Are U.S. Advance Directives/DNRs Valid in Europe?
 

Having reached the age when I have to consider these things, yet still intending to travel, I have to think about what sort of preparation and paperwork I should have when out of the country in case of medical emergency. I've looked on line, but it is not clear to me if the Advance Directives, DNRs, Living Wills, and Durable Powers of Attorney, I have prepared in the States would be recognized in Europe and if I my spouse would need any additional documentation in order to make sure my wishes are carried out.

My dear wife has clear instructions on what to do if I fall over in the street; step on my neck, but I worry that if I end up a veggie in a hospital I may have things unnecessarily prolonged due to lack of some stupid piece of paper.

Can anyone give me insights on whether U.S. Advanced Directives (directions anticipees?) are considered valid by the French medical community (since that is where my next trip will be) and if the Durable Power of Attorney designating my wife (who has a different last name) as my Health Care Surrogate (personne de confiance?) would be able to insist that the plug be pulled/

I should think you would need to have your DNR translated into French, then have the directive anticipée signed and dated in front of a notaire (who would presumably also verify the translation).

http://fr.wikipedia.org/wiki/Directive_anticip%C3%A9e

I don't know about all the attorney powers, but designating a personne de confiance in France isn't difficult, you can do it yourself when you get there, if you want. But I would expect them to honor that if you have it in writing and it makes sense. Because that's all you need, a statement in writing as to whom you are designating, and dated and signed by you. The person has to be legally an adult and accept it. So I don't see a problem.

Of course you could do it at the beginning of a hospitalization, on the spot, the hospital can give you a form, but it sounds like you are afraid you won't be conscious.

I don't know French law, these are just my thoughts from what I've read on the subject, in French and under French law.

Look at the one on this page, it is simple. http://www.prochedemalade.com/inform...nfiance.aspx#4

Here is a blank form for "Directives anticipées" which must be handwritten, dated (they are valid 3 years) and signed.
There is absolutely no need to see a notaire.

Je soussigné(e), (Nom de naissance ou d’épouse, prénom) : .................................................. .................................................. ...................................
.................................................. .................................................. .................................................. .................................................. .................................................. .
née (Nom de jeune fille) : .................................................. .................................................. .................................................. .................................................. .
le (date de naissance) : .................................................. ..... à (lieu et pays de naissance) : .................................................. .............................................
Adresse : .................................................. .................................................. .................................................. .................................................. ..............................
.................................................. .................................................. .................................................. .................................................. .................................................. .
Courriel : .................................................. .................................................. ........................ @ .................................................. ..................................................
Téléphones : .................................................. .................................................. .................................................. .................................................. .....................
déclare rédiger ce document en toute liberté, sans pression extérieure et en pleine possession de mes facultés.
Si je me trouve hors d’état d’exprimer ma volonté à la suite d’une affection incurable quelle qu’en soit la cause,
ou d’un accident grave entraînant une dégradation irréversible de mes facultés,
JE DEMANDE :
 qu’on n’entreprenne ni ne poursuive les actes de prévention, d’investigation ou de soins qui n’auraient pour
seul effet que la prolongation artificielle de ma vie (art L. 1110-5 du code de la santé publique), y compris
pour les affections intercurrentes.
 que l’on soulage efficacement mes souffrances même si cela a pour effet secondaire d’abréger ma vie (art
L. 1110-5 du code de la santé publique).
 que si je suis dans un état pathologique incurable et que je suis dans des souffrances intolérables, je puisse
bénéficier d’une sédation terminale, comme l’autorise l’article L. 1110-5 du code de la santé publique.
 que s’il n’existe aucun espoir de retour à une vie consciente et autonome, l’on me procure une mort rapide
et douce.
 autres précisions personnelles .................................................. .................................................. ...........................


And here is the form to designate a personne de confiance :
http://www.sfap.org/pdf/formulaire_p..._confiance.pdf

Be careful in the Netherlands where euthanasia is legal and I believe can be decided by a panel of doctors!

Thank you both for your replies; both were very helpful and led me to do more searching on line. What I found was that while the DNR (Do Not Resuscitate order) does not seem to exist in France, per se, the Advanced Directive (AD) does. It was only recognized in law in 2005, and is not very prevalent, but does come into play.

The main difference between the application of an AD in the two countries, according to a comparative study, seems to be that in the U.S. the physician is much more likely to follow the wishes of the patient, as expressed in the AD, than the wishes of the family, if they differ. In France, the physician is more likely to follow the wishes of the family.

From all of this it seems that my best course is to write out a "personne de confiance" assignment for my wife, have it translated and notarized, and have her take that with her when we next go to Paris. Then she can tell the hospital to step on my neck and go spend my insurance at LV and Dior.

In my admittedly not direct experience, since I am here alive and posting, doctors in some parts of Europe are more likely than doctors in the US simply to make a terminal/vegetative patient comfortable rather than to try to prolong life at any cost. This is a comfort in your circumstance but might terrify travelers of the "do everything" persuasion.

It's a good idea to make your wishes known, though I would suppose that there as here, your wishes aren't worth anything at all if the EMT's get to you.

It would be much simpler to copy the blank form here : http://www.sfap.org/pdf/formulaire_p..._confiance.pdf
to avoid translation and notary fees.

I responded before reading some of the other posters, so a belated thanks to all of you. Not a pleasant topic, but more important for some than what shoes to wear, or how much to tip.

Come to think of it, I had better thank you now. No way I could report back and tell you how well your advice worked.

:-)

<i>spend my insurance at LV and Dior.</i>

Monte Carlo would be more appropriate than LV when in France.

pal,
yes Euthanasia is legal here, but the request for it comes from the patient. It is not something a panel of doctors decides arbitrarily to apply to someone.
I suggest you read http://en.wikipedia.org/wiki/Euthana...he_Netherlands rather than spreading malicious and unfounded rumours.

Belgium and Luxembourg have similar systems, as does Colombia I believe. Some US states (Oregon for instance) have, like Switzerland, legalised assisted suicide.

France faces problems in this from the Catholic church. Interestingly the same church doesn't have a problem in the Benelux countries, or in Colombia.

Other countries have non-legal euthanasia, where a doctor gives an overdose of morphine to a dying patient.

FYI, Hetismij2, the State of Washington, where I live, also has a Right to Die law in effect.

The whole concept of having an Advance Directive is to ensure that the person's wishes with that directive are followed AS OPPOSED TO anyone else's INCLUDING some family member.

If a physician "is more likely" to follow a family's wishes then what is the point of the patient having an advance directive?

A practical thing to keep in mind - whatever document pertains (at home or when traveling) will be of no use unless it is available when needed. You would be amazed at the number of patients who say "yes, I have an AD" but when asked for a copy have no idea where it is located. If you cannot produce a valid copy then the treating providers will proceed as if it did not exist.

So, if you go to the trouble of executing the document, be sure to have a copy with you so it is available if/when needed. I suggest having an electronic copy that you email to yourself (as is sometimes suggested to do with a copy of one's passport) or have in a cloud based account like Google Drive in addition to having a copy in the care of a couple trusted relatives or friends. Not as good as having an original copy with a raised seal, but better then nothing.