Advance Directives in Kenya: Ensuring Your End-of-Life Wishes Are Respected

Advance directives (ADs) are essential legal documents that allow individuals to specify their medical care preferences if they become unable to communicate their wishes. These directives typically include living wills and durable powers of attorney for healthcare, ensuring that a patient’s healthcare preferences are respected and guiding healthcare providers and family members in making decisions that align with the patient’s values during critical times.

 

Current Status of Advance Directives in Kenya

The adoption of ADs in Kenya shows promising but limited progress. A study at Aga Khan University Hospital in Nairobi revealed that 41.2% of terminally ill patients had completed an AD. This rate is relatively high compared to some Western countries, indicating growing awareness and acceptance. However, a majority of terminally ill patients still lack ADs, pointing to significant room for improvement.

The prevalence of ADs in Kenya varies when compared internationally. Some Western countries have higher AD completion rates due to established legal frameworks and public education. For example, approximately 33% of adults in the United States have an AD. In Kenya, the most common ADs include limitation of care documents and do-not-resuscitate (DNR) orders, with less frequent use of living wills and durable powers of attorney for healthcare.

 

Challenges in End-of-Life Care and AD Implementation

End-of-Life Care Challenges:

• Limited capacity and resources among healthcare providers.
• Absence of comprehensive guidelines, leading to variability in care quality.
• Legal and ethical dilemmas related to life-sustaining treatments.
• Cultural and spiritual considerations influencing end-of-life decisions.

Challenges in AD Implementation:

• Ambiguity and inconsistency in legal recognition and enforcement.
• Reluctance among medical professionals and patients to discuss ADs.
• Limited understanding among stakeholders about the importance of advance care planning (ACP).
• Cultural beliefs and norms affecting decision-making processes.

The Kenya Palliative Care Policy 2021-2030 addresses these challenges by proposing measures to build the capacity of healthcare providers through training, developing comprehensive guidelines, enacting legislation to address legal and ethical dilemmas, and incorporating cultural and spiritual practices into end-of-life care protocols.

 

Factors Influencing the Completion of Advance Directives

Positive Influences:

1. Role of Caregivers and Physicians: Caregivers and physicians play a crucial role in facilitating AD discussions, helping patients understand the importance of documenting their healthcare preferences.
2. Impact of Palliative Care Specialists: Palliative care specialists, trained to address the needs of seriously ill patients, promote the completion of ADs through in-depth discussions about future medical care.
3. Functional Impairment: Awareness of declining physical or cognitive abilities may motivate patients to complete ADs to ensure their care preferences are known and respected.

Barriers to Completion:

1. Lack of Legal Framework: The absence of a specific legal framework governing ADs in Kenya creates uncertainty about their validity and enforceability.
2. Cultural Attitudes Towards Death and Dying: Cultural reluctance to discuss mortality may prevent individuals from engaging in advance care planning.
3. Institutional Policies Versus National Law: Without national legislation, the practice of ADs is guided by varying institutional policies, leading to inconsistencies in their recognition and enforcement.

 

Future Prospects and Recommendations

To enhance the recognition and implementation of ADs in Kenya, several steps are recommended:

• Enhancing Awareness: Public education campaigns and workshops for healthcare professionals are crucial for informing the public and training medical practitioners on ADs.
• Legal and Policy Reforms: Advocacy for comprehensive AD laws to standardize procedures for creating and honoring ADs, and fostering collaboration between government entities, healthcare institutions, and NGOs.
• Cultural Shifts: Encouraging open discussions about end-of-life care to normalize these conversations and involving community leaders to advocate for ADs within their communities.

 

Conclusion

The implementation and recognition of ADs in Kenya show both progress and challenges. Despite the relatively high adoption rate in some healthcare settings, overall completion remains insufficient. Enhancing legal frameworks, increasing public awareness, and fostering cultural shifts are critical to improving end-of-life care. By integrating these strategies, Kenya may enhance the quality of palliative care and ensure that individuals’ end-of-life choices are honored and implemented effectively.