Protect elderly from ‘subtle coercion’ when drafting living wills – academics
Academics warn that end-of-life decisions cannot be reduced to 'legalistic application of written instructions'
University academics and senior clinical staff are calling for stronger safeguards against "subtle coercion" when elderly people are drafting living wills.
In a position paper on the government’s proposed Advanced Medical Directives Act, the academics argue that the introduction of a trusted proxy provides a more flexible and ethically robust safeguard than a static living will.
The proposed law will allow terminally ill patients to make decisions about the care they want to refuse if they are unconscious.
This legally binding “living will”, or advanced medical directive, will need to be authorised by a notary to be enforced.
The academics warned that decisions taken at the end of life “cannot be reduced to a legalistic application of written instructions”.
A proxy, they note, can interpret a patient’s wishes in light of unforeseen medical circumstances, which a document drafted years in advance may not adequately anticipate.
They further warned that vulnerable people, particularly the elderly, can be susceptible to “subtle coercion” when drafting directives.
The position paper says that the exclusion of a durable power of attorney for healthcare from the proposed legislation is an omission that causes “significant ethical and clinical gap”.
They welcomed the intent behind the proposed legislation, saying advance medical directives are a vital tool for safeguarding patient dignity at the end of life, supporting families navigating complex decisions, and offering legal clarity to healthcare professionals.
However, they stressed that such directives must be applied within a broader ethical context.
“Decisions at the end of life cannot be reduced to a legalistic application of written instructions,” the paper states. “Advance directives must be interpreted within a broader ethical framework grounded in prudence, proportionality of treatment, and respect for human dignity.”
The paper also examines the clinical and ethical complexities surrounding artificial nutrition and hydration (ANH), highlighting that different medical contexts - including reversible conditions, chronic illness and the final stages of dying - require distinct ethical assessments rather than a uniform rule.
Apart from the proposal to bolster safeguards for the elderly when drafting such directives, the position paper advocates the introduction of clinical ethics consultation services, enhanced palliative care infrastructure, the inclusion of a conscience clause for healthcare professionals, and clearer procedures for assessing mental capacity.
The authors say that advance medical directives can serve as compassionate and ethically responsible instruments for end-of-life care, but only when supported by a legislative framework that prioritises dignity, solidarity and sound clinical judgement.
The position paper has been submitted to all Members of Parliament and stakeholders.