Advance directives as autonomy enhancers: reality or myth?

Ponència presentada al Congreso Internacional "Multiculturalism and Health", celebrat al Parc Científic de Barcelona, el 17 de març de 2006, organitzat per la European Association of Global Bioethics i l'Observatori de Bioètica i DretIn the last few decades there has been a wealth of literature and legislation on advance directives. As you all know, it is an instrument by which a person can express their wishes as regards what treatment they should be given or, more to the point, not to be given, when he is in a situation when he can not do so himself. Regulations in the western world seem to promote advance directives as a way to enhance patient¿s autonomy in the context of human rights, and the media has presented advance directives as another milestone in this era of selfdetermination. However, if we look closely at some of those regulations we will see that there are a few elements which may undermine their efficacy, shattering this nicely presented picture. I will focus on two elements. First, formal requirements, and secondly, certain limits or what I like to call "escape clauses"