The Physician's advance directives.

Abstract

On December 2017 the Italian Parliament approved the law n. 219/2017 on the advance directives (ADs) and the appointment of a health care proxy (HCP). The law has been considered as a civil conquest for defending the rights of sick people. At the same time the literature shows that a low proportion of patients have a written ADs document before admission to the hospital; when available, the ADs do not guarantee consistency between the received treatments and patient wishes; ADs exert little influence in regard to forgo treatments, withholding or withdrawing them; they are static compared with the dynamic nature of diseases and, therefore, so they are unable to consider all complications. Thus, a useful way for drafting an ADs document probably should not focus attention on specific treatments or outcomes, but, rather, it should supply doctors with the patient's scale of values so that they can use it as a border within which they are free to decide case by case what to do for the patient's best interest, accordingly with the evidence, their experience, letting the HCP to represent the patient's preferences and wills in relation to each specific situation, balancing benefits and burdens. This story shows that the ADs are far from being a simple means for facing with the illness, representing instead a strong call to ethical reflection intended as a tool to argue in a fully responsible way about the care choices and their consequences. In this case, it is evident that the success of this law will depend on the cultural evolution that people will be able to achieve.