Advance care planning in Spain. A short national report. Part I

Purpose: Ethical and legal recognition of patient autonomy and rights is a reality in Spain. Together with informed consent, advance directives and advance care planning have also played a major role in bringing about this situation. This paper aims to provide a description and critical analysis of their ethical and legal framework, concept, grounds, purpose and requirements under Spanish law, and to show that the appropriate way to understand and implement advance directives is to integrate them into the broader process of advance care planning, combining its legal, ethical and clinical dimensions.Materials and methods: Descriptions, arguments and conclusions presented in this paper are based on a review of legislation, case law and scientific bibliography. Conclusions: Spanish legal norms on advance directives represents a step forward in the consolidation of autonomy as a core of doctor-patient relationship and in the guarantee of patients, healthcare professionals and health institutions’ rights and duties. Moreover, it guides professionals and eases decision-making process in healthcare. Finally, it improves the quality, humanisation and justice of Spanish health system.