Advance Directives for Medical Decisions
Costa Rica took an essential step in respecting people’s autonomy over their life regarding health care and medical treatment. In the second debate on April 26, 2022, Congress approved the bill Ley de voluntades anticipadas, allowing advance directives for medical decisions.
This law will become enacted once it is published in La Gaceta journal, but it will require government approval of the regulation within six months of the publication date.
This law allows people to express their will to dispose of their bodies when they undergo medical interventions to “safeguard the person’s life or the vital functions of their organism.” They do so by executing a document called “advance declaration of will.” In some countries, it is known as a “living will,” “vital will” or “advance directive for medical decisions.”
The exercise of this right will be held by any persons of legal age (18 years or older), with legal capacity, who can express their will clearly, freely and consciously.
The written document will specify the medical care they want or don’t want, including when the medical scenario becomes critical, and they become unable to communicate their will. Medical personnel, as well as relatives or guardians, must refer to and follow the patient’s advance declaration of will or directives for medical decisions.
Questions for better understanding
Who can execute advance directives?
Any person of legal age, with legal capacity, who can express their will clearly, freely, and consciously.
What can be disposed of in advance directives?
The content of advance directives will vary depending on an individual’s detailed medical history and moral and spiritual beliefs. Advanced directives can include, among others:
- Disposition about the treatment of diseases the person already has or others that could eventually appear
- Preferences for other medical decisions such as treatments near the end of life, palliative measures in case of terminal disease, organ donation and blood transfusions
- Designation of a healthcare executor (representante sanitario) and two substitutes
How can the advance directive be executed?
The new law provides three options for executing it:
- Before a CR notary public, plus two witnesses
- Before at least two healthcare workers (doctors, nurses, or clinical psychologists), plus two witnesses
- Before one clerk from the National Registry of Advance Declaration of Will, plus two witnesses
The witnesses shall be of legal age, with legal capacity, and not family-related to the grantor by marriage, free union or de facto union, or related up to the second degree by consanguinity or affinity.
All public and private health centers must provide the necessary measures for exercising this right. Said declaration will be kept in the clinical file with confidentiality and protected by the terms established in Law N° 8968, the Costa Rican Personal Data Protection Law.
Can the advance directive be modified, and must it be updated?
At any time, the advance directive can be modified, revoked or updated. However, the law establishes that the advance declaration of will must be updated every five years to verify if what was stipulated remains valid or if there are medical advances in treatments.
What is expressly prohibited by the law?
This law contains an express prohibition of euthanasia, stipulated in sections one and twelve. Euthanasia remains prohibited and is an illegal practice in Costa Rica.
What are the limitations of advanced directives?
Section four of the law outlines the limitations of the advance directives, among them: any containing actions prohibited by laws or against the best medical practices, or when the advance directives suppose an omission of a medical procedure that puts public health at risk (highly contagious diseases, radiation, etc.).
It is essential to understand the legal implications of this new law. We will keep you informed in the future articles. We are at your service at email@example.com