What is the National Registry of Living Wills (RENTEV)?
The National Registry of Living Wills (RENTEV) is an information system developed by the Shared Services of the Ministry of Health (SPMS), which enables the reception, registration, organization and updating of all information and documentation related to the advance directive document/living will and the health care power of attorney.
What is a living will?
A living will is a document in which any citizen of legal age can express what kind of treatment and health care they do or do not want to receive when they are unable to express their will. You may also appoint one or more health care proxy.
Who can make a living will?
All nationals, foreigners and refugees (stateless) residing in Portugal, of legal age, who are not interdicted or disabled by psychic anomaly, can make a living will.
What is a Health Care Proxie?
The health care proxy is the person previously appointed and called upon to decide on what health care is to be received by the user, who has appointed him, when he is unable to express his will personally and autonomously.
Who can be a health care proxy?
The health care proxy must be a person trusted by the user, who may or may not be a family member.
However, the following may not be health care proxies:
- RENTEV officials (with intervention in advance directives of will)
- Employees of the notary's office (with intervention in advance directives of will)
- owners and managers of units that administer or provide health care (unless you have a family relationship with the user)
If my health care attorney has an opinion contrary to mine, what decision prevails?
There are two distinct situations. The prevailing decision is:
- that of the patient, when in the living will in which he appointed his health care proxy he also specified the health care he wants to receive
- that of the attorney-in-fact, if the user has filled in the living will without specifying the health care to be received, and only the indication of the attorney-in-fact
For the living will to be valid, does it have to be registered with RENTEV?
No. As long as the signature of the living will is notarized by the notary, the user can have his or her living will on paper with him, and it is valid. However, assurance that the treating physician is aware that there is a living will can only be given if the living will is registered in RENTEV.
Am I required to use the living will document template?
No. However, it is highly recommended since it stores the information in a structured way, facilitating the process of its creation and consultation.
Does the document specify which health care I can opt for?
yes. After stating in which clinical situations the advance directive of will has effects, you can choose to place a cross in the following cases:
- not undergo cardiopulmonary resuscitation
- not to be subjected to invasive means of artificial support of vital functions
- not be subjected to artificial feeding and hydration measures to slow down the natural process of death
- participate in experimental phase studies, scientific research or clinical trials
- not be subjected to treatments that are in the experimental phase
- refuse to participate in scientific research programmes or clinical trials
- interrupt treatments that are in the experimental phase or participation in research programs or clinical trials, for which you have given prior consent
- Do not authorize the administration of blood or blood products
- receiving palliative measures, minimal oral or subcutaneous hydration
- be administered the necessary drugs to effectively control pain and other symptoms that may cause me suffering, anguish or discomfort
- receive religious assistance when one decides to interrupt artificial livelihoods
You can also decide which person you want to have with you when the artificial means of living are interrupted.
What are the clinical situations in which the advance directive of the will takes effect?
As a result of your physical and/or mental state, and when you are unable to express your will autonomously, the advance directive of the will takes effect in the following clinical situations:
- have been diagnosed with an incurable end-stage illness
- there are no expectations of recovery in the clinical evaluation performed
- unconsciousness due to irreversible neurological or psychiatric disease, complicated by respiratory, renal, or cardiac complications
Can I make a living will just to name the health care proxy?
yes. You can deliver the living will only with the indication of the person you appoint as your health care proxy.
And if I don't want to appoint a health care proxy, can I deliver with only the health care receivable?
yes. You can deliver your living will with information of:
- appointment of the health care proxy, only (in this case it will be the attorney who decides which health care you will receive)
- appointment of the health care proxy and what health care you do or do not want to receive
- what health care you want to receive, only
Can I change the living will?
yes. You can change your living will at any time. To do this, simply fill out a new document and repeat the submission process. The RENTEV official must access the active living will, inactivate it and create a new one with the new data.
Can I cancel my living will?
yes. You can cancel your living will at any time, and to do so you must submit a signed declaration declaring the cancellation of the living will. The validation of this declaration is done in the same way as the living will: signed in the presence of the RENTEV official or signed and notarized by the notary.
Why does the signature have to be notarized?
It is mandatory for the signature to be notarized by the notary, whenever the document is not signed in the presence of a RENTEV official, so that there is certainty that he himself has his will.
What is the validity of a living will?
The living will is valid for 5 years from the date of signature and can be renewed.
Who can consult my living will?
The living will can be consulted by different people:
- the user himself through:
- health professionals in the provision of health care through EHR | Professional's Portal
- RENTEV staff and validating physicians via the RENTEV app
Each time someone consults the living will, the user will be notified of it, through email and/or SMS.
Why can my living will be consulted?
The living will can be consulted for different reasons depending on who makes it.
- a RENTEV employee can consult via the RENTEV app to:
- verify personal data of the user or proxy
- Verify Attached Document
- Other reason to be filled in by the employee
- a validating doctor can consult via the RENTEV app to:
- Verify Attached Document
- another reason to be filled in by the validating physician a health professional can consult through RSE | Professional's Portal:
- within the scope of the provision of health care
Whenever the living will is consulted, the user receives an automatic notification, via email and/or SMS, with the information that he or she has been consulted. The user receives the same notification when he consults his living will.
When will I receive automatic notifications?
The user receives a notification whenever the living will:
- Moves to approved status
- has been consulted
- is about to expire
- Goes to inactive state
Why am automatic notifications sent to me?
Notifications are sent to the user as a security and privacy measure, and are intended to alert the user whenever the document is consulted.
I have a health care proxy. Do you also receive notifications?
yes. Notifications are sent to the user and their health care proxy via email and/or SMS. If there is an alternate health care proxy, you will also receive notifications.
Can I make a living will in a language other than Portuguese?
Yes, but to be accepted in the RENTEV counters has to be translated into Portuguese.
Can I refuse to receive the documentation if the official believes that I am not fully mentally capable?
No. All citizens are free to use their capacities as they see fit and only the court can assess and decree incapacity, whether by interdiction, disqualification or even temporary incapacity.
Is it mandatory to have a doctor's consultation to advise me on the living will?
No. It is not mandatory to have any type of medical procedure prior to the completion and delivery of the documentation.
However, it is important that you are properly advised or clarified about the scope of the decisions expressed in the living will. To do this, you can discuss the matter beforehand with a health professional you trust or with the health team that cares for you.
Can a family member contest my living will?
yes. However, the challenge can only be made by the courts. The family member must be informed of this, verbally or in writing.
Is the living will only valid in national territory?
yes. The living will is only valid in national territory. In cases of emigration or temporary stay (tourism, for example) in other countries, the applicable legislation is that of the country of destination and not that of the country of origin.
Source: Shared Services of the Ministry of Health (SPMS)