How to revoke advance healthcare directives (DAT) on blood

1. What Italian Law 219/2017 says

Article 4 — Advance Healthcare Directives

Italian Law of December 22, 2017, no. 219 (“Rules on informed consent and on advance healthcare directives”), published in the Official Gazette, General Series no. 12 of January 16, 2018, and in force since January 31, 2018, governs DAT in Article 4.

Key points of Art. 4

Paragraph 1— Who can make a DAT:

“Every adult capable of understanding and willing, foreseeing a possible future inability to self-determine, may express his/her wishes regarding healthcare treatments through DAT.”

Paragraph 4— How DAT are drafted:

• Public deed (with a notary)
• Authenticated private writing (signature authenticated by a notary)
• Private writing delivered personally to the Civil Registry Office of the City Hall of residence
• Private writing delivered to healthcare facilities (in the Italian regions that have regulated DAT collection)
• Authenticated private writing delivered to Italian consular offices abroad (for Italian citizens residing abroad)

Paragraph 6 — Revocation (the most important paragraph for you):

“DAT can be renewed, modified and revoked at any time, in the same formsin which they were expressed.”

And, fundamentally:

“In cases where reasons of emergency and urgency prevent revoking the DAT in the forms provided in the previous sentences, they may be revoked by verbal declarationrecorded or video-recorded by a doctor, with the assistance of two witnesses.”

What this means in practice

1. Revocation is always possible. At any moment. Nobody can prevent it.
2. No clause of irrevocability is valid. Any clause that makes a DAT non-modifiable or non-revocable is null and ineffective (by analogy with art. 679 of the Italian Civil Code on wills).
3. The form of revocation must match the form of creation (but in an emergency a verbal declaration is enough).

2. How DAT were filed

Where DAT are recorded

DAT are kept in two places:

a) With those who collected them:

• The City Hall (Civil Registry Office) if filed as a private writing
• The notary if drafted as a public deed or authenticated private writing
• The healthcare facility / local health authority (ASL) in the regions that allow it
• The consular office for citizens abroad

b) In the National DAT Database (Italian Ministry of Health)

Since December 10, 2019, there is the National DAT Database at the Italian Ministry of Health (accessible at dat.salute.gov.it). The bodies collecting DAT (City Halls, notaries, consulates, ASL) are required to send a copy of the DAT to this database and to update it promptly in case of renewal, modification or revocation.

The role of the database is to ensure that the attending doctor, in cases where the patient is incapacitated, can consult the up-to-date DAT.

National DAT Help Desk: Toll-free number 800.178.178 (active on weekdays, Mon-Fri 8:00-18:00, Sat 8:00-13:00, Italian time).

For Jehovah’s Witnesses specifically

Jehovah’s Witnesses generally file DAT in one of these ways:

1. At the City Hall of residence— the most common method, as a private writing delivered personally to the Civil Registry Office.
2. With a notary— as a public deed or authenticated private writing (less frequent due to costs).
3. Through the Jehovah’s Witnesses organization — Witnesses are often assisted in compiling them, but the formal filing under Law 219/2017 always takes place at the City Hall or with the notary.

3. The correct procedure to revoke a DAT

General rule: “In the same forms”

Revocation must take place in the same formin which the DAT were created. Here are the cases:

Case A: DAT filed at the City Hall (the most frequent case)

If the DAT was filed as a private writing delivered personally to the Civil Registry Office of the City Hall:

1. Appear in person at the Civil Registry Office of the City Hall where the DAT was filed
2. Bring a valid ID
3. Hand in a written declaration of revocation (see template below)
4. Request that the revocation be noted in the register and that the National DAT Database be updated
5. Have a receipt issued for the revocation completed

Important: The delivery must be in person. The original filing was done in person, so the revocation must also be done in person. It cannot be delegated.

Case B: DAT drafted by a notary

If the DAT was drafted as a public deed or authenticated private writing by the notary:

1. Go to a notary (not necessarily the same one)
2. Draft an act of revocation in the same forms (public deed or authenticated private writing)
3. The notary will update the National DAT Database
4. It is advisable that the notary also communicate the revocation to the notary who had drafted the original DAT

Case C: Medical emergency

If you are in the hospital and there is urgency:

1. Verbally declare to the doctor that you are revoking your DAT
2. The doctor records the declaration (or video-records it)
3. Two witnesses must be present
4. The revocation is noted in the medical chart and in the electronic health record

This is expressly provided for by Art. 4, paragraph 6 of Law 219/2017.

Frequently asked questions on the procedure

Can it be revoked via certified email (PEC)?

The law does not expressly provide for PEC as a means of revocation. Art. 4 says “in the same forms” in which the DAT was expressed. If the DAT was filed by personal delivery at the City Hall, the revocation should occur in the same way: in person.

However, the practical advice is:

• Send a PEC to the City Hall right away as a first step to signal your intention to revoke (this creates a documentary trail with the legal value of registered mail with return receipt)
• Then appear in person at the City Hall to formalize the revocation

Warning: An ordinary email (Gmail, Yahoo, etc.) has no legal value as registered mail. Only a PEC (Certified Electronic Mail, in Italy) has legal value equivalent to registered mail with return receipt.

Is a specific form needed?

No, the law does not require a mandatory form. A free-form letter is enough, containing:

• Your full personal details
• An explicit declaration that you wish to revoke the DAT
• Reference to the original filing (date and place)
• Date and signature

Some City Halls provide a pre-printed form. You can ask your City Hall if they have one, but using it is not required.

Is a notary needed?

Only if the original DAT was drafted by a notary (as public deed or authenticated private writing). If it was filed at the City Hall as a simple private writing, a notary is not necessary.

4. Specific aspects for Jehovah’s Witnesses

The “No Blood” card — does it have legal weight?

Jehovah’s Witnesses typically carry a pocket card (commonly called the “no-blood card” or “medical document”) expressing refusal of blood transfusions.

What the Italian Court of Cassation says:

The Italian Court of Cassation has established that the simple wording “no blood” on a card is too vague and is not sufficient to constitute a valid refusal of medical treatment. Refusal of transfusions must be:

• Express (not generic)
• Unambiguous (not vague)
• Current (not pre-emptive and generic)
• Informed (given after receiving information about the seriousness of the situation)

Step-by-step guide for those who want to revoke everything

If you have decided to reconsider your position on blood transfusions and want to revoke the refusal of transfusions, here is what to do:

Step 1: Revoke the formal DAT

If you filed your DAT at the City Hall:

1. Go in person to the Civil Registry Office of the City Hall where you filed it
2. Bring a valid ID
3. Deliver the revocation letter (see template in section 5)
4. Ask for the receipt of the revocation
5. Ask for confirmation that they will update the National DAT Database at the Ministry of Health

If you don’t remember where you filed it, or whether you filed it, you can:

• Call the Toll-free number 800.178.178 (National DAT Database Help Desk) to verify
• Contact the Civil Registry Office of your City Hall of residence

Step 2: Destroy the “No Blood” card

• Physically destroy the card / medical document you carry with you
• If you have copies in your wallet, in the car, or elsewhere, destroy them all
• The card itself does not have the same legal weight as the formal DAT, but it could create confusion in an emergency

Step 3: Revoke the appointment of the proxy

If in your DAT you had appointed a proxy (probably another Jehovah’s Witness):

• In the same DAT revocation letter, indicate that you also revoke the appointment of the proxy
• Art. 4 provides that “the appointment of the proxy may be revoked by the principal at any time, in the same way as provided for the appointment and without obligation to give reasons”

Step 4: Communicate the revocation to your doctor

• Inform your general practitioner that you have revoked your DAT
• Ask that it be noted in your electronic health record
• If you have planned surgeries, inform the hospital

Step 5: Keep the proof

• Keep the receipt of the revocation issued by the City Hall
• Keep a copy of the revocation letter
• Keep everything in an accessible place (and tell a trusted family member where it is)

Is the hospital required to honor the DAT?

Yes, the doctor is required to honor the DAT (Art. 4, paragraph 5, Law 219/2017).

But if the DAT has been revoked:the doctor must follow the patient’s most recent indications. If you have revoked the DAT, the old directives no longer have any value. That’s why it is fundamental to:

• Formally revoke the DAT
• Make sure the National Database is updated
• Inform your doctor

In an emergency:if you arrive in the hospital unconscious and the DAT is still active in the Database, the doctor may honor it. That’s why it’s urgent to formally revoke it as soon as possible.

5. Revocation letter template

DAT revocation letter to deliver to the City Hall

Copy this text, personalize it with your data, print it, sign it and deliver it in person to the Civil Registry Office. The template is in Italian, since it is to be submitted to an Italian municipal office.

Letter via PEC (to send as a first step)

If you want to send a PEC to the City Hall as a formal anticipation, use this Italian-language text. Remember: the PEC alone may not be enough. Then appear in person.

6. Operational checklist

Use this checklist to make sure you’ve done everything:

Verify for yourselves every piece of information in this guide. The legislative and case-law sources are linked directly.

— A Member of the Lovers of Truth