You can plan for this by formally stating your wishes while you are still able to do so, preferably in writing.
One way is to make what is often referred to as a living will, advance decision, advance directive or advance statement.
An alternative is to set up a Power of Attorney in which you choose someone to make decisions on your behalf if you become unable to do so in the future.
In each UK country the legal name for each of these is different, as is the paperwork.
If you record your wishes in writing in some way, ask for a copy to be added to your medical records or care plan. Even if you don’t have anything in writing, you can ask for your wishes to be added to your records.
If your wishes are not known, your doctor may consult your next of kin. Life partners may not be considered next of kin unless you are married or in a civil partnership. Your doctor is obliged to use his or her medical judgment and act in your best interests, whoever they talk to.
Making decisions in advance
You can decide what treatments you would want to refuse in specific circumstances but you cannot insist on receiving specific treatment (for instance, you cannot insist that a doctor resuscitate you if it is against their medical judgment).
You will have to state what treatments you wish to refuse, and in which circumstances your refusal of treatment will apply. For instance, you might state that if you are terminally ill and expected to die within a few days, you do not want to be treated with antibiotics if you get an infection. You cannot rule out all medical treatment for any condition that might arise.
You are not expected to use medical terms. Your GP or another healthcare professional can advise you about what to include and what may be relevant in your situation. Standard forms to help you, or guide your discussion with a healthcare professional, may be available from your District Nurse or GP surgery
Do give the relevant healthcare professionals involved in your care (eg your GP or consultant) a copy of any formal paperwork or tell them you have recorded your wishes in this way. If you have a District Nurse it is a good idea to discuss this with them and put a copy in your care plan. If you update your wishes in writing make sure everyone who needs it gets a new copy.
If your health changes significantly you may find it useful to review your existing paperwork. It is a good idea to review your paperwork on a regular basis even if there are no changes, just to make sure it still reflects your wishes.
Try to discuss your choices with your family. This may make it easier for them to understand and accept your decisions. It can be difficult to discuss your wishes with people who are close to you. If you put your wishes in writing your family can see what you would like if you become unable to tell them.
England and Wales
- You can use an Advance Decision to state your wishes about refusing certain forms of medical treatment in certain situations. An Advance Decision does not have to be in writing unless it includes your wishes relating to treatment that could keep you alive, but it is helpful if it is. An Advance Decision to refuse treatment is legally binding if you follow some specific requirements.
- You can use an Advance Statement to state your wishes about any other aspects of your general care and treatment, including non-medical issues such as dietary preferences. An Advance Statement can also reflect your beliefs and values so people know what is important to you. An advance statement is not legally binding, but should be taken into account by your doctor and family.
For more information, Age Concern has an information sheet on Advance Decisions, Advance Statements and Living Wills which could be useful for any age group.
If you drew up paperwork before October 2007, you are strongly advised to review it because the Mental Capacity Act is now in force and may affect it.
Nominating someone to make decisions on your behalf
You can choose a person to make decisions on your behalf if you are unable to do so in the future by setting up a:
- Personal Welfare LPA (for healthcare matters)
- Property and Affairs LPA (for financial matters)
Information about LPAs is available in the leaflet Making decisions … about your health, welfare or finances from the Office of the Public Guardian, Archway Tower, 2 Junction Road, London N19 5SZ.
Click here to download or phone 0845 330 2900 and ask for a copy.
If you drew up an Enduring Power of Attorney in the past, please note that this would only cover financial issues, and you may wish to add to or replace it with a Personal Welfare LPA.
Scotland
An Advance Directive sets out your wishes regarding future care and treatment. It is not legally binding but your wishes would be taken into account by your family and doctors if you became unable to communicate.
Nominating someone to make decisions on your behalf
You can choose a person to make decisions on your behalf if you are unable to do so in the future by setting up a:
- Welfare Power of Attorney (for health and welfare decisions)
- Continuing Power of Attorney (for financial decisions)
Click here for the Office of the Public Guardian (Scotland) guidelines
Northern Ireland
There is currently no legislation covering Advance Decisions, Advance Statements or living wills in Northern Ireland. However, your doctor will still act in your best interests when planning your care and treatment.
At present you can set up an Enduring Power of Attorney which relates to your financial affairs. This does not cover welfare or healthcare issues.
Click here for the Northern Ireland Court Service Guide
