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Advance Directives in the United Kingdom: Ethical, Legal, and Practical Considerations

  • V. MetaxaEmail author
Chapter
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Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Abstract

Advance directives have been proposed as a way to promote self-determination in situations where the individual has lost decision-making capacity and cannot make important life and death decisions. They have significant theoretical advantages, as they allow patients to refuse future therapies and plan their future care, ensuring that the treatments they receive are consistent with their values and wishes. In the critical care setting, they have the potential to assist intensivists in their decision-making, especially as the majority of patients have impaired level of consciousness near the end of life. Despite the conceptual advantages, the number of valid advance directives in the UK remains very small, demonstrating an issue with their uptake. The most important moral concerns raised are around validity and applicability of advance directives in future scenarios, springing from uncertainties around understanding of the future disability, accuracy in forecasting one’s future preferences and potential changes in the values and wishes following the occurrence of that disability. Even though advance directives are legally binding in the UK, the courts have demonstrated reluctance to honor the wishes they express, especially when the outcome will be the patient’s death. The difficult balance between medicolegal paternalism and respect for the sanctity of life on one side and patient autonomy on the other prevents the universal adoption of advance directives, a fact that legalization itself did not change. A change of culture is required in order to accept the fact that patients have a right to refuse treatment, even it leads to their death.

Keywords

Advance care planning Advance directives Paternalism Autonomy 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Critical Care DepartmentKing’s College Hospital NHS Foundation TrustLondonUK

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