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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