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authors: Tamayo Velázquez MI ,Simón Lorda P, Pascalev A, Bernal Solano, M.
last update: 03/05/2012
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Advance Directives are not regulated by any specific law in Bulgaria and t here is not any particular bill regarding ADs.
The only exception concerns oncology patients with less than 6 months of life expectancy and whose treatment is covered by the National Health Insurance Fund (NHIF).
Advance directives in Bulgarian can be named as:
The number of ADs is very limited because ADs are available only to a very limited number of patients. The low impact of ADs in Bulgaria is also due to the lack of specific legislation and information on the topic among Bulgarian citizens and medical professionals, and to the dominant culture of medical paternalism.
The issue of ADs is just beginning to be raised in Bulgaria and a public debate is still to take place.
Generally speaking, the citizens of Bulgaria do not complete AD s except as specified above.
No register of AD s exists in Bulgaria. As a result, it is very difficult to determine who have completed an AD either before a notary public or by another method.
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Currently, Advance Directives are not available or legally binding in Bulgaria and t here is no specific legislation regulating ADs.
The only exception concerns oncology patients with less than 6 months of life expectancy and whose treatment is covered by the National Health Insurance Fund (NHIF).
There are no special legal provisions for designating a proxy for health care in Bulgaria. It is possible to appoint such a proxy under the provisions of the civil code following the existing legal process for general durable power of attorney. Under Bulgarian Law, a legal proxy can be appointed for any purpose by signing a power of attorney witnessed by a notary public or by any two witnesses unrelated to the person appointing the proxy. In general, the practice of appointing health care proxies does not exist. If a patient is incapacitated, the decisions are made by the physician in consultation with the next of kin.
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There is no official procedure to register an advance directive in Bulgaria.
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There is no official form to complete an advance directive in Bulgaria except for NHIF oncology patients with less than 6 months of life expectancy and whose treatment is covered by the National Health Insurance Fund (NHIF).
The Bulgarian translation of this form is available on the NIHF by clicking here, (Annex 17, Clinical Path 297, p. 23). The form specifies treatment choices including artificial nutrition and hydration, palliative care and a health care proxy. The opportunity to complete such a living will is limited only to this single category of Bulgarian patients.
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Publications -
Parashkevova B, Marinova
J, Petrova G. Advace health care directives- a documento of clinical
pathway in Bulgaria: is this compatible to the Bulgarian legislation?, Trakia
Journal of Sciences, 2010, Vol.8, Suppl. 2., pp 476-79.
- A. Pascalev, “Report on Advance Directives in Bulgaria” in Country Reports on Advance Directives, eds. N. Biller-Andorno, S. Bauer and R. Andorno. (Zurich: Institute of Biomedical Ethics, 2008)
Links
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Bulgarian Center for Bioethics (BCB) . In June 2008, the Center initiated a debate on ADs by organizing a national conference “Advance Directives as an Instrument for Expanding Patient Rights” with participation from all major stakeholders: health care providers, bioethicists, legal experts, patient organizations, hospital staff, administrators from the NHIF. Information about the conference and the Declaration adopted at the conference is available on the Center’s web page (Available by clicking here)
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National Health Insurance Fund (NHIF). It was founded on 15 th March 1999 as an independent public institution separated from the structure of the social healthcare system and has its own bodies of management.
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