Advance Medical Decisions Or Directives

What Is An Advance Medical Decision/Directive Or Living Will?

Advance Medical Decisions are better known as ‘living wills’. You will also see them referred to as:

Advance Decisions
Advance Directives To Refuse Treatment (ADRT)
Advance (Medical/Healthcare) Directives
Personal Directives.

An Advance Decision/Directive enables you to specify what actions should be taken on your behalf if you become unable to take decisions for yourself due to illness, old age or life-changing injuries.

At present these important documents are rare. But they are likely to become more common as dementia and other similar conditions become more prevalent in society.

Who Is Most Likely To Need One? Why Do I Need One?

Advance Directives enable you to refuse certain types of medical treatment in advance. They communicate your wishes to doctors and other healthcare professionals if you are unable to do so.

Some people may not wish to have particular types of medical treatment because they are concerned about what their quality of life would be if it were prolonged despite severe injuries. They do not wish to live in an irreversible coma or vegetative state, trapped within their bodies and unable to communicate their wishes.

Typically they could refuse in advance life-sustaining treatments such as cardiopulmonary resuscitation (CPR) if their heart stopped, ventilation to help them breathe or antibiotics to combat infection.

An Advance Directive can be a life-or-death decision so it requires a great deal of thought in consultation with your loved ones.

In drawing up an Advance Directive To Refuse Treatment, you must be very clear about:

the circumstances in which you would not wish to receive treatment
the fact that you are prepared to refuse the treatment even through it could lead to your death.

An Advance Decision to refuse one type of medical treatment cannot be used as a way of requesting another form of treatment.

Nor is it a suicide request. You cannot use it as a way of asking for your life to be ended.

How Do Advance Decisions Work? How Do I Create A Living Will?

You must be aged 18 or over to create an Advance Decision. You must have sufficient mental capacity to take decisions about your treatment – and you must be able to communicate those decisions clearly.

You must specify precisely which treatments you wish to refuse.

Your Advance Decision does not have to be in writing but it is much safer if it is written down. You should sign and date it.

If you wish to refuse potentially life-saving treatments then your Advance Decision must be signed and dated by a witness.

The decision must be yours – with no pressure from anyone else to take the course of action that you propose.

Your Advance Decision will be deemed invalid if you have since said or done anything which suggests you have changed your mind.

Do I Still Need An Advance Decision If I Already Have A Power Of Attorney?

Option A under the Health and Welfare Power of Attorney gives you the option to nominate one or more trusted individuals to make all medical decisions on your behalf.

In theory, that includes the right to make life-or-death medical decisions on your behalf. They could refuse certain life-sustaining treatments if they know that is your wish. Doctors and other healthcare professionals must abide by those decisions taken on your behalf.

But in practice some doctors might be understandably reticent to withhold treatment in life-or-death situations simply because of a power of attorney. This would be a rare and extreme scenario for the use of such a document.

So it makes sense to back up your power of attorney with an Advance Decision which is designed specifically for situations such as this. Healthcare professionals would then have two legal documents confirming your wishes.

How Much Does An Advance Directive Cost?

Advance Decisions/Directives are not expensive compared with some other legal documents and certainly not when one considers what an important role they play.

A single Advance Decision for an individual costs £110+VAT. For a couple, the cost of two Advance Decisions is £180+VAT.

How Long Does It Take To Create One?

Not long at all. We can create an Advance Decision for you very quickly. Unlike a power of attorney, they do not have to be registered.

So it’s simply a matter of telling us your wishes, approving the document then signing and dating it. The document must be legally witnessed if you are choosing to refuse life-sustaining treatment.

What Is An Advance Statement? How Does It Differ From An Advance Decision?

An Advance Decision concerns whether or not you would wish to receive certain types of medical treatment – whereas an Advance Statement is about how would like to be cared for, such as:

whether you would like to receive care in your own home, in a care home or in a hospice
what you like to eat
whether you prefer baths or showers
what kind of clothes you wish to be dressed in
which types of music and TV programmes you like
your normal bedtime, whether you like to sleep with a light on
your faith or other spiritual beliefs and values
whom your carers should consult about your care
whom you would like to visit you.

Are Advance Decisions/Directives And Advance Statements Legally Binding?

Advance Decisions/Directives (Living Wills) are legally binding – but only if they comply with the Mental Capacity Act (MCA).

This legislation helps to protect people who have lost the ability to take decisions for themselves.

It sets out the circumstances under which nominated attorneys (or deputies appointed by the Court of Protection) can take decisions on behalf of people who have lost capacity and when they can’t.

To be legally binding, an Advance Decision must also be valid – it cannot conflict with any other decisions you have made in a power of attorney. It must also apply to the situation or circumstances in question.

Advance Statements are not legally binding.

Can I Change My Mind? How Easily Can Living Wills Be Amended?

Yes, you can change your mind. You can review, amend or tear up your Advance Decision at any time.

Can An Advance Decision Be Changed Without My Approval If I Have Lost Mental Capacity?

No – it can’t be changed by anyone else. The decision is yours alone.

Can I Write A Living Will Without A Solicitor?

Yes but we don’t recommend it. Never forget that you’re dealing with something even more far-reaching than a will or a power of attorney (two of the most important legal documents you will ever sign).

Do not trust your life or future healthcare to a DIY living will.

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