Acknowledgement, therefore, of the possibility of enhancing the
value of the system of support administration by means of a mechanism
based on a prior nomination in terms of the implementation of
earlier decisions regarding treatment, does not exclude the fact that it
is preferable to lay down a systematic discipline on the subject which
guarantees full implementation of the principle of self-determination
in the field of health care, particularly in the light of the imperfect overlap
between the institution in question and the so-called living will.
For some authors,18 even the need for the directives and for the designation
of a fiduciary to be conveyed in a notarial act or in a stronger
form seems inappropriate: the absence of directives regarding property
and assets, the connection with the sphere of very personal rights and
the fact that the directives can be revoked or modified at any time
result surely in unfair burdensome formalities, making it seem preferable
that these directives are grouped in an original and signed statement
or declared by word of mouth to the health care staff and put in
writing by them. An ad hoc regulatory framework, as wished for by
many, for advance health care directives, may therefore take its place
in the legal system, while being assimilated within existing principles,
regulations and institutions, and providing an element of certainty for
the healthcare staff involved as well as a certified guarantee of the wishes of the individual concerned