Karşılaştırmalı Bir Bakış Açısıyla İleriye Dönük Hasta Direktifleri ve Türk Hukuku İçin ÖnerilerGökçe Kurtulan Güner
Nüfusun yaşlanması ve ortalama yaşam süresinin uzaması ve bunlara paralel olarak toplumda ileride ayırt etme gücünden yoksunluğa sebep olabilecek psikiyatrik hastalıkların görünürlüğünün artması beraberinde toplumsal değişikliklerin yanı sıra birtakım hukuki gelişmeleri de getirmiştir. Bu doğrultuda kişilerin kademeli olarak karar verme yetilerini kaybetmeleri riskine karşı yasa koyucuların ve öğretinin daha geniş kapsamlı bir hukuki koruma arayışına girmesi söz konusu olmuştur. Bu çalışmanın konusunu, kişilerin karar verme yetilerini kaybettikleri zaman uygulanması için hazırladıkları ve ileriye dönük hasta direktifleri (advance healthcare directives) olarak anılan düzenlemeler oluşturmaktadır. Bu doğrultuda, öncelikle hem yönlendirici direktifleri hem de süregelen temsil yetkisini içine alan bir çatı kavram olarak kullanılan ileriye dönük hasta direktifi kavramının ortaya çıkışı ve karşılaştırmalı hukuk alanında bu yönde yaşanan gelişmeler incelenmiştir. Ardından bu tür düzenlemelerin bağlayıcılığına ilişkin herhangi bir kurala sahip olmayan Türk hukuk sistemindeki durum değerlendirilerek de lege feranda önerilerde bulunulmaya çalışılmıştır.
Advanced Healthcare Directives From a Comparative Perspective and Proposals for Turkish LawGökçe Kurtulan Güner
As a result of the aging population and the improvement in average life expectancy, the visibility of psychiatric diseases causing loss of mental competence has considerably increased. The aging population presently enjoys expanded options in social life and improved support within the legal system. These positive changes resulted from the combined effort of the academic and legislative bodies toward finding ways to support patient autonomy and self-involvement in decisionmaking in case of loss of mental competence. This article focuses on the regulations, known as the advance healthcare directives, prepared for application when a drafter loses mental capacity. The genesis of this concept and efforts toward its adoption are discussed and analyzed from a comparative lens. This study examines advance healthcare directives in a wider sense, including instruction directives and durable powers of attorney. As Turkish law lacks a legal rule providing for bindingness for these kinds of dispositions, certain de lege ferenda proposals in line with the comparative findings have been proposed at the end of this paper.
The aging population is considered one of the most significant demographic megatrends, along with overpopulation, immigration, and urbanization. According to the United Nations Economic and Social Council report in 2019, one out of every 11 individuals is over 65 years old, and the ratio is estimated to be 1:6 by 2050. Another report highlights that Turkish people over 65 years constitute between 5–10% of the entire population. This percentage will likely increase to 25–30% by 2050. Although the aging population trend is per se a great success for humanity, certain problems follow this current trend.
As a result of the aging population and rise in the average life expectancy, the visibility of psychiatric diseases causing loss of mental competence has considerably increased. According to the World Health Organization, 20% of individuals over 60 years cope with some kind of mental or neurologic condition, particularly dementia or depression. As a result, adjustments were made to social life and legal support systems. These changes are attributed to a combined effort of academic and legislative bodies toward finding ways to support patient autonomy and self-involvement in decision-making in case of loss of mental competence. This article discusses and analyzes these efforts from a comparative lens.
This paper examines the concept of advance healthcare directives in a wider sense, including instruction directives and durable powers of attorney. First, we analyze the genesis and development of advance healthcare directives in the United States, as the concept was introduced in Europe more recently. In order to have a general look over the European systems, we examine the Article 9 of the Oviedo Convention and the Recommendation (2009)11 of the European Council. Next, we scrutinize recent developments in Germany, France, Austria, Switzerland, and Italy, to critically examine the commonalities and differences between the choices made in the respective legal systems.
The concept of advance healthcare directives is almost unknown in Turkish law, unlike in the previously mentioned systems. One reason is the continued dominance of the paternalistic approach toward the patient–doctor relationship. The other reason is the lack of a legal rule rendering these kinds of dispositions binding. Although it is possible to offer a validated mandate for the condition of loss of mental capacity, the content will be sensitive due to disputes on whether “highly personal” decisions can be made through a representative. The second reason is the role of the guardian. Unlike German or Austrian law, legal representation is not a subsidiary or secondary legal institution in Turkish law. Therefore, although an advance directive gets drafted, it may be revoked by the guardian if deemed necessary, even if it is related to matters that are not considered highly personal (such as asset administration). Considering the recent developments in the United States and certain European countries, while keeping in mind Turkish ratification of the Oviedo Convention, a swift change in policy regarding the concept of advance health care directives would not be a surprise. To support this change, certain de lege ferenda proposals for Turkish law, in line with the comparative findings, have been proposed at the end of this paper.