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Statement of the standing committee of doctors of the EC on living wills/advance directives

Creación: Comité permanente de médicos europeos (Comité Permanent des Médecins Européens, Standing Committee of European Doctors, CPME)
Fuente: Comité permanente de médicos europeos
Lengua original: Inglés.
Copyright del original inglés: No
Adopción: 12-13 de noviembre de 1993
Traducción castellana: No
Comprobado el 16 de mayo de 2002


Statement of the standing committee of doctors of the EC on living wills/advance directives


The Standing Committee is opposed to any legislation giving living wills/advance directives the force of law, because if that were the case, it would constrain the ability of the doctor to treat the patient to the highest professional and ethical standards.

Such a document can only be a written expression of the wish and intention of the patient, made at the time when the patient was fully "compos mentis", which can later be of use as a basic framework of care.

The Standing Committee recognises that approaches to this issue are determinated by a range of social, cultural and religious factors, which mean that there are wide variations in legal provision and professional attitudes from one country to another. While respecting these national differences, the Standing Committee has identified basic principles.


1. This form of expression of wish and intention is not intended to promote active euthanasia.

2. Doctors should not be obliged to act contrary to their consciences. The doctor should inform the patient at the outset of any objections which she/he may have to the content of an individual expression of wish and intention and, if necessary, assist the patient in transferring to the care of another colleague.

3. Doctors should at all times seek to act in the best interests of their patients and to recommend the treatments which they consider most appropriate.

4. The doctor/patient relationship is based on mutual respect, trust and good communication. Doctors should explain treatment options to patients and ensure that they have sufficient information on which to base decisions.

In the absence of contrary evidence, a valid statement of wish and intention is of value in representing a patient's settled wish when the patient may no longer be competent to express a view.

The patient is responsible for ensuring that the existence of his/her advance directive is known to those who may be asked to comply with its provisions.

Those who interpret it must take account of the possibility that the patient's views about treatment may change as his or her clinical condition changes.

5. Patients may wish that every possible treatment should be provided to the point of death. They also have the right to refuse treatment at all times.

6. Patients who become incompetent should retrain the same rights in respect of health care as those who remain competent.

7. It should be possible for a statement of wish/intention to be overridden where the clinical circumstances are not precisely covered by their provisions. Such circumstances are a matter of clinical judgement and would merit further discussion.

8. If there are discussions about developing policy on the use of statements of wish/intention, representatives of medical and other health professions should be involved while the complexity and sensitivity of the various factors which must be taken into account should be drawn to the attention of the public and appropriate authorities.

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