Physicians’ perspectives on patient preferences and advance directives in England and France: other countries, other requirements?
Since the Nuremberg Code (1947), international attempts have been made to strengthen patient rights and autonomy by focusing on the requirement of free and informed consent for medical treatment or participation in research. In the same way as a patient can chose to consent to a medical intervention, he or she can chose to refuse treatment. The 1997 European Convention on Human Rights and Biomedicine, which came into force in 1999, specified that a patient can withdraw consent at any time (article 5). Furthermore, article 9 of the Convention stipulates that, where a patient has lost competence, the physician should take into account previously expressed wishes and preferences with regard to medical treatment. Although the Convention considers previous wishes not to be legally binding, the Council of Europe in 2009, and again in 2012, urges all member states to adopt legislation on previously expressed and written wishes and preferences of patients, also called advance directives (ADs). Several European countries have adopted legislation on ADs which refuse treatment. However, depending on the value a country attributes to patient autonomy, ADs may be legally binding, or they have only advisory value.