Patient advance care planning in end of life care: international data review

Abstract

Intensive care allows maintaining the vital functions of patients with irreversible brain damage for a long time. Under appropriate criteria, human death is determined by brain death, but most patients die after an undetermined period from the inevitable complications. Our legislation does not allow stopping futile treatment and letting a hopeless patient die naturally. In Russia, patient’s right to autonomy and self-determination is fulfilled through the informed consent or refusal to medical intervention. An adult comatose patient with a brain damage isn’t able to make this decision and sign the consent or refusal form, doesn’t have a Health Care Agent, and the medical council makes decision. In this situation, proper treatment is performed regardless of the prognosis. Even if the patient would prefer to die with dignity and comfort, his right to decide cannot be realized.In many countries of the world, there has long been a practice of the advance care planning in case the patient is unable to decide. A person signs advance directives, appoints a Health Care Agent for the medical decision-making. Based on the documented preferences of the patient and communication with his surrogate, doctors can limit the life-sustaining treatment for a hopeless patient and allow him to die. The presented analysis of international data provides basic information for the discussion of the possibility of advance care planning in our country.