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An important step in the promotion of patients' self-determination.

On 9 December 2009, the Council of Europe’s Committee of Ministers adopted the Recommendation (2009)11 on “continuing powers of attorney and advance directives for incapacity”.1 This document is of great relevance for the field of health law, as it represents an important step forward in the promotion of patients’ self-determination regarding medical care to be implemented in the event that the individual becomes incapacitated. Although the scope of the recommendation is actually much broader than health care, since it also covers decisions regarding welfare, and economic and financial matters, this commentary only focuses on those provisions that are relevant for health care issues. The key concept of the recommendation is clearly self-determination of incapacitated adults. This is not surprising, since the value today attached to advance directives responds to a growing commitment to patient autonomy. Furthermore, this tendency seeks to promote the well-being and dignity of patients by offering them a way to better deal with the burdens and diminishing benefits of aggressive medical treatments in situations of futility or very poor prognosis. It is worth remembering that advance directives may take three forms: a living will, a continuing power of attorney, or a combination of both. Living wills are (usually written) instructions that specify ahead of time what types of medical treatment are desired or not; lasting or continuing powers of attorney are documents which allow individuals to appoint someone to make health care decisions on their behalf and in their best interests should they become incapable of doing so themselves. Although in Europe it is still unusual to base clinical decisions on patients’ previous instructions, the situation has been changing during the last few years. An increasing number of countries are now realizing the value in promoting patients’ self-determination and enacting legislation on advance directives, in