An advance directive that states the types of care someone wants – or doesn’t want – when they become incapacitated
“Advances in medical technology now allow the human body to be kept alive in conditions that would normally lead to death. But many do not want to be kept alive if there is no chance of recovery. As some patients are unable to express their wishes, these wishes can be stated in advance through a Living Will.”
The above was pointed out by the head of the 1st Nursing Department of the “Gennimatas” hospital and postgraduate student of Medicine at the University of Athens, Olympia Anastasiadou, speaking from the podium of the 12th Scientific Conference of Medicine at the University of Athens on “Issues of consent in medical procedures by patients who are unable to externalize their will – Living Testaments”.
What is the Life Covenant
A Living Will, as Ms. Anastasiadou explained, is a type of advance directive that states the specific types of medical care that a patient, a person, wishes to receive when they are no longer able to make medical decisions due to a terminal illness or permanent anesthesia. .
“A Living Will usually has instructions about whether certain treatments should be used to keep the person alive, such as the use of dialysis machines, breathing tubes, feeding tubes and CPR.
Overall a Living Will is a written document that reflects an act of personal responsibility. It is one tool for making clinical decisions, especially applicable to patients with chronic diseases, who are prone to the development of cognitive disorders and in a state of dependence” explained Mrs. Anastasiadou.
The purpose of Living Wills, as Ms. Anastasiadou noted, is to describe the goals and desires of a person regarding life-sustaining medical care, to appoint one responsible health care decision-maker who will speak on behalf of the patient when he is no longer able to participate in his health care treatment decisions, provide instructions about treatments that may be offered to prolong life. For this reason, they contain specific health care instructions, a power of attorney and the designation of a health care proxy who is the substitute decision maker.
The pros and cons of Living Wills
“Living Wills provide a great advantage to the patient himself, even when he cannot communicate with his environment himself, but still has the right to make decisions about his medical care. It is ensured autonomy of the patient, respect goes beyond the patient’s competences by allowing the prediction of clinical situations to make relevant decisions in advance.
However, a number of questions related to bioethics are raised.
Important questions concern whether the patient understands the difference between treatments that can save his life and treatments that can prolong his life. Patients’ goals and preferences for care may change in the future, especially since health and therefore illness is a dynamic state. Another problem may arise with respect to the representative’s clear and complete understanding of the patient’s needs and wishes.
What the law provides – When can the doctor refuse?
Referring to the legislation on Living Wills, Mrs. Anastasiadou mentioned that in the USA laws on Living Wills have been established which are different for each state and there is no uniform legislation.
He also noted that they are not binding and that a physician or facility may refuse to honor advance directives for ethical or religious reasons or if the care the patient requests is not medically appropriate.
“In many countries a doctor or clinic that refuses to honor an advance directive must make an effort to transfer care to another doctor or facility.
As for her Europe Article 4 of the European Charter of Patients’ Rights makes the exercise of the right to consent a condition for every therapeutic act and procedure.
In Austria the Living Will is a declaration of will by which a patient refuses a given medical treatment in the future when he is no longer able to perceive his condition, appreciate it or express himself. In Spain the living will was legislated in 2000 while in Belgium passive euthanasia is allowed.
In Hellas the autonomy of the patient has not yet become an object of social assertion, much less has a right to death been raised. More broadly, there is no legal culture of sensitivity to individual rights and therefore the earlier directives have not been fully institutionalized. Overall, however, valid consent conditions are generally regulated by article 12 of the Code of Medical Ethics for informed patient consent in combination with articles 5 to 9 of the Oviedo Convention”, pointed out Ms. Anastasiadou.
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