Advance Directives and the Role of Family and Close Persons – Legal Provisions and Challenges

  • Margot Michel
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 54)


While in recent decades respect for patient autonomy has become one of the core principles of modern Western medical law and ethics, the question how autonomy can be protected when patients become incompetent remains controversial. The Council of Europe sees advance directives and continuing powers of attorney as the most important means of extending patient self-determination and has therefore issued several recommendations and resolutions on this topic. However, while advance directives and continuing powers of attorney enable patients to provide for incapacity, it would be illusory to perceive them as a solution to the challenge of involvement of third parties in the decision-making process. Advance directives need to be interpreted and implemented by third parties; therefore, family members, close persons and medical staff all play a crucial role in interpreting the document and are responsible for ensuring that the patient’s wishes are met. If a patient has not issued an advance directive or created a continuing power of attorney, law, according to the Council of Europe, should grant power of attorney to family members and close persons. Switzerland’s completely revised federal adult protection law takes account of these recommendations and assigns power of attorney to family members and close persons. However, there are certain drawbacks to this approach; therefore, the power of attorney is limited by law and legal guidelines regulate the decision-making process.


Human Dignity Advance Directive Fundamental Freedom Incompetent Patient Close Person 
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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Institute of LawUniversity of BerneBerneSwitzerland

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