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Why have Advance Directives failed in Spain?

Benjamín Herreros1,2, María Benito3, Pablo Gella4

  • 1Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid, Madrid, Spain. benjaminherreros@gmail.com.

BMC Medical Ethics
|November 17, 2020
PubMed
Summary

Advance Directives (ADs) have failed in Spain due to low awareness, complex procedures, and a paternalistic medical culture. Strategies are needed to improve AD implementation and honor patient autonomy in end-of-life care.

Keywords:
Advance care planningAdvance directiveLiving will

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Area of Science:

  • Bioethics
  • Medical Law
  • Public Health Policy

Background:

  • Spain has made legislative efforts to implement Advance Directives (ADs) since 2002, coinciding with the rise of bioethics and patient autonomy discussions.
  • Despite these efforts, AD implementation in Spain is considered a failure due to low prevalence, lack of public knowledge, and minimal impact on clinical decisions.

Purpose of the Study:

  • To analyze and discuss the primary reasons behind the failure of Advance Directives (ADs) in Spain.
  • To identify barriers hindering the effective use of ADs in honoring patient autonomy.

Main Methods:

  • Qualitative analysis of factors affecting AD implementation.
  • Discussion of legal, ethical, and cultural barriers to AD utilization.

Main Results:

  • Key reasons for AD failure include inadequate training for health professionals on end-of-life care and ADs.
  • Lack of public awareness campaigns and complex bureaucratic procedures for AD documentation pose significant barriers.
  • Persistent paternalistic medical culture hinders shared decision-making, further limiting AD impact.

Conclusions:

  • Advance Directives have not effectively served as a tool for patient autonomy in Spain due to identified issues.
  • Despite challenges, both healthcare professionals and the public hold positive views towards ADs.
  • Developing targeted strategies is crucial to overcome identified problems and improve future AD implementation.