It is an established fact that in human life, death is inevitable.

Ang kamatayan ay di maiiwasan. Ang buhay ay hindi cycle na paikot ikot kundi isang deretsong linya
point to point na magtatapos sa kamatayan.

Death will always come no matter what the time is or what the cause may be- be it an illness or disease,
old age or accident

Tandaan natin , a terminal illness is a progressive, irreversible illness that despite cure-focused medical
treatment will result in the patient’s death.

Despite this fact, most people have the difficulty of talking about matters of death and dying and the
concept of preparedness in terms of end-life medical care.

With this in mind, the concept of advance directive was introduced.

Advance directive is based on the principle that adults have the right to control their medical treatment
as long as they are mentally able to do so.

It is a legal document that allow people to communicate their decisions about medical care to family,
friends, and health care professionals in the event that they are unable to make those decisions
themselves-

for example, due to being unconscious or in a coma.

The two main types of advance directives are the living will and the medical power of attorney.

In the living will, people indicate what kind of medical care, especially life-sustaining care, they would or
would not like to receive if they become unable to speak for themselves.

The most common types of care that are addressed in a living will include the use of life sustaining
equipment and procedures.

Whereas in the medical power of attorney, it allows people to name another person to make decisions
about their medical care if they are temporarily or permanently unable to communicate or make these
decisions for themselves.

The scope of a medical power of attorney is not limited to choices at the end of life but also includes
decisions in other medical situations.

The document goes into effect when a doctor declares that a person is unable to make his-her own
medical decisions.

In the Philippine setting, the idea of having discussions about death is regarded as taboo pinagbabawal
at kinatatakotan and usually done in hushed tones.

Nevertheless, there will come a time when one will be faced such, albeit in different ways (Leido, 2012).

The Senate Bill No. 1887 of the Sixteenth Congress of the Republic of the Philippines entitled Natural
Death Act discusses the fundamental right of every adult to decide for their own health care including
their decisions to have life-sustaining treatments to be withheld or withdrawn in instances of a terminal
condition or permanent unconscious condition. Advance directives are seen as a concrete guide in
making decisions for a person who could no longer decide for himself by virtue of his condition.

Advance directives are written documents that allow the individual of sound mind to document

preferences regarding the end-of-life care that should be followed when the signer is terminally ill and
unableto verbally communicate his/her wishes. Thedocuments are generally completed in advance of

serious illness, but may be completed after a diagnosisof serious illness if the signer is still of sound
mind. Themost common types are the durable power of attorneyfor health care and the living will [1].

The concept of advance directives is related to ethical, legal and cultural considerations of patients’

rights and determinations about their end-of-life careand treatment. Studies showed that advance
directivescan help to improve patient’s autonomy, end-of-lifecare and treatment, grief and
bereavement processabout death and dying

Advance directives are important but often underused tools in critical care. Healthcare professionals'
understanding of how culture influences attitudes toward advance directives can improve knowledge
and completion of these documents.

Attitudes of critically ill Filipino patients and their families toward advance directives

Jennifer L McAdam 1, Nancy A Stotts, Geraldine Padilla, Kathleen Puntillo

Overall attitudes toward advance directives were positive; however, the completion rate and knowledge
of advance directives were low. Participants may have been saying what they thought the researcher
wanted to hear in order to avoid disagreement. Such behavior could partly explain the positive attitudes
of the Filipino Americans toward advance directives. Further research is warranted to understand how
to increase completion rates for advance directives among Filipino Americans.

However, by the late 1980s, public advocacy groups became aware that many people remained
unaware of advance directives[17] and even fewer actually completed them.[18][19] In part, this was
seen as a failure of health care providers and medical organizations to promote and support the use of
these documents.[20] The public's response was to press for further legislative support. The most recent
result was the Patient Self-Determination Act of 1990,[21] which attempted to address this awareness
problem by requiring health care institutions to better promote and support the use of advance
directives.

Durable power of attorney and healthcare proxy Second generation advance directives

As before, the next generation advance directive was drawn from existing law – specifically from
business law. Power of attorney statutes have existed in the United States since the days of "common
law" (i.e., laws brought from England to the United States during the colonial period).[29] These early
powers of attorney allowed an individual to name someone to act in their stead. Drawing upon these
laws, "durable powers of attorney for health care" and "healthcare proxy appointment" documents
were created and codified in law, allowing an individual to appoint someone to make healthcare
decisions in their behalf if they should ever be rendered incapable of making their wishes known

Australia

The laws regarding advance directives, powers of attorney, and enduring guardianships vary from state
to state. In Queensland, for example, the concept of an advance health directive is defined in the
Powers of attorney act of 1998 and Guardianship and Administration act of 2000.

In 2008, The Advance Care Planning in Canada: A National Framework and Implementation Project was
founded.[79] The goal was to engage healthcare professionals and educate patients about the
importance of advance care planning and end of life care.

In England and Wales, people may make an advance directive or appoint a proxy under the Mental
Capacity Act 2005

On 18 June 2009in Germany the Bundestag passed a law on advance directives, applicable since 1
September 2009. Such law, based on the principle of the right of self-determination, provides for the
assistance of a fiduciary and of the physician.

On 14 December 2017, Italian Senate officially approved a law on advance healthcare directive that
came into force on 31 January 2018

Japan

Advance healthcare directives are not legally recognized in Japan

Israel

In 2005, the Knesset passed a law allowing people to write advanced care directives. Right to refuse care
is only recognized if the patient is considered terminally ill and their life expectancy is less than six
months.[97]

In the US Uniform Rights of the Terminally Ill Act.

On July 28, 2009, Barack Obama became the first United States President to announce publicly that he
had a living will, and to encourage others to do the same. He told an AARP town meeting, "So I actually
think it's a good idea to have a living will. I'd encourage everybody to get one. I have one; Michelle has
one. And we hope we don't have to use it for a long time, but I think it's something that is
sensible."[112] The announcement followed controversy surrounding proposed health care legislation
that included language that would permit the payment of doctors under Medicare to counsel patients
regarding living wills, sometimes referred to as the "infamous" page 425.[113] Shortly afterwards,
bioethicist Jacob Appel issued a call to make living wills mandatory

India

Supreme Court of India on March 9, 2018 permitted living wills and passive euthanasia. The country's
apex court held that the right to a dignified life extends up to the point of having a dignified death
best known third-generation advance directive is the Five Wishes directive.[54] This document was
developed in collaboration with multiple experts with funding from the Robert Wood Johnson
foundation,[55] and is distributed by the organization Aging with Dignity. The document was endorsed
by Mother Teresa of the Sisters of Calcutta and by the Chief Justice of the Florida state supreme court.
[citation needed] The document meets statutory criteria in 42 state