In Anticipation of a Future Period of Incapacity

1 General introduction 9
1.1 Introduction 9
1.2 Legal-normative context 11
1.3 Research questions 14
1.4 Research delineation 15
1.5 Research design 18
1.6 Research overview 21
1.7 Terminology 22

2 A changing paradigm of protection of vulnerable adults and its implications for the Netherlands 25
2.1 Introduction 25
2.2 Historical context – embedding the new human rights-based paradigm 26
2.3 Article 12 UNCRPD: Two conflicting interpretations 28
2.4 Beyond the two conflicting interpretations: the alternate framework 32
2.5 Support measures for adults unable to make their own decisions 33
2.6 The Dutch adult guardianship measures 36
2.7 The living will 40
2.8 Conclusion 43

3 The misuse or abuse of continuing powers of attorney: what are appropriate safeguards? 45
3.1 Introduction 45
3.2 The risk of abuse or misuse of CPAs 48
3.3 Appropriate safeguards in the context of the CPA 56
3.4 Safeguards in Belgium, England & Wales, Germany, the Netherlands, and Switzerland 64
3.5 Conclusion 71

4 The legal basis and scope of the levenstestament in the Netherlands 73
4.1 Origin of the levenstestament in the Netherlands 73
4.2 Regulation in the absence of a statutory framework 80
4.2.1 An ambiguous legal basis 80
4.2.2 The efforts of the notariate 92
4.2.3 The judiciary 98
4.3 The levenstestament for health and medical affairs 104
4.3.1 The legal status of treatment advance directives 105
4.3.2 Research on treatment advance directives in the Netherlands 107
4.3.3 Weighing the pros and cons 111
4.4 Conclusion 113

5 The levenstestament in practice 117
5.1 Introduction 117
5.2 The application of the levenstestament by the notariate 118
5.2.1 Research questions 119
5.2.2 Methods 120
5.2.3 Results 121
5.2.4 Discussion 136
5.3 An analysis of court cases featuring the levenstestament 139
5.3.1 A brief overview of the legal framework 140
5.3.2 Methods 141
5.3.3 The deliberations of the court when issuing an adult guardianship measure 142
5.3.4 Discussion 146
5.4 Overall conclusion 148

6 Decision-making by and for adults with impaired capacity: the potential of the Dutch levenstestament 151
6.1 Introduction 151
6.2 Decision-making by and on behalf of adults with impaired capacity 153
6.2.1 The Dutch levenstestament 153
6.2.2 The normative aspirations of the UNCRPD 155
6.2.2 Supported and substitute decision-making in practice 158
6.3 Current study 161
6.4 Methods 162
6.4.1 Research design 162
6.4.2 Procedure 163
6.4.3 Analytic strategy 164
6 In Anticipation of a Future Period of Incapacity
6.5 Results 165
6.5.1 Sample 166
6.5.2 Expectations of adults who had recently made a levenstestament 166
6.5.3 Expectations of nominated attorneys 170
6.5.4 Experiences of active attorneys 172
6.6 Discussion and conclusion 175
6.6.1 Discussion 175
6.6.2 Limitations and strengths 178
6.6.3 Conclusion 179

7 Continuing powers of attorney – different legal rules, similar problems and solutions: What can the Netherlands learn from Belgium, England and Wales, Germany and Switzerland? 181
7.1 Introduction 182
7.2 Methods 183
7.3 The Netherlands: an exploration of the existing problems 187
7.4 Belgium: the zorgvolmacht 190
7.4.1 Regulatory framework 190
7.4.2 Form and registration 191
7.4.3 Entry into force and appointment of the attorney 192
7.4.4 Rights and duties of the attorney 193
7.4.5 Supervision 194
7.4.6 Law in action 194
7.5 England and Wales: the lasting power of attorney 197
7.5.1 Regulatory framework 197
7.5.2 Form and registration 198
7.5.3 Entry into force and appointment of the attorney 199
7.5.4 Rights and duties of the attorney 200
7.5.5 Supervision 201
7.5.6 Law in action 202
7.6 Germany: the Vorsorgevollmacht 203
7.6.1 Regulatory framework 203
7.6.2 Form and registration 205
7.6.3 Entry into force and appointment of the attorney 205
7.6.4 Rights and duties of the attorney 207
7.6.5 Supervision 208
7.6.6 Law in action 208
7.7 Switzerland: the Vorsorgeauftrag 211
7.7.1 Regulatory framework 211
7.7.2 Form and registration 212
7.7.3 Entry into force and appointment of the attorney 212
7.7.4 Rights and duties of the attorney 214
7.7.5 Supervision 215
7.7.6 Law in action 216
7.8 Comparative synthesis and best practices for the Netherlands 219
7.9 Conclusion 232

8 Conclusion 235
8.1 Introduction 235
8.2 Part I: a legal-normative perspective 236
8.3 Part II: an empirical perspective 243
8.4 Part III: a comparative perspective 247
8.5 Main conclusion 248
8.6 Methodological reflection: strengths and limitations 250
8.7 Recommendations 251
8.7.1 Implications for policy and practice 251
8.7.2 Suggestions for future research 261
References 263

Appendix 1: Questionnaire ‘Experiences of notaries with the levenstestament’ 275
Appendix 2: Interview schedule Adult cohort 1 – interview study ‘The levenstestament in practice’ 287
Appendix 3: Interview schedule Attorney cohort 1 – interview study ‘The levenstestament in practice’ 297
Appendix 4: Interview schedule Attorney cohort 2 – interview study ‘The levenstestament in practice’ 305
Appendix 5: Country report Belgium 313
Appendix 6: Country report England and Wales 341
Appendix 7: Country report Germany 385
Appendix 8: Country report Switzerland 419