Advance directives: how to write them?

You have a serious illness, you have thought carefully and you do not want to be resuscitated in case ofcardiac arrest. You are in good health, but you do not wish to be kept alive artificially in the event of coma irreversible after a serious traffic accident. You have the possibility to record your wishes in advance directives.

Definition of advance directives

Advance directives exist in many European countries. They appeared in France with the Léonetti law on April 22, 2005. Since February 2, 2016 (Claeys-Léonetti law), they are no longer only consultative but binding. This means that they prevail over the opinion of the spouse, parents or any trusted person previously designated.

Only adults can write advance directives. These should be written by the person themselves. The document must be dated and signed, with mention of the first name, last name, date and place of birth of the person. If it is impossible to draft it yourself, two witnesses must certify that the document is indeed the expression of the will of the person concerned. Persons under guardianship can also write advance directives, with the authorization of the judge or the family council.

Two models on the HAS website

On the site of the High Authority of Health (HAS), two models of advance directives are available:

• one for people who know they have a serious illness and who wish to express their wishes regarding their end of life, in case this is not possible one day;
• one for healthy people who wish to express their wishes in the event that they are victims of a serious accident or an acute pathology (Stroke, infarction …).

Advance directives can also be written on plain paper, the HAS form is not essential. It should be noted that the drafting of advance directives is not compulsory. They can be canceled or revised at any time.

In the case of a chronic pathology with risk of aggravation, it is recommended to be accompanied by your referring doctor. If advance directives are too waves and imprecise, they will be of no use when the time comes. The healthcare professional will explain to the patient the different possible situations, the possible treatments with their chances of success and their associated risks.

Content of advance directives

In the models of the HAS, formulations are proposed to help the person to consider the different situations and the associated treatments, in the event that these would have no other goal than to maintain life artificially, with no possible return. For example, the person has the opportunity to express themselves on the implementation of cardiopulmonary resuscitation in the event ofcardiac arrest and / or respiratory, on the establishment of a diet or hydration by artificial route in the event of a vegetative state, on intubation, on the establishment of a chronic dialysis … In all cases, comfort care will always continue to be administered.

The person also has the possibility of informing his wishes concerning his death: the place, the people present, the wish for cremation … Advance directives are also an opportunity to communicate on organ donation.

Once the advance directives have been drafted, the patient should give a copy to a trusted person. It is also ideal to give a copy to your doctor so that it is recorded in the medical file (and the shared medical file if there is one), available when the time comes.