Friday 27 January 2023

Advance Directives Law: The new declaration to tell doctors how I wish to die

Law will allow Costa Ricans to issue a document to anticipate if they do not want to undergo certain medical treatments, in case of accidents or serious irreversible illnesses

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27 January 2023 - At The Banks - BCCR

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QCOSTARICA – In the event of an accident or sudden serious illness, through a prepared medical statement, a person can request not be connected to machines to prolong life or undergo painful medical procedures with the approved law “Ley de Voluntades Anticipadas” (Advance Directives Law).

In that same document, people may also request, to the contrary, to be subjected to extraordinary medical procedures to try to stay alive, in the most critical moments of their internment in hospital.

Independent legislator Paola Vega, proponent of the bill “Ley de Voluntades Anticipadas” (Advance Directives Law)

In neither extreme, does it authorize euthanasia in Costa Rica. However, it does authorize orthothanasia in Costa Rica.

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The initiative, proposed by independent legislator Paola Vega in July 2019, was approved in second and final debate on Tuesday, by a large majority (36 in favor and 4 against).

“There a person expresses in advance what happens if they enter a state of health where they cannot make decisions about treatments such as transfusions, such as remaining connected to an artificial respirator for a long time.

“It does not authorize euthanasia but to avoid painful clinical treatments such as therapeutic ridicule, which is when a lifeless person is subjected to being connected against their will for a long time, for example, that for religious reasons they do not accept,”Vega explained.

The law clarifies that these advance directives will not be applied in four scenarios:

a) When the declaring person has the capacity to express by any means his/her will to annul the declaration of advance directives. In these cases, the person’s statement will prevail over the provisions contained in the declaration of advance directives.

b) When they are contrary to the legal system, to the best medical practices or those that do not correspond to the assumption of fact that the declaring person has foreseen at the time of manifesting them. In these cases, a reasoned record will be left in the clinical history through the corresponding annotations. The declaring person or their relatives will be informed in writing if they so request.

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c) When the advance directive entails the omission of a medical procedure that poses a risk to public health, as in the cases of prevention, control and treatment of communicable diseases, radioactive contamination or others, as provided by the Ministry of Health or the General Health Law, or in exceptional or emergency situations provided for in the Costa Rican legal system, in which public health, the common good and the rights of third parties prevail.

d) In the care of a medical emergency, which leads to the application of the clinical procedure, immediately, with the real impossibility of verifying the advance will of the person, or requesting the respective informed consent from their representative.

Independent legislator Shirley Díaz, who had voted in favor the previous week in the first debate, voted against it on Tuesday, assuring that a person can sign that will, but then change their mind without having the opportunity to express it.

Partido Liberacion Nacional (PLN) legislator Roberto Thompson, also pointed out that “under no circumstances can such a declaration be understood or interpreted as some type or form of euthanasia”, referring to the vote in the second debate.

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The legislator explained that “the purpose of the initiative is to guarantee the right of people, in full use of their faculties, to express their will in advance with respect to medical interventions that are required to be carried out to safeguard the life of the person or functions of their body, by a health team, through their free and voluntary manifestation, which will be indicated in writing in a declaration of advance directives, so that it is respected in situations in which they cannot express it.”


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