Advance Directives. Comparison of current legislation within the European Union

Abstract Advance Directives have been legally binding in Spain since the publication of Act 41/2002, of 14th November, which regulates patients’ rights to autonomy and obligations concerning clinical information and recording clinical information. However, the situation in each country of the European Union remains heterogeneous and unknown to most health care professionals. By collecting and studying the legislation on patients' rights in European Union countries we have made an updated comparison of the different features of Advance Directives in each country. Only 15 of the 28 European Union Countries have developed specific rules on advance directives which makes them legally binding in 86% of cases if they are written. A formal Advance Directive signed before a notary, a civil officer or a witness, is required in only 7 countries. The designation of a patient’s attorney for health matters is regulated in 11 of the countries. There is an Advance Directives Register in 3 countries, whereas in the other countries it is only included in the medical record. Regular revision of an advance directive document, to maintain its validity, is required in five countries. All legislations provide for amendments and the revocation of advance directives, as they forbid unlawful actions. Rejection of routine supportive measures and treatment limitation are the main content of advance directives, although specific treatment applications are viewed as guidance. There seem to be many differences between laws concerning advance directives among the European Union Countries. A more homogeneous legislation, publicized and applied within the wider social consensus, would be desirable.