Clinical Practice of Informed Consent for Percutaneous Tracheostomy



Fig. 16.1
Critically ill patients divided according the mental status



The rules of IC and the way to design the surrogate for critically ill patients differ across countries [5]. Many countries recognise the figure of a designated surrogate or proxy, while the other countries give the legal right to the relatives. Furthermore, different countries recognise the legal validity of the advanced directives of treatment. However, the types and the contents of the advanced directives of treatment vary across countries. The most common advanced directives of treatment are the living will and the power of attorney or healthcare proxy. The living will is a document designed to control future healthcare decision or treatment when patients become incompetent. The living will describes the type of medical treatment the person would want or would not want in state of unconsciousness. The power of attorney, also called healthcare proxy, is a legal document in which the patient names a person to be his proxy to make all your healthcare decisions if he/she becomes unable to do so. The person indicated in this document has the right to consent to medical treatment (Table 16.1).


Table 16.1
Summary of the legislation about informed consent and surrogate designation in different countries











































































 
Competent patient

Incompetent patients

Advanced directives of treatment

Austria

Validity of self-assessment and decisional capacity

Validity of decisional power of a relative

Validity of living will and power of attorney

Belgium

Validity of self-assessment and decisional capacity

Validity of decisional power of a relative

Validity of living will and power of attorney

Bulgaria

Validity of self-assessment and decisional capacity

Validity of decisional power of the closest relative

No legal availability of living will and power of attorney

Denmark

Validity of self-assessment and decisional capacity

Validity of decisional power of a relative or friend

Validity of living will and power of attorney

Finland

Validity of self-assessment and decisional capacity

No possibility to appoint a surrogate. Consultative role of relatives

Still debating

France

Validity of self-assessment and decisional capacity

Consultative role of relatives

Consultative role

Germany

Validity of self-assessment and decisional capacity

Validity of designed surrogate. Lacking this, consultative role of relatives

Validity of living will and power of attorney

Hungary

Validity of self-assessment and decisional capacity

Validity of decisional power of a proxy

Validity of living will and power of attorney

Italy

Validity of self-assessment and decisional capacity

No possibility for patients to appoint a surrogate. Only a judge may appoint a support administrator

No legal availability of living will and power of attorney

The Netherland

Validity of self-assessment and decisional capacity

Consultative role of relatives

Validity of living will and power of attorney

Norway

Validity of self-assessment and decisional capacity

Consultative role of proxy

Legal authority still debating

Spain

Validity of self-assessment and decisional capacity

Validity of decisional power of a relative

Validity of living will and power of attorney

Switzerland

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May 4, 2017 | Posted by in CRITICAL CARE | Comments Off on Clinical Practice of Informed Consent for Percutaneous Tracheostomy

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