[Bioethical principles: planning and advance directives in Puerto Rico]

Abstract

The libertarian principles of Personal Autonomy and Personalized Justice which grew mightily in the rapidly spreading young American democracy in the 18th and 19th centuries led to the development of Bioethics in the United States. The bioethical principles of Respect for Autonomy, Beneficence, non-Maleficence and Justice support the elaboration of advance directives (living will and the designation of a proxy to attend health matters) for when the patient is no longer capable to make health decisions. Advance directives can be drafted and signed in Puerto Rico with the help of a lawyer. They can also be legally prepared in a doctor's office or in a hospital if witnessed by a doctor and two persons who will not benefit from the patient's demise or are directly involved in his/her care). We present a model for advance directives which may be executed in a doctor's office or a hospital. The model fulfills the legal requirements of Puerto Rico Law 160 which became effective November 2001. It also fulfills requirements of the Patients Self-Determination Act that became effective in 1991.The document also contains standard options for organ donations. We discuss the fundamental bioethical principles which have given root to the development of the advance directives. We suggest that it may be economically advantageous to health insurance carriers to compensate physicians who help their patients in the execution of a valid document. The existence of this document may help prevent the large expenses associated with inappropriate admissions to intensive care of patients at the end-of-life.