Who should consider making an Advance Decision?
An Advance Decision can be made by anyone who is over 18 years old in the UK and over 16 years old in Scotland, is of sound mind and cares about the issues involved. You do not have to be terminally ill to create one, however many people may be more likely to choose to create an Advance Decision if they are facing an incurable or progressive condition, such as those with terminal cancer or progressive neurological diseases. Even someone with slight memory loss may decide to take out an Advance Decision in the event that their condition deteriorates to dementia.
I have an old Living Will. Do I need to replace it with an Advance Decision?
There are likely to be a large number of people who currently have Living Wills. Figures for the US, suggest that as many as 42% of the population have a Living Will in place. Whilst figures are likely to be less for the UK, there will still be many who may be unaware that their currents plans are not enforceable and could be made much more robust by replacing them with an Advanced Decision. If you already have a Living Will, it would be adviseable to consider officially registering it with the UK Living Will Registry.
There are some circumstances in which an Advance Decision could be over-ridden by medical professionals. It cannot be used to
– Ask for a specific medical treatment
– Request something that is illegal (such as assisted suicide)
– Choose someone to make decisions for you, unless that person is given ‘lasting power of attorney’
– Refuse treatment for a mental health condition. This is because doctors are obliged to treat such conditions under Part 4 of the Mental Health Act.
– refuse treatment at a time when you still have capacity to give or refuse consent
– refuse basic care essential to keep you comfortable, such as washing or bathing
– refuse the offer of food or drink by mouth (but it can be used to refuse feeding by tube, for example)
– refuse the use of measures solely designed to maintain comfort – for example, painkillers (which relieve pain but do not treat the condition.
A doctor can refuse to follow your Advance Decision if:
– you make changes which invalidate the directive (such as changing to a religion which prohibits the refusal of treatment)
– there have been advances in treatment which have affected the initial treatment (unless you have specifically stated that any advances in medical treatment associated with your condition would be declined)
– If there is ambiguity in the wording of the directive or the wording is not relevant to the current medical condition
– If the Decision is not signed properly
– If there is a reason to doubt its authenticity (for example, if it was not witnessed)
It there is any doubt over the person’s state of mind at the time of creating the Advance Decision
If you live in Scotland or Northern Ireland, the situation is a little different. Advance decisions here are still governed by common law rather than legislation. However, providing that the decisions were made whilst the patient was of sound mind and clearly set out their intentions, it is widely considered that any court would treat it as being legally binding if challenged.
Do I need professional advice when creating my Advance Decision?
You may wish to discuss the contents of your Living Will with your GP and family. However you do not need professional advice to write and execute a Living Will.
Can I change my Advance Decision at any time?
It is advised that you re visit and update your Living Will at least annually to confirm that your wishes have not changed or to update your wishes. This updating service is part of our Registry Service. You can update your Living Will and the link on your registration card will then show your new wishes.
Create and Register Your Living Will
What is the difference between an Advance statement and an Advance Decision?
Currently, there are two types of statements relating to your end of care life. They are:
Advance Statement – This statement relates to the level of medical treatment you want should you become medically ill. It can include a range of preferences including the location of your care (such as a home or hospice), the influence of your religious or spiritual beliefs on the type of care you receive and how you might want to be treated (such as whether you’d like to be bathed or showered). It is important to acknowledge than an Advance Statement is NOT legally binding, however, the NHS has stated that anyone in charge of your care must take your wishes as outlined in your statement into consideration. In order for this to take place, you do need to ensure that your Advance Statement is known to your doctor or medical team, so that it can be kept alongside your medical records.
Advance Decision – If however, you want to leave very specific instructions with regards to the types of treatments you wish to have, or refuse, in the future, you can write an Advance Decision. You can be very detailed in the instructions you leave, choosing to refuse treatments that may keep you alive, such as life support or CPR. Ideally, you need to be to as clear as possible about the circumstances in which you would refuse treatment, so that your wishes can be assessed and applied in the right circumstances.