Advance care directives: Citizens, patients, doctors, institutions.

Abstract

Italian Law no. 219/2017 established the advance care directives (“Disposizioni anticipate di trattamento” – DAT), a legal document specifying the person’s wishes in relation to health, drawn up in case of the possible future incapacity to make informed decisions. DAT are an important instrument of empowerment for a person who is not necessarily a “patient” and enable the dialogue between healthcare providers and patient to continue when the latter is no longer able to take part consciously. DAT can only be implemented by guaranteeing the fundamental rights of the person, i.e. by ensuring the “non-complicated” use of this instrument and easy access to the DAT whenever it may be necessary. Furthermore, on the one hand, the requirement of adequate prior medical information has to contend with the fact that the wishes expressed in the document may have been formed outside of the therapeutic relationship; on the other hand, institutions must ensure that DAT are collected and recorded in such a way as to ensure their availability whenever and wherever necessary.Significance for public healthThe impact of such legislation on public health could be significant for various reasons: empowering individuals who are able, precisely, to make decisions “now” to be applied “later”, means fully respecting an individual’s choices irrespective of the reasons: for example, the reasons may be of an entirely personal nature, in some cases driven by the past experience of someone they know, or of a religious nature, with repercussions on the family (such as their children’s health). In this sense, healthcare choices are identified with full acceptance of individual empowerment, which can occur only after the doctor has provided the person/patient with adequate information. Moreover, should the patient refuse treatment, the health resources allocated for their treatment could be re-allocated to another individual who needs them and could benefit in terms of quality and quantity of life.