Advance directives across Europe

Abstract

An advance directive is a legal document through which one conveys decisions regarding end-of-life care ahead of time. This may involve withholding treatment, do not resuscitate orders, removing of feeding tubes or organ donation or receiving blood products. One must be competent to take medical decisions in order to procure an advance directive. Competency testing raises many ethical dilemmas. Another form of advance directive authorizes 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. There are many legal issues that accompany the production of an advance directive and legislation differs across the different European member states. The differences in legislation outline a number of ethical presuppositions. The focus of this study is to explore and discuss the ethical issues tied with advance directives and to delve into the different legislation across Europe regarding documentation and affectivity of advance directives. The concept of 'ordinary' and 'extraordinary' treatment is highlighted as a guide involving advance refusal of treatment. The topics of autonomy, beneficence and non-maleficence are tantamount when one discusses health care decisions and above all personhood and the value of human dignity and human life.