Why now is the time to think about your medical advance directive.
September 29, 2026Author: Dana Kweekel
Why now is the time to think about your medical advance directive.
In August, 2026, participants gathered at the White & Yellow Cross Care Foundation (WYCCF) for a Café Lecture on Advance Care Planning under the theme ‘Let’s Start the Conversation’ jointly organized by the WYCCF and St. Maarten Medical Center (SMMC). The meeting brought together healthcare and other professionals, patients, caregivers and community members to discuss shared decision-making, how to start conversations about advance directives, a medical power of attorney, do-not-resuscitate (DNR) decisions, and the importance of multidisciplinary collaboration in healthcare decision-making. The meeting made clear that advance care planning is not simply about completing a document. It is about communicating what matters to you, involving the people who may need to speak for you, and making your wishes known while you are still able to make informed decisions. Against that backdrop, there is one important – yet in our society often underappreciated – legal instrument: the written advance directive.
What is a written advance directive?
There are three main types of advance directives. The core purpose of all these directives is to protect personal autonomy once a person is no longer able to express his or her will verbally, for example due to dementia or unconsciousness after an accident. The discussion at the WYCCF-SMMC meeting emphasized that these choices are most useful when they are considered and communicated before a person loses the ability to express his or her wishes.
First, a written power of attorney. By means of a power or attorney, a person designates a trusted representative such as a partner, child or friend to speak on the person’s behalf with physicians and healthcare institutions when one can no longer do so personally. Designating one or more representatives helps to prevent disagreements within families at the most difficult time and gives healthcare professionals a clear point of contact. Choosing and informing a trusted representative can also support clearer communication among the patient, family and healthcare team. Where a written power of attorney is used, it is essential that healthcare professionals involved in your medical care, such as your general practitioner, are made aware of this directive, that they know how to reach the appointed representative and that the designated representative is informed about the person’s wishes on medical treatment and end of life.
Second, a negative advance directive. In a negative advance directive, a person outlines treatments he/she no longer wishes to undergo, such as resuscitation, intensive ventilation, specific medication, artificial nutrition or hydration, or blood transfusions. In legal systems such as ours, where treatment requires a patient’s informed consent, a physician is, in principle, required to respect such a directive when the patient later becomes incapacitated. When discussing or drafting such a directive, it is important to consider under which circumstances the person does or does not want certain treatments, what the person would want if they were to become permanently incapacitated (should physicians then do everything to prolong life, or not) and whether the person would still want to be admitted to a hospital or hospice at the very end of life, or would prefer not to. The discussion of DNR decisions at the joint WYCCF-SMMC meeting also highlighted the importance of understanding what a DNR order means, when such decisions are made, and the respective roles of patients, families and healthcare professionals.
And finally, a positive advance directive, containing for example preferences regarding palliative and end of life care.
Positive advance directives clarify which treatments a person would want at the end of life, such as a written instruction that life‑prolonging treatment should be continued as long as medically feasible, even if chances of recovery are small or a statement that the person wishes to receive artificial nutrition and hydration (tube feeding or IV fluids) in advanced illness, even when oral intake is no longer possible. Written euthanasia requests are well-known positive advance directives. Sint Maarten does not have specific legislation in place linking a written advance directive to end of life decisions. As a consequence, in Sint Maarten a positive advance directive does not create an enforceable right to active termination of life. Another example is a preference for palliative sedation (terminal sedation): the deliberate, medically supervised reduction of consciousness in the final stage of life to relieve suffering that can no longer otherwise be controlled. Unlike euthanasia, palliative sedation aims at comfort, not at ending life. Including such a preference in an advance directive gives healthcare providers clear guidance on the level of comfort and care a person wishes to receive.
Difference between advance directive and living will.
A living will (‘levenstestament’) is broader in scope than a medical advance directive. In addition to medical wishes, a living will can address, for example, who will manage the person’s financial affairs, who will handle day to day practical matters and/or what should happen to digital data. A living will can best be executed before a notary, whereas a medical advance directive does not necessarily need to be notarized.
As for medical advance directives, the more carefully the document is drafted and formalized, the greater its legal and practical value for physicians, care institutions and representatives.
Form and content: how to document a medical advance directive.
When drafting a medical advance directive, make sure to include the concerned person’s name and that it is dated and signed. Also, use clear, unambiguous language, describe the person’s wishes and the situations (such as dementia) to which the directive applies as concretely as possible and, preferably, in the person’s own words. Finally, but certainly not less important, coordinate, where possible, with a physician – for example the general practitioner or a medical specialist – especially before someone undergoes a medical procedure, so that capacity and content are properly documented and understood and to discuss the existence and content of an advance directive with close relatives, so that they are aware of the person’s wishes and can – when necessary – notify the relevant care providers.
Physicians are advised to (naturally with the patient’s consent) record the conversation and to place the directive in the medical file, and patients should be encouraged to review and, where necessary, update their directive regularly and to share any changes with their doctor.
It is also advisable to discuss the existence and content of an advance directive with close relatives, so that they are aware of the person’s wishes and can – when necessary – notify the relevant care providers.
Validity and updating: not a “one off document”.
In principle, an advance directive remains valid for as long as the person is alive, until it is revoked or has evidently become outdated due to changed circumstances. From a practical standpoint, it is sensible to review the document periodically: advance care planning is an ongoing conversation rather than a single administrative exercise. Especially where dementia or other forms of incapacity later arise, it is crucial that the directive was drawn up earlier, while the person was still capable of making informed decisions.
Why this is urgent now for Sint Maarten.
Advance directives do not only serve an individual interest; in an ageing society with a growing number of people living with psychogeriatric conditions, they increasingly serve a wider social purpose. For healthcare and legal professionals in Sint Maarten, this means we must do a better job of informing citizens about the possibilities and limits of advance directives. This does not only prevent legal uncertainty but also contributes – in a very concrete way – to appropriate, client-centered care and to better safeguarding autonomy, dignity and quality of life in later years. The recent joint WYCCF-SMMC meeting is one example of how this conversation can be brought into the community. Its focus on shared decision-making, advance directives, DNR decisions and multidisciplinary collaboration demonstrated the practical need for clear information and open communication.
In conclusion: take timely control of your medical future.
A written advance directive is a powerful instrument to maintain control over your own life, especially in a time when ageing and cognitive decline are becoming increasingly common. It is important that you discuss your wishes early, put them in writing where appropriate, and make sure the people and professionals who may need to act on them know what matters to you. Drawing up such a directive do ...
More articles →
In August, 2026, participants gathered at the White & Yellow Cross Care Foundation (WYCCF) for a Café Lecture on Advance Care Planning under the theme ‘Let’s Start the Conversation’ jointly organized by the WYCCF and St. Maarten Medical Center (SMMC). The meeting brought together healthcare and other professionals, patients, caregivers and community members to discuss shared decision-making, how to start conversations about advance directives, a medical power of attorney, do-not-resuscitate (DNR) decisions, and the importance of multidisciplinary collaboration in healthcare decision-making. The meeting made clear that advance care planning is not simply about completing a document. It is about communicating what matters to you, involving the people who may need to speak for you, and making your wishes known while you are still able to make informed decisions. Against that backdrop, there is one important – yet in our society often underappreciated – legal instrument: the written advance directive.
What is a written advance directive?
There are three main types of advance directives. The core purpose of all these directives is to protect personal autonomy once a person is no longer able to express his or her will verbally, for example due to dementia or unconsciousness after an accident. The discussion at the WYCCF-SMMC meeting emphasized that these choices are most useful when they are considered and communicated before a person loses the ability to express his or her wishes.
First, a written power of attorney. By means of a power or attorney, a person designates a trusted representative such as a partner, child or friend to speak on the person’s behalf with physicians and healthcare institutions when one can no longer do so personally. Designating one or more representatives helps to prevent disagreements within families at the most difficult time and gives healthcare professionals a clear point of contact. Choosing and informing a trusted representative can also support clearer communication among the patient, family and healthcare team. Where a written power of attorney is used, it is essential that healthcare professionals involved in your medical care, such as your general practitioner, are made aware of this directive, that they know how to reach the appointed representative and that the designated representative is informed about the person’s wishes on medical treatment and end of life.
Second, a negative advance directive. In a negative advance directive, a person outlines treatments he/she no longer wishes to undergo, such as resuscitation, intensive ventilation, specific medication, artificial nutrition or hydration, or blood transfusions. In legal systems such as ours, where treatment requires a patient’s informed consent, a physician is, in principle, required to respect such a directive when the patient later becomes incapacitated. When discussing or drafting such a directive, it is important to consider under which circumstances the person does or does not want certain treatments, what the person would want if they were to become permanently incapacitated (should physicians then do everything to prolong life, or not) and whether the person would still want to be admitted to a hospital or hospice at the very end of life, or would prefer not to. The discussion of DNR decisions at the joint WYCCF-SMMC meeting also highlighted the importance of understanding what a DNR order means, when such decisions are made, and the respective roles of patients, families and healthcare professionals.
And finally, a positive advance directive, containing for example preferences regarding palliative and end of life care.
Positive advance directives clarify which treatments a person would want at the end of life, such as a written instruction that life‑prolonging treatment should be continued as long as medically feasible, even if chances of recovery are small or a statement that the person wishes to receive artificial nutrition and hydration (tube feeding or IV fluids) in advanced illness, even when oral intake is no longer possible. Written euthanasia requests are well-known positive advance directives. Sint Maarten does not have specific legislation in place linking a written advance directive to end of life decisions. As a consequence, in Sint Maarten a positive advance directive does not create an enforceable right to active termination of life. Another example is a preference for palliative sedation (terminal sedation): the deliberate, medically supervised reduction of consciousness in the final stage of life to relieve suffering that can no longer otherwise be controlled. Unlike euthanasia, palliative sedation aims at comfort, not at ending life. Including such a preference in an advance directive gives healthcare providers clear guidance on the level of comfort and care a person wishes to receive.
Difference between advance directive and living will.
A living will (‘levenstestament’) is broader in scope than a medical advance directive. In addition to medical wishes, a living will can address, for example, who will manage the person’s financial affairs, who will handle day to day practical matters and/or what should happen to digital data. A living will can best be executed before a notary, whereas a medical advance directive does not necessarily need to be notarized.
As for medical advance directives, the more carefully the document is drafted and formalized, the greater its legal and practical value for physicians, care institutions and representatives.
Form and content: how to document a medical advance directive.
When drafting a medical advance directive, make sure to include the concerned person’s name and that it is dated and signed. Also, use clear, unambiguous language, describe the person’s wishes and the situations (such as dementia) to which the directive applies as concretely as possible and, preferably, in the person’s own words. Finally, but certainly not less important, coordinate, where possible, with a physician – for example the general practitioner or a medical specialist – especially before someone undergoes a medical procedure, so that capacity and content are properly documented and understood and to discuss the existence and content of an advance directive with close relatives, so that they are aware of the person’s wishes and can – when necessary – notify the relevant care providers.
Physicians are advised to (naturally with the patient’s consent) record the conversation and to place the directive in the medical file, and patients should be encouraged to review and, where necessary, update their directive regularly and to share any changes with their doctor.
It is also advisable to discuss the existence and content of an advance directive with close relatives, so that they are aware of the person’s wishes and can – when necessary – notify the relevant care providers.
Validity and updating: not a “one off document”.
In principle, an advance directive remains valid for as long as the person is alive, until it is revoked or has evidently become outdated due to changed circumstances. From a practical standpoint, it is sensible to review the document periodically: advance care planning is an ongoing conversation rather than a single administrative exercise. Especially where dementia or other forms of incapacity later arise, it is crucial that the directive was drawn up earlier, while the person was still capable of making informed decisions.
Why this is urgent now for Sint Maarten.
Advance directives do not only serve an individual interest; in an ageing society with a growing number of people living with psychogeriatric conditions, they increasingly serve a wider social purpose. For healthcare and legal professionals in Sint Maarten, this means we must do a better job of informing citizens about the possibilities and limits of advance directives. This does not only prevent legal uncertainty but also contributes – in a very concrete way – to appropriate, client-centered care and to better safeguarding autonomy, dignity and quality of life in later years. The recent joint WYCCF-SMMC meeting is one example of how this conversation can be brought into the community. Its focus on shared decision-making, advance directives, DNR decisions and multidisciplinary collaboration demonstrated the practical need for clear information and open communication.
In conclusion: take timely control of your medical future.
A written advance directive is a powerful instrument to maintain control over your own life, especially in a time when ageing and cognitive decline are becoming increasingly common. It is important that you discuss your wishes early, put them in writing where appropriate, and make sure the people and professionals who may need to act on them know what matters to you. Drawing up such a directive do ...
More articles →