Testamento Vital e Boa Prática Médica

Abstract

Background - The Advance Healthcare Directives, though legislated, are a subject of intense debate. In this context we have taken into account the Living Will in order to understand its applicability in the presence of a Good Medical Practice, in a bioethical perspective, exposing the conflict resulting from its application, and analysing its existence in legal terms. Methods - A national and international literature search was carried out, namely of scientific literature through the PubMed and ClinicalKey. Other documents such as monographs, conventions, legal opinions, reports and legal documents were consulted. Results - We emphasized the reflection on the normalization and ethical foundation of clinical action at the end of life, as well as on the autonomy vs beneficence conflict. We have given special attention to aspects of the Good Medical Practice and to the possible juridical non-existence of the Living Will when in the presence the Good Medical Practice and the leges artis. We have highlighted some clinical situations such as artificial nutrition and hydration, refusal of reanimation, palliative sedation and pain palliation, as well as the need for empowerment for an informed decision. Conclusions - The legislation, according to the analysis made, does not empower the patient to make a conscious decision about the end-of-life care, thus depriving it of legitimacy. Likewise, the Living Will can easily prove to be legally non-existent. We conclude that there should be continuous follow-up and empowerment of the patient, as part of a doctor-patient relationship, seeking to achieve the patient's good, according to his expectations and wishes, endorsed by a Good Medical Practice.