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Planning your future care with blood cancer | CION Cancer Clinics
Advance care planning means deciding now what care you would want if blood cancer later left you too unwell to speak for yourself, and naming who should speak for you. In India, a written advance directive is legally recognised. This guide walks through the steps, the decisions a blood cancer plan should cover, and how to talk about it as a family. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is advance care planning, and why does it matter in blood cancer?
- How do you make an advance care plan, step by step?
- Which decisions should a blood cancer plan cover?
- What do the planning words mean?
- Is an advance directive legally recognised in India?
- Which beliefs stop families from planning ahead?
- Common questions about advance care planning
The short answer
What is advance care planning, and why does it matter in blood cancer?
Advance care planning means deciding now, while you can, what care you would want if you later became too unwell to speak for yourself. You talk it through with your family and your haematologist, and you write it down.
Why blood cancer makes it urgent
Blood cancers can change quickly. A serious infection, bleeding or a sudden drop in blood counts can take a person from the day-care chair to intensive care within a short time. In that moment, the family is asked to decide about breathing machines or resuscitation, often at night, often without knowing what the patient would have wanted.
What it is not
It is not giving up treatment. You can plan ahead and still take every treatment your team offers. It is also not only for the elderly or for the last weeks of life. The calmest time to plan is when you are reasonably well.
What this page cannot tell you
This page explains the process in general terms. It is not legal advice, and the rules for written advance directives in India have been changed by the courts more than once. Check the current procedure with a lawyer or the hospital's social worker before you sign anything.
The process
How do you make an advance care plan, step by step?
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Understand where things stand
Ask your haematologist what the illness is likely to do and what the treatment is aiming for. Planning only makes sense once you know the likely course.
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Think about what matters most to you
Being at home, being free of pain, seeing a family event, staying clear headed, or trying every possible treatment. There are no right answers, only yours.
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Choose who will speak for you
Name one or two people who would make decisions if you could not. Pick someone who will follow your wishes, even where they differ from their own.
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Talk it through as a family
Share your wishes with everyone who may be at the bedside, including relatives who live abroad. Disagreements are far easier to settle now than in an emergency ward.
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Write it down
Record your wishes clearly. If you want a formal advance directive, follow the current legal procedure, which includes witnesses and attestation by an official.
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Share copies and review
Give copies to the people you named and to your treating team, and keep one with your medical file. Look at it again whenever the illness or the plan changes.
Not sure whether this applies to you?
Ask an oncologistWhat goes in the plan
Which decisions should a blood cancer plan cover?
Your haematologist can explain what each choice would mean for you. These are the questions families most often face without warning.
Resuscitation
Whether doctors should attempt to restart the heart if it stops. In advanced blood cancer this is rarely successful and can be traumatic, so many people choose to decide in advance.
Intensive care and breathing machines
Whether you would want to be moved to intensive care or placed on a ventilator, which is a machine that breathes for you. Some people want this for a short trial only.
Transfusions and antibiotics
Whether to continue blood transfusions and hospital treatment for infections as the illness advances. These decisions are made with your team, never by stopping on your own.
Where you want to be cared for
Home, hospital or a hospice. Think about what is practical for your family.
Worth considering
- Distance from your district to the hospital
- Who can care for you at home
- Religious or cultural wishes at the end of life
Terms you will meet
What do the planning words mean?
- Advance directive or living will
- A written document stating what treatment you would or would not want if you could no longer decide for yourself.
- Healthcare representative
- The person you name to make medical decisions on your behalf. Sometimes called a guardian or surrogate.
- DNR or DNAR
- Do not attempt resuscitation. A decision, recorded in your notes, that the team will not try to restart your heart.
- Palliative care
- Care focused on comfort, symptoms and support for the family. It can start early and run alongside treatment.
- Mental capacity
- Being able to understand a decision, weigh it up and communicate it. Advance plans matter when this is lost.
In India
Is an advance directive legally recognised in India?
Yes. The Supreme Court of India has recognised a person's right to refuse life-sustaining treatment through a written advance directive, and later made the procedure simpler. The exact steps and forms can change, so confirm them before you sign.
What the formal route usually involves
The document is signed by you while you are able to decide, in front of witnesses, and attested by a notary or gazetted officer. It names the people who will speak for you. Before it is acted on, doctors and a medical board review whether it applies to your situation.
If you do not make a formal directive
A written plan, clear conversations and notes in your hospital file still help a great deal. Most decisions near the end of life in India are made by the family and the treating team together. Knowing your wishes lets your family decide with confidence instead of guilt.
Where CION fits
CION's haematology team can explain the likely course of your illness and what each choice would mean medically. For the legal document itself, you will need a lawyer or a notary.
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Commonly believed
Which beliefs stop families from planning ahead?
"Talking about it will bring bad luck."
Planning does not change the course of the illness. What it changes is whether your family has to guess in a crisis. Many families say afterwards that knowing the patient's wishes was a comfort.
"If we sign a plan, the hospital will stop treating him."
A plan only covers the situations you describe. Treatment you want continues. Comfort care, pain relief and nursing are never withdrawn because a plan exists.
"The eldest son decides anyway, so there is no need."
The patient's own wishes come first. Writing them down protects the person who has to decide, and prevents painful arguments between siblings at the bedside.
"It is too early. We will think about it when things get worse."
In blood cancer, things can worsen suddenly, and the patient may not be able to talk by then. Planning early, while well, is kinder to everyone.
Questions we are asked
Common questions about advance care planning
When is the right time to start advance care planning?
Ideally soon after diagnosis, or whenever the treatment aim changes, while the patient is well enough to think clearly. It does not have to happen in one sitting. Start with who should speak for you, then add details over several conversations with your family and team.
Do we need a lawyer to make an advance care plan?
Not for the conversations or a written note of your wishes. For a formal advance directive under Indian law, the document needs witnesses and official attestation, so a lawyer or notary is helpful. Ask them to check the latest procedure, as it has changed before.
Can I change my mind after writing the plan?
Yes, at any time while you are able to decide. Tell your family and your treating team, and replace old copies with the new version so that nobody acts on a plan you no longer want. Reviewing it after each change in treatment is a good habit.
What if family members disagree with the patient's wishes?
This is common. Talk it through early, with the patient present if possible. A palliative care doctor or counsellor can help the family understand the medical facts behind each choice. A clearly written plan makes it easier for everyone to respect the patient's voice.
Does a do-not-resuscitate decision mean no other treatment?
No. It covers only restarting the heart if it stops. Pain relief, antibiotics, transfusions and other care can continue as agreed with your team. Ask your haematologist to explain exactly what the decision does and does not include in your case.
Will the hospital follow my plan in an emergency?
Teams take written wishes seriously, but they can only follow a plan they know about. Keep a copy with your medical file, give one to the person you named, and carry a note of it when you travel to an emergency department.
Can the patient ask to be cared for at home at the end?
Yes, and this is one of the most useful things to put in the plan. Ask your team what home care support is available, what symptoms may need a hospital visit, and who to call at night. Home is not right for everyone, and that is fine too.
How do I start this conversation with my mother?
Choose a quiet time, not a crisis. You might say, "If you ever became too unwell to tell the doctors what you want, who should speak for you?" Listen more than you speak. Her treating team or a counsellor can join if that feels easier.
Your Haematologist
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- Cancer.Net — Advance Care Planning
- NHS — End of life care
- World Health Organization — Palliative care fact sheet
- Macmillan Cancer Support — Cancer information and support
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 and End-of-Life Care in Blood CancerThe full guide to comfort-focused careTalking to a Haematologist About PrognosisKnow the likely course before you planHome Care for Advanced Blood CancerIf your plan says you want to be at homeTransfusions at the End of Life: When to StopOne of the hardest decisions a plan may cover
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