Legal aspects of end-of-life decision policies in health care institutions.

Nowadays, health care institutions develop policies on how to deal with medical decisions concerning the patients' end-of-life stage (hereafter: "end-of-life decision policies" or "ELD-policies"). This evolution is not only noticeable in hospitals, but also in nursing homes, residential facilities for the disabled and home care services. However, these policies raise several legal issues. The developing and implementing of institutional ELD-policies are legitimated as such and imposing additional criteria or limitations on patients or physicians are allowed if all patients' rights are respected. Due to many differences in form and content, their legal value is difficult to define. Nevertheless, institutional ELD-policies are only enforceable on physicians after incorporation into a binding agreement and without violation of their (deontological and/or legal) right to professional autonomy. Patients (or their legal representatives) can never obligate physicians or health care institutions to comply with institutional ELD-policies, unless enforceable patients' rights are violated.