Advance Directives in Spain. Perspectives From a Medical Bioethicist Approach

Abstract

Spain is one of the most advanced European countries in terms of the legislative and administrative development of ADs. Article 11 of Law 41/2002, concerning Patient Autonomy, regulates 'advance directives' and has prompted various Autonomous Regions to develop legislation in this area. Nevertheless, whilst the variety of legislations in different territories presents advantages, the disparity of criteria also presents problems. Despite significant legislative development, only 23,000 Spanish citizens have filled in an AD. Clearly, AD use is confined to a minority. Several surveys, however, show that the Spanish population views these documents in a positive light. Thus, we must analyse this discrepancy between attitude and practice. A similar situation exists amongst health professionals. Whilst they generally feel that the use of ADs is positive and necessary, they are frequently unwilling to employ them. Bioethical literature and research on ADs has significantly increased in Spain over the last six years. It is likely that this trend will continue in the foreseeable future; but more resources and effort are required if ADs are to become consolidated.

What are the ethical questions raised by the integration of intensive care into advance care planning?

“…Similar rates of uptake have been reported in Germany (19), the Netherlands (20), and the United Kingdom (21). Rates are reportedly even lower in Australia, at 0.2% to 7.9% (22) and Spain (<1%) (23). In France, less than 2% of the population has prepared AD according to the national institute for demographic studies (24,25).…”

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

“…Generally, advance directives are defined as mechanisms by which individuals make known how they want decisions on medical treatment to be made when they can no longer make the decisions themselves [5]. So, advance directives inter alia can take the form of living wills, healthcare proxies, do-not-resuscitate orders, and enduring powers of attorney [6, 7]. …”

Diretivas antecipadas de vontade aos doentes terminais: revisão integrativa

“…Health care professionals have important influence in the assistance to patients, and can propose the ADLW practice, in a contextualized manner, through its interaction with families and patients. We point out that students and health care professionals (nurses and doctors) value the practice of completing the ADLW (14,21,24,37,43,52) . However, sometimes, they show a resistance for holding discussions on its implementation with patients and their families.…”

“…In Canada, 86% of 643 doctors surveyed were in favor of its use, however, only 19% had actually discussed the ADLW with more than 10 patients, and more than half said they didn't always follow the information contained in the ADLW (14) . On the other hand, other studies indicate that approximately 90% of the doctors would attend to the advanced directives of the patient at the time that the patients were no longer able to participate in the decision making process (52) . In Japan, 55% of 301 doctors approved of the use of the ADLW.…”