The advanced healthcare directive: state regulations and regional regulations comparative

Abstract

The Bioethical Principle of Respect for the Autonomy of People is documented in two options, Informed Consent and Advance Directives Document (ADD) or Living Wills; the first one is a document signed by the patient before a health intervention, and the second one is drawn up and signed in anticipation that in the future he could not express his wishes intelligibly. ADD allows healthcare teams to know and follow patient’s decisions, who will guide clinical actions even if he can not communicate it actually.
In Spain, normative, denominative and functioning aspects of the adjudication and registration services’ heterogeneity in the different autonomic communities can lead to confusion in a State with a unique structure of the National Health System for the whole territory, which may result in an anticipated wills’ lack of equity.
As an example, regulations in Andalusia do not require the intervention of a notary or witnesses, allows telematic transmission and the document proposed by the administration contains open responses; in contrast, other communities (as Catalunya, Navarra) require the intervention of witnesses and/or notary, transmission and registration must be personal and the proposed standard documents are closed. Among them, some communities have intermediate proposals.
A subsequent study of the rates of ADD adjudication and registration differences may inform about the autonomic communities in which its use should be promoted or, where appropriate, the legislation may be modified in order to facilitate population’s ADD drafting, adjudication and registration.