The Cayman Islands has implemented the Health Care Decisions Law, 2019 (the “Law”) which allows a mentally competent individual to issue an advanced health care directive (a “directive”). The directive should provide instructions about the nature and extent of medical care should the person become mentally incompetent. It can include consent or refusal for medical procedures and treatments such as cardiopulmonary resuscitation, being placed on a ventilator, or use of a feeding tube.
The paramount principle of the Law is that all questions pertaining to a person’s best interest and their corresponding health care are ultimately the responsibility of that person’s registered medical practitioner(s). A registered practitioner’s ability to determine the health care a person receives will only be superseded where:
- An individual has instructed the denial of his health care in an operative directive;
- The maker of a directive has delegated the decision to another person (a “proxy”); or
- An order is made under the Law that health care is to be denied or such other order with like effect.
The Law provides that an advanced health care directive shall be made by:
- Completing the relevant parts of the form in the Schedule to the Law and following the instructions contained in the form;
- The directive-maker signing the form personally in the presence of two adult witnesses (one of whom must be a doctor that is satisfied that the person is mentally competent and is freely making the direction and understands its nature and consequences); and
- Both witnesses signing the form.
A person being appointed as a proxy in the directive may not be a witness. Neither may a beneficiary or spouse of a beneficiary of the directive-makers’ estate or person with an interest under the directive, be a witness.
The Law does not affect the functions of registered practitioners for the giving of palliative care or a person’s right to receive palliative care. The Law specifically states that it does not authorize euthanasia or assisted suicides.
There is provision for the recognition by health care professionals of directives executed in certain specified jurisdictions other than the Cayman Islands.
While it can be difficult for an individual to consider becoming incapacitated and no longer being able to make health care decisions, many find comfort in being able to retain some autonomy through a directive. A directive can open helpful dialogue with an individual, ones medical practitioners and those close to the directive-maker thereby minimizing the potential for difficulties should the time come when one is no longer competent to decide the medical treatment one would wish to receive.