Advance directive

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Advance health care directives or advance directives are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. A living will is one form of advance directive, leaving instructions for treatment. Another form authorises a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions on their behalf when they are incapacitated. People may also have a combination of both. It is often encouraged that people complete both documents to provide the most comprehensive guidance regarding their care.^[1] One example of a combination document is the Five Wishes advance directive, that is applicable in the USA.

1 Living will
2 Durable power of attorney and health care proxy
3 Legal situation by country
4 See also
5 References
6 External links

Living will

Refusal of treatment form

A living will usually covers specific directives as to the course of treatment that is to be taken by caregivers. In some cases a living will forbids treatment and sometimes also food and water, should the principal be unable to give informed consent ("individual health care instruction") due to incapacity. A living will can be very specific or very general. An example statement in a living will is: If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.

More specific living wills may include information regarding an individual's desire for such services such as analgesia (pain relief), antibiotics, hydration, feeding, and the use of ventilators or cardiopulmonary resuscitation. However, studies have also shown that adults are more likely to complete documents written in everyday language.^[2]

Durable power of attorney and health care proxy

Main articles: Health care proxy and Power of attorney

A durable power of attorney (also known as a lasting or enduring power of attorney) is an authorization in which the principal designates another person (the agent) to make decisions for them in the event that the principal is rendered incapable of making their wishes known. If the decisions relate to medical treatment then the agent appointed is known as a health care proxy. The health care proxy has, in essence, the same rights to request or refuse treatment that the individual would have if capable of making and communicating decisions. A durable power of attorney may also apply to financial matters. In this case, the agent makes financial transactions on behalf of the agent, while the principal is incapacitated.

Legal situation by country

The Netherlands

In the Netherlands, patients and potential patients can specify the circumstances under which they would want euthanasia for themselves. They do this by providing a written euthanasia directive. This helps establish the previously expressed wish of the patient even if the patient is no longer able to communicate. However, it is only one of the factors that is taken into account. Apart from the will in writing of the patients, at least two physicians, the second being totally unrelated to the first physician in a professional matter (e.g. working in another hospital, no prior knowledge of the medical case at hand), have to agree that the patient is terminally ill and that no hope for recovery exists.^{[citation needed]}

Switzerland

In Switzerland, there are several organizations which take care of registering patient decrees, forms which are signed by the patients declaring that in case of permanent loss of judgement (e.g., inability to communicate or severe brain damage) all means of prolonging life shall be stopped. Family members and these organizations also keep proxies which entitle its holder to enforce such patient decrees. Establishing such decrees is relatively uncomplicated.

However, in Switzerland, a patient decree has, as of November 2008, no legally binding effects, whether concerning civil nor criminal aspects. Such a decree is today merely viewed as representing the supposed will of the person with the incapability. There is, however, a revision of the Swiss Civil Code under way that aims to change this situation (intended to be article 360 of the Swiss Civil Code) by making the patient decree a legally binding document.^[3]^{[citation needed]}

United Kingdom

In the UK, people may make an advance directive or appoint a proxy under the Mental Capacity Act 2005. This is only for an advanced refusal of treatment for when the person lacks mental capacity and must be considered to be valid and applicable by the medical staff concerned.^[4]

United States

In the United States, most states recognize living wills or the designation of a health care proxy.^[5] For example California does not recognize a living will but instead uses an Advanced Health Care Directive.^[6] However, a "report card" issued by the Robert Wood Johnson Foundation in 2002 concluded that only seven states deserved an "A" for meeting the standards of the model Uniform Rights of the Terminally Ill Act.^[7] Surveys show that one-third of Americans say they've had to make decisions about end-of-life care for a loved one.^[8]