Advance wishes

The advance directive document is the document addressed to the doctor or responsible medical team in which a person of legal age, with sufficient capacity and freely, expresses the instructions to take into account when he is in a situation in which the circumstances, at some point, they do not allow you to express your wishes personally. In this document, the person can also designate a representative, who is the valid and necessary interlocutor with the doctor or the healthcare team, to replace them in the event that they cannot express their wishes on their own.

There must be reliable evidence that this document has been granted under the conditions mentioned above. For this purpose, the declaration of advance directives must be formalized through one of the following procedures:

• In front of the notary. In this case, the presence of witnesses is not necessary.
• In front of three witnesses of legal age and with full capacity to act, of which two, at least, must not have a kinship relationship up to the second degree or be linked by patrimonial relationship with the grantor.
• Advance directives that incorporate provisions contrary to current law or good clinical practice, or that do not correspond exactly to the factual assumption that the subject has foreseen at the time of issuing them, cannot be taken into account. In these cases, the pertinent reasoned notation must be made in the patient's medical history.

If there are advance directives, the person who has granted them, their relatives or their representative have to deliver the document that contains them to their doctor and that it remains in the medical record of the health center where the person is treated.

This document can be a draft in which the wishes of the patient are expressed or follow a preformed form that can be obtained in the health centers dependent on the autonomous communities. In general, it is recommended that the advance directive document have the following contents:

• The criteria that take into account the prioritization of personal values ​​and expectations, even if it is not very specific and is far from any decision of this type.
• The specific health situations in which you want the instructions to be taken into account.
• The more concrete instructions and limits in medical action in the face of planned decisions, especially when there is information on evolutionary probabilities.
• The representative is the person who is appointed to act as a valid and necessary interlocutor with the doctor or the healthcare team in the event that the grantor cannot express his or her wishes on his own.

The declaration of advance directives may decrease:

• Personal concern
• Feelings of helplessness and guilt on the part of family members.
• Unsuccessful, expensive, or specialized medical interventions that the patient may not want.
• Total cost of medical care.
• Legal concerns for everyone involved.

The process of stipulating advance directives can be difficult and requires thinking about individual priorities regarding quality of life and death. Treatment options and their potential influence on quality of life need to be fully understood and considered. It is important to know the possible consequences of choosing or rejecting certain forms of medical care.

Of interest

It is desirable to discuss the wishes regarding advance directives with the patient's medical staff, family and friends, as well as to go over the wishes from time to time to remind everyone of them.