Living wills in the Cayman Islands

In 2019, the Health Care Decisions Law was implemented in the Cayman Islands.

The law allows a person to determine their wishes surrounding medical care and treatment, including end-of-life care, should they become mentally incompetent, and prepare a legal document to this effect.

The legal document, referred to as an advance health care directive, outlines preferred medical treatments and procedures such as ventilator and feeding tubes, resuscitation and life-support, and also allows for appointment of a proxy to make healthcare decisions on their behalf if the directive-maker wishes.

The directive will only take effect once the directive-maker is deemed to be mentally incompetent by a doctor and can be revoked at any time while they are still mentally competent.

Mentally incompetent means that you are unable to make a decision and do not possess the faculties to understand the nature and effect of decisions. Examples of being mentally incompetent include being sedated for medical reasons or suffering from a medical condition leaving you unable to make informed decisions – on many occasions, this might only be a temporary situation.

Health Care Decisions Bill, 2019

It has been clear for a while that appropriate legislation and guidelines were necessary to allow for a patient’s preference about their treatment and end-of-life decisions to be upheld and honoured.

“The issue of helping people manage difficult times in the hospital, and/or around end-of-life matters, has troubled a number of people for many years,” said Dr. John Lee, Chief Medical Officer at the Ministry of Health, Environment, Culture & Housing.

Conflicts of opinions do arise, both amongst family members, and between practitioners and family members; and while healthcare workers do their best to do what is right, there are still times when involved parties do not agree.

The Ethics Committee of the Health Services Authority is often asked to intervene or assist in such matters, which usually relate to end-of-life issues.

“The Ethics Committee was really keen that this matter be explored further and as a result of some encouragement, the subject of End of Life Decisions and Palliative Care was discussed at our 2015 annual Healthcare Conference,” said Dr. Lee. “Following this, the Ministry of Health took the lead in 2017 and brought together a consultation team to work on a Health Care Decisions Bill for Cayman which came into Law early 2019.”

“This law is a watershed moment for Cayman,” said Dr. Virginia Hobday, medical director for Jasmine and a member of the consultation team for the Health Care Decisions Bill. “Our laws have now come into line with most countries in the world who seek to protect the wishes of individuals facing life-limiting illnesses. Society is judged by how it treats its most vulnerable.”

What are advance health care directives?

An advance health care directive allows a person to determine what course they would like physicians to take in a situation where the individual has become mentally incapacitated or otherwise unable to communicate his or her wishes.

A person can revoke or amend their own advance directive at any time, while mentally competent. They can also appoint one or more proxies to act as a substitute decision-maker in cases where the advance directive-maker becomes mentally incompetent.

“The ability to appoint a proxy might help if you have a large family, or complex relationships – you might want one particular person who you trust to do what’s right, and that person does not need to be related to you,” noted Dr. Lee.

Advance health care directives ensure an individual’s wishes are known, respected and upheld. It can also alleviate potentially difficult decision making in a time of crisis.

“Advance directives are important as we never know when we might not be able to speak for ourselves,” said Dr. Lee. “Especially as we get older, we might not want aggressive resuscitation; or on the other hand, we might want every effort made to save us if there’s at all a chance of any sort of survival. Now with advance directives, we can make our feelings known and share this with our healthcare providers and loved ones, thereby saving our family and friends from making decisions during a very difficult and emotional time.”

According to the Health Care Decisions Law 2019, advance directives from the United Kingdom, Australia, Canada, South Africa, New Zealand, Jamaica, the United States of America, and jurisdictions that are a member State of the European Union under the Treaty on European Union signed in Maastricht on 7 Feb., 1992 will also be recognised.

How to complete an advance health care directive

As well as being available for collection at Cayman Islands Hospital, Faith Hospital, and district health centres, the advance health care directive form is available from the Ministry of Health website:
www.ministryofhealth.gov.ky/sites/default/files/health-care-directive-and-proxy-appointment-form.pdf

According to the Healthcare Directives, 2019 law a person must be older than 18 and mentally competent to file an advance directive. The form must be signed in the presence of a doctor, who will witness and sign the form, as well as one other witness who is not the directive-maker’s beneficiary or proxy.

The full law can be accessed through the following link:
www.gov.ky/portal/pls/portal/docs/1/12798504.pdf

If you have filed an advance health care directive, share it as widely as you can, advises Dr. Lee. Give a copy to your lawyer and doctor, let your family know it exists, and add it to the Medic Alert Pack on your fridge, if you have one. These packs are available from Hazard Management Cayman Islands and provide first responders with quick and ready access to information about your medical history, medications and allergies.

You can also take your directive to the HSA records department and ask them to attach it to your records, a step Dr. Lee has taken with his own directive.

“We encourage all people to have advance care planning in place before getting very ill or unexpectedly injured,” said Dr. Hobday. “We encourage people to decide on what they think they want, to discuss with family and their physician and document them in writing in the form of an advanced directive.”

Individuals are encouraged to contact the Ministry of Health on 244-2318 or 244-2377 or
visit the Ministry’s website (www.ministryofhealth.gov.ky) if they have any questions.

Jasmine also offers an advanced care planning booklet. Contact them on 945-7447.