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EP01.013 Mapping the regulatory state of advance directives in Latin America: lessons learnt
  1. Natália Rocha Tardelli1,
  2. Fernanda Bono Fukushima2,
  3. Alex Sander Watanabe Palácio1,
  4. Daniel Neves Forte3,
  5. Rasa Mikelyte4,
  6. Marco Antônio Carvalho Filho5,
  7. Leonardo de Andrade Rodrigues Brito6,
  8. Manuel Ivan Cobas Rodríguez7 and
  9. Edison Iglesias de Oliveira Vidal1
  1. 1São Paulo State University (Unesp), Botucatu Medical School (FMB), Department of Internal Medicine, Botucatu, Brazil
  2. 2São Paulo State University (Unesp), Botucatu Medical School (FMB), Department of Surgical Specialties and Anesthesiology, Botucatu, Brazil
  3. 3Faculdade de Medicina da Universidade de São Paulo (FMUSP), Department of Intensive Medicine, São Paulo, Brazil
  4. 4University of Kent, Centre for Health Services Studies, Canterbury, UK
  5. 5University Medical Center Groningen, Wenckebach Instituut voor Onderwijs en Opleiden (WIOO), Groningen, Netherlands
  6. 6Hospital Israelita Albert Einstein, Abram Szajman Education and Health Center, São Paulo, Brazil
  7. 7Instituto de Bioética Juan Pablo II, La Habana, Cuba


Background Advance Directives (AD) are a strategy developed in high-income countries to achieve goal-concordant end-of-life care. However, it is unclear how AD have been regulated and implemented in the context of Latin American (LA) countries. We aimed to map the current regulatory state of AD in LA, which is important for the development and refinement of Advance Care Planning (ACP) initiatives in the region.

Methods We contacted all existing national palliative care associations from 20 LA countries and asked them to appoint a key informant for this research. We conducted 18 online semi-structured interviews with informants from 18 different LA countries.

Results Only Argentina, Brazil, Colombia, Costa Rica, Mexico, Panama, and Uruguay have AD regulations. In Colombia and Brazil those regulations do not take the form of laws but of resolutions by other institutional bodies related to healthcare. Costa Rica was the only country where a large part of the population prepares for the end of life by sharing their preferences of care with healthcare professionals and their families. That success story was not attributed to its very recent legislation on AD but to the longstanding integration of palliative care in their healthcare system. Brazil is the only country where AD were regulated strictly within the patient-physician relationship. In only three of the 7 countries with AD regulations, healthcare professionals feel legally secure to honour patients’ preferences documented in an AD and in none of them there is sufficient training in that area.

Conclusions Few LA countries have specific AD regulations and even where regulations exist, healthcare professionals often do not feel secure honouring patients’ preferences of care documented in those documents. Our findings suggest that the development of ACP in the region must go beyond AD legislation and involve the implementation and strengthening of palliative care within healthcare systems.

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