly as you want, and the tumour board's view of your scans shapes that answer.
Talk to the person you have chosen
Tell them what matters to you and what you would not want. Ask them to repeat it back. Choose a calm moment at home, not the waiting room on chemotherapy day.
Write it down and share copies
Give copies to your chosen person, your oncologist and your family doctor. Keep one with your treatment file, and look at it again whenever your treatment or health changes.
Words you may hear
The terms, in plain language
- Advance directive
- A written record of the treatments you would or would not want if you could not decide for yourself. In India it is often called a living will.
- Nominated representative
- The person you name to speak to doctors on your behalf. They should speak for your wishes, not their own.
- Capacity
- Being able to understand a decision, weigh it up and tell others what you have decided. The plan is used only when this is lost.
- Do-not-resuscitate decision
- A decision not to attempt to restart the heart if it stops. It does not mean stopping any other care, food, fluids or pain relief.
- Comfort-focused care
- Care where the main aim is easing symptoms and keeping the person settled, rather than treating the cancer itself.
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Commonly believed
Four worries families have about planning ahead, and what is true
"Talking about this will bring bad luck."
Planning does not change what happens in the body. Many families find that once wishes are spoken aloud, the fear becomes easier to carry, and later decisions are made calmly rather than in a crisis.
"Making a plan means giving up on treatment."
Most people who plan ahead carry on with treatment exactly as before. The plan sits in a file until it is needed, and for some people it never is.
"Elders should be protected from this. The children will decide."
Many older patients want to be asked and feel relieved when they are. Deciding for them, however lovingly, can leave children unsure for years whether they chose what their parent would have wanted.
"The doctors will decide anyway, so there is no point."
Doctors decide what is medically possible. Your wishes decide which of those options is right for you. Without a plan, that second part is guesswork.
Being straight with you
What this page cannot tell you
It cannot give legal advice. India recognises written advance directives, and the Supreme Court has set out how they should be signed, witnessed and attested. Those steps have been revised over time. A lawyer or the hospital where you are treated can tell you what is currently needed.
It cannot tell you what you will face
Which situations are realistic depends on where the cancer is, how it is responding and your other health conditions. Only your oncologist can link the plan to your own picture. Our page on deciding when to stop active treatment covers a related conversation.
Who this does not apply to in the same way
If you have been treated for an early colon cancer and are well, a detailed plan is not urgent. Naming who speaks for you is still sensible before any operation. If the cancer started in the rectum, the rectal cancer section covers that disease and its own decisions.
If you would like help starting, ask for time with your oncologist and the supportive care team, and bring the person you have chosen.Questions we are asked
Common questions about advance care planning
When is the right time to make an advance care plan?
While you are well enough to think clearly and talk it through. For many people with advanced colon cancer that is soon after diagnosis, or before a major operation. Waiting for a crisis usually means someone else has to guess what you would have wanted.
Is a living will legally valid in India?
Yes. The Supreme Court has recognised advance directives and laid down how they must be made, including signing in front of witnesses and having the document attested. The rules have been simplified over time, so check the current steps with a lawyer before you sign.
Can I change my plan later?
Yes, at any time, as long as you can still make decisions. Many people change their views after a good response to chemotherapy, a hard hospital stay or a family event. Tell your chosen person and your doctors, and replace the old copies so nobody follows an outdated version.
Does a do-not-resuscitate decision mean no more treatment?
No. It covers one thing only: whether to try to restart the heart if it stops. Chemotherapy, antibiotics, pain relief, food and fluids can all continue. Ask your oncologist how likely resuscitation is to help in your situation before you decide.
What if my family disagrees with my wishes?
It helps to explain your reasons to them directly, while you can. Ask your oncologist to meet you together if that would make it easier. A written plan and a clearly named person make it much harder for your wishes to be set aside later.
How do I raise this with a parent who will not discuss it?
Start with values rather than death. Ask what they would want if they had to stay in hospital, or who they trust to speak for them. Some parents find it easier when the doctor raises it. You can ask the oncologist to open the topic at a visit.
Should money, property and a will be part of the same plan?
They are separate documents, but many families do them at the same time. Sorting bank access, insurance papers and a will early spares relatives a great deal of stress. A lawyer handles the will. Your medical plan is the conversation with your doctors.
Can CION help us start the conversation?
Yes. Ask your oncologist for a longer visit to talk about what may lie ahead, and bring the person you want to speak for you. The supportive care team can join. Call the CION helpline if you are not sure how to arrange it.
Your Specialists
Meet CION's colon cancer specialists. Bring your colonoscopy, scan or biopsy report.
Our surgical and medical oncologists plan colon cancer care together: which operation, whether chemotherapy is needed, and the follow-up that comes after.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- National Cancer Institute — Advanced Cancer
- National Cancer Institute — Palliative Care in Cancer
- National Cancer Institute — Caregivers of Cancer Patients
- National Cancer Institute — Cancer Prognosis
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Palliative care alongside treatmentSymptom and comfort care that runs beside chemotherapyDeciding when to stop active treatmentThe harder conversation, and how families approach itAsking your doctor about prognosisHow to ask what lies ahead, and how much to hearEnd-of-life care in colon cancerWhat care looks like in the final weeks, at home or in hospital
Talk to us
Not sure how to begin this conversation?
Ask for time with your oncologist to talk through what may lie ahead and what matters most to you, with the family member you choose beside you. One helpline serves every CION centre.