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Advance care planning in Spain. A short national report. Part II

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Seoane J.
Progress in Health Sciences
|
2015
|
vol. 5
|
issue 1
169-175
EN
Purpose: Ethical and legal recognition of patient autonomy and rights is a reality in Spain. Together with informed consent, advance directives and advance care planning have also played a major role in bringing about this situation. This paper aims to provide a description and critical analysis of their ethical and legal framework, concept, grounds, purpose and requirements under Spanish law, and to show that the appropriate way to understand and implement advance directives is to integrate them into the broader process of advance care planning, combining its legal, ethical and clinical dimensions.Materials and methods: Descriptions, arguments and conclusions presented in this paper are based on a review of legislation, case law and scientific bibliography. Conclusions: Spanish legal norms on advance directives represents a step forward in the consolidation of autonomy as a core of doctor-patient relationship and in the guarantee of patients, healthcare professionals and health institutions’ rights and duties. Moreover, it guides professionals and eases decision-making process in healthcare. Finally, it improves the quality, humanisation and justice of Spanish health system.
2
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Reframing Patient’s Autonomy in End-of-Life Care Decision-Making: Constructions of Agency in Interviews with Physicians

100%
Buscariolli A., Vesala K. M.
Qualitative Sociology Review
|
2021
|
vol. 17
|
issue 2
70-87
EN
In the research literature, critical viewpoints question the idea of patient autonomy as a robust basis for approaching end-of-life treatments. Yet physicians express distinctly positive attitudes towards patient autonomy and advance directives in questionnaire studies. In this article, we unravel taken-for-granted assumptions about the agency that physicians use when evaluating patient autonomy in end-of-life care. We use Goffmanian frame analysis to analyze semi-structured interviews with eight Finnish physicians. Instead of measuring standardized responses, we explore in detail how distinct evaluations of patient autonomy are made through approving or reserved stand-taking. The results show that the interviewees reframed patient autonomy with the help of biological, medical, ethical, and interaction frames. Through such reframing, the patient’s agency was constructed as vulnerable and weak in contrast to the medical expert with the legitimated capacity to act as an agent for the patient. Further, end-of-life treatment decisions by the patient, as well as the patient’s interests appeared as relationally defined in interactions and negotiations managed by the physician, instead of attesting the sovereign agency of an autonomous actor.
3
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Advance care planning in Spain. A short national report. Part I

100%
Seoane J.
Progress in Health Sciences
|
2015
|
vol. 5
|
issue 1
162-168
EN
Purpose: Ethical and legal recognition of patient autonomy and rights is a reality in Spain. Together with informed consent, advance directives and advance care planning have also played a major role in bringing about this situation. This paper aims to provide a description and critical analysis of their ethical and legal framework, concept, grounds, purpose and requirements under Spanish law, and to show that the appropriate way to understand and implement advance directives is to integrate them into the broader process of advance care planning, combining its legal, ethical and clinical dimensions.Materials and methods: Descriptions, arguments and conclusions presented in this paper are based on a review of legislation, case law and scientific bibliography. Conclusions: Spanish legal norms on advance directives represents a step forward in the consolidation of autonomy as a core of doctor-patient relationship and in the guarantee of patients, healthcare professionals and health institutions’ rights and duties. Moreover, it guides professionals and eases decision-making process in healthcare. Finally, it improves the quality, humanisation and justice of Spanish health system.
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