Patient autonomy and the advance healthcare directive

Abstract

Introduction. Mexico City and several other Mexican states have laws dealing with advance healthcare directives. In the case of Mexico City, the law was enacted in 2008. Its purpose is to allow terminal patients to outline which forms of treatment they wish to receive should they no longer be able to make such a decision in the future, for example in the event that a patient’s cognitive state does not allow him or her to autonomously make a decision regarding treatment². An advance directive is a document signed by a notary public in which the person—in full possession of his or her mental faculties—consciously, unequivocally, and repeatedly requests not to be subject to aggressive and persistent medical treatment and/or processes.

Body. These regulations deal with two factors: first, the development of informed consent with a basis in autonomy; second, fear of aggressive and persistent medical treatment and a prolongation of suffering. Beauchamp and Chldress define an autonomous person as someone who acts intentionally, with sufficient knowledge and without external influences, to decide his or her therapeutic treatment¹. The key is to establish therapeutic restrictions according to each patient’s necessities, which must be outlined in writing in the form of a legal medical document. Moreover, it is the healthcare professional’s responsibility to provide the patient with information regarding different possible forms of treatment, along with the benefits and potential complications of each, thereby allowing a free and autonomous decision.

Conclusion. Advance directives support healthcare in the final stages of a person’s life. The focus is on accompanying the patient at this crucial and vulnerable time without prolonging life at the cost of more suffering.