Advance Directives

When will an advance directive be carried out?

In general, a patient’s advance directive will be carried out when he or she is terminally ill, in a state of irreversible coma or in a persistent vegetative state. The above three medical conditions should be confirmed and certified by at least two doctors before any directive applicable in those conditions can take effect.

In those circumstances, your family, your doctors and you may need to judge if certain treatments have become futile. On this, doctors not only need to judge if those treatments are physiologically futile but also balance the burdens the treatments will put on you against the benefits of the treatments to you. The decision-making process for balancing the burdens against the benefits to the patient should be a consensus-building process between the healthcare team and the patient and family. In balancing the burdens against the benefits to a patient, factors to consider include but are not limited to:

  1. clinical judgments about the effectiveness of the proposed treatment;
  2. the likelihood of irreversible loss of consciousness;
  3. the likelihood and extent of any degree of improvement in your condition if treatment is provided;
  4. whether the invasiveness of the treatment is justified in the circumstances;
  5. your known values, preferences, culture and religion which may influence the treatment decision; and
  6. Information received from those who are significant in your life and who could help in determining your best interests.

The decision of withholding or withdrawing life support should have sufficient participation from you, if possible, and your immediate family members and they should be provided with full information relating to the circumstances and the doctors’ recommendations. In case of conflict, your right of self-determination should prevail over your family members’ wishes.