Bernardo García-Camino, Facultad de Filosofía, Universidad Autónoma de Querétaro, Querétaro, Qro., México
Irene Córdova-Jiménez, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., México
This article proposes healthcare self-determination as an ethical-legal category capable of systematically organizing the relationship among informed consent, advance directives, and representation in medical decision-making under Mexican law. Its point of departure is that, although these figures share a common normative foundation in respect for the person’s will, they are not equivalent and cannot be treated as interchangeable expressions of the same institution. Based on a doctrinalanalytical methodology and conceptual reconstruction, drawing on the Mexican constitutional, legislative, and regulatory framework, relevant decisions of the Supreme Court of Justice of the Nation, and specialized bioethical literature, the article argues that informed consent constitutes the ordinary expression of present healthcare self-determination; the advance directive, a form of prospective healthcare self-determination aimed at projecting the person’s will into future scenarios of incapacity; and medical representation, a subsidiary mechanism of substitution or implementation that should not be confused with the patient’s previously expressed will. The analysis further shows that many of the difficulties in Mexican law in this area do not stem from a lack of regulation, but rather from persistent conceptual confusion among advance directives, informed consent in end-of-life contexts, palliative care plans, and mechanisms of representation. In this sense, the proposal of healthcare self-determination makes it possible to distinguish more clearly the temporality, structure, and function of each figure, while also providing a more consistent interpretive basis for strengthening the effective protection of the patient’s will in clinical practice and in Mexican health law.
Keywords: Healthcare self-determination. Informed consent. Advance directive. Representation.