ABOUT ADVANCE DIRECTIVES (ADs)

Advance Directives (ADs) are written documents made by people in advance of a situation in which they may be incompetent to decide about their own care, stating their treatment preferences or authorizing a third party to make decisions for them (proxy or substitute).

Usually oral statements, declarations of patients not written, are not considered Advance Directives.

Several types of advance directive documents exist:

• Living Will (LW) is a document that specifies treatments that would be desired/not desired if a person were unable to make his/her own choices. LWs commonly address choices about Cardiopulmonary Resuscitation (CPR) such as Do Not Resuscitate (DNR) orders, mechanical ventilation, artificial feeding and hydration, provision of blood and antibiotics, and surgical procedures. It is said that the term Living Will was introduced for first by Louis Kutner in 1969, in his seminal paper "Due process of euthanasia: The Living Will, a proposal".

• Durable Power of Attorney for Health Care(DPAHC) is an advance directive document where the person specifies a proxy decision-maker to take decisions if she/he does not have decision-making capacity.

• Values History (VH) is a document that tries to collect the values that are important for the person and should be respected in end-of-life decision-making.

A person therefore can have one, two or all three documents, depending on the circumstances. In fact, nowadays, most ADs are complex documents that include a Living Will, a Durable Power of Attorney and a more or less complete Value History. The "Medical Directive" or the "Health Care Directive", designed by Linda and Ezekiel Emanuel, are good examples of this kind of complex ADs (Emanuel 1991).

Proxy, surrogate, substitute or healthcare agent are usually considered synonyms. They refer to the person appointed to make healthcare decisions for the patient when she becomes incompetent and is unable to make them for herself. The proxy can be appointed previously by the own patient using a DPAHC. If a DPAHC doesn’t exist when the patient becomes incompetent, then usually can be appointed at that moment following legal provisions or court decisions. These proceeding depends on the regulation of each country or state.

Psychiatric Advance Directives , also known as "Ulisses Directives", are written documents that provide people with these illnesses the opportunity to convey their treatment preferences if in the future they become incompetent. Our website is not devoted to this kind of documents. The National Resource Center on Psychiatric Advance Directives (USA) is specialized in these documents.

Advance Care Planning (ACP) was a term that began to be used in the literature around 1995. It consists of a discussion or a set of encounters between persons, their surrogates, and professionals about the goals and desired direction of the patient's care, particularly end-of-life-care, in the event that the patient is or becomes incompetent to make decisions. So ACP includes a set of interventions to promote communication or discussions, like structured interviews, meetings, use of videotapes, booklets or written advance directives aiming to involve persons and surrogates in discussions about end-of-life decisions . A signed AD may be one of the outcomes of an ACP process.