Enforceability of Advance Directives

It appears to be near impossible to get an advance directive effectuated in Italy.

In contrast, on Friday the Maryland Court of Special Appeals held, in Stouffer v. Reid, that a prisoner with end-stage renal disease had the right to refuse dialysis.  None of the state's asserted rights were compelling enough to outweigh the prisoner's right to refuse.  

Unfortunately, the case seems wrongly decided.  The court mentions at least four separate times that the patient did not even believe that he had kidney disease.  The court observed that the prisoner was "ill-informed"and had "concerns . . . regardig appellee's understanding of his condition."  In other words, while the patient may have been legally "competent," it looks like he did not have the capacity to make this particular decision.  The case looks a lot like Tennessee v. Mary Northern.