Background The Law 219/2017, entered into force on January 31, 2018, regulated for the first time advance directives (ADs) and advance care planning (ACP) in Italy. We aimed to examine main legal differences between ADs and ACP according to this law.
Methods The Law 2019/2017 was analyzed, and relevant differences between ADs and ACP were described.
Results ADs and ACP differed mainly with regard to subjects involved, legal formalities required, and the healthcare professionals’ duty to respect the patient’s will. ADs may be made by mentally competent adults through notarization or delivery to a municipal office or to a health facility with electronic health record database structure; ADs are, in principle, binding for physicians, but the physician, in agreement with the healthcare proxy, may go against the patient’s will in some circumstances. On the other hand, ACP may be carried out by the patient and the physician with regard to the expected trajectory of a chronic disabling disease or a progressive illness with a poor prognosis; there are no particular legal formalities for establishing the ACP, which should be included in the patient record; ACP is always binding for both the physician and the healthcare staff members.
Conclusion(s) The Italian Law 219/2017 set up a binary approach to guaranteeing patient self-determination in the case of lack of decision-making capacity, establishing the primacy of the ACP carried out with the physician when patients’ outcomes are already predictable.
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