DAT (“Disposizioni Anticipate di Trattamento”, “Advance health care directives”): a case-study as a clinical, legal and bioethical reflection on their observance

Advance health care directives (in Italian DAT, “Disposizioni Anticipate di Trattamento”) have been present in Italy since 2018. With this instrument, a person of legal age and capable of mental capacity can express in advance his or her position regarding the consent or refusal of diagnostic and therapeutic treatments in case of later incapacity of self-determination. This is therefore a significant obligation for physicians assisting a person who is no longer able to express a valid consent or dissent independently, but who has in the past recorded this will in a legally valid form. In this clinical case we analyze the situation of a Patient with severe cognitive decline and terminal oncological pathology in a palliative perspective, in which the attending physician identified a possibile conflict between “advance health care directives” and a more recent nomination of a different legal administrator of health care needs and decisions. The case was resolved with an urgent decree of the court of reference, which confirmed the priority of “advance health care directives”, decided by the Patient when she was able to express herself independently. The specific case can be analyzed as a bioethical and legal reflection.