Law of advance directives in Costa Rica: benefits and limitations for people with terminal illnesses from the Palliative Care approach

Abstract

Introduction: Diseases in the terminal phase lead to death in a variable time, are progressive and cause intense symptoms. Palliative Care contributes to maintaining or improving quality of life at this stage. Having an Advance Directive Document for the assistance of the interdisciplinary team in Palliative Care, in charge of the intervention of these people with this type of pathology, will allow us to know and respond to the set of needs that arise during the process of the disease and end of life. Objective: Analyze the benefits and limitations of the advance directives law in Costa Rica, for people with terminal illnesses from the Palliative Care approach.   Methodology The descriptive study included a qualitative literature review and two conferences on Advance Wills, given in 2022. Search engines such as Google Scholar and PubMed were used. 21 articles were analyzed between 2017 and 2023, classified according to Sackett's level of evidence: V (17), IV (3), and III (1). Results: Advance Directives contribute significantly to the philosophy of Palliative Care by allowing people to make decisions about their treatment, thus ensuring dignified and respectful care. VA law in Costa Rica respects people's autonomy, avoiding euthanasia and ensuring that their wishes are carried out even when they can no longer express them. This relieves the decision-making burden on families/caregivers and professionals, improves quality of life by avoiding unwanted treatments, and can reduce medical costs. However, the effectiveness of the law is limited by the lack of awareness and the need to strengthen its implementation and education. Conclusions: The advance directives law in Costa Rica can improve end-of-life care by respecting patient autonomy, but it is crucial to enhance education and implementation to maximize its benefits.