The advance directives document (DVA), also known as living will or advance directives, is a legal instrument that allows a person to communicate in advance which medical care he/she accepts and which he/she rejects in the future; in the event that, when the time comes, the person is no longer capable of making decisions for him/herself, according to his/her preferences and values. Dr. Coll Rolduà, specialist in Geriatrics and member of Top Doctors, informs about when and how this document should be made.
Formulating this document is a right and represents the maximum guarantee of respect for one’s own will for one’s own benefit, even if one is not in a position to express it, avoiding leaving it in the hands of the doctor and/or relatives. For this reason, it is considered an act of responsibility of exercising one’s own personal autonomy.
When is it advisable to draw up an advance directives document?
The preparation of an advance directives document facilitates and strengthens the healthcare relationship based on collaboration and trust between physicians and patients. Regardless of age, it is advisable to draw up this document when diagnosed with a degenerative and/or terminal disease, in the context of the geriatric population or in chronic multi-pathological patients.
It is an exercise in reflection and a complicated moment, emotionally speaking, because it connects the person with the end of his or her life. However, drawing up this document is a way of taking care of the family, since it saves them from having to make difficult decisions and avoids conflicts that may arise due to differences in beliefs, the intensity of emotions or subjective opinions, among others.
The existence of an advance directives document obliges both the responsible physician and the healthcare team to take it into account when making clinical decisions and to apply it, as long as it does not imply an action against current legislation and/or contrary to good medical practice.
How to formalize an advance directives document
In order to formalize an advance directives document, it is necessary that the person has full decision-making capacity, that it is stated as precisely as possible and that it is formalized in accordance with the applicable regulations. Although each autonomous community has the capacity to regulate the procedure for the formalization of this document, in general terms the necessary requirements are common.
There is no official document. The content of the text is free and is not standardized, although it is true that there are various models that can serve as a guide:
- Indicate what treatment or care is desired, with the aim of not prolonging life, suffering and/or pain unnecessarily and artificially.
- Indicate where you wish to receive care at the end of life, avoiding transfers outside the home.
- Indicate if you wish to donate organs for transplantation, research and/or teaching.
- Indicate if you wish to receive spiritual assistance according to your beliefs.
- Designate a representative (or even a substitute representative) who can act as a valid interlocutor with the doctor or the health care team, in the event that the person himself cannot express his will on his own.
The document must be formalized in writing:
- Before three witnesses, who must be persons of legal age, with full capacity to act and not linked to the person in question by marriage, free union or domestic partnership, kinship -up to the second degree- or any patrimonial relationship whatsoever.
- Before a notary public
Once the living will has been drafted, the regular physician should be informed and copies should be given to the patient’s physician for the medical record, as well as to family members or representatives. It is also highly recommended that it be included in the official registry of advance directives to ensure that it is available when needed.
It is necessary to remember that it can be modified, substituted or revoked at any time, either directly, orally, or by means of a document. As long as the person retains his or her capacity, the oral will prevails over any written document.