There may come a time in your life when you decide that you want to take control of how you will be looked after if you become very ill. This control can be to some degree gained by making a "living will". We set out on this page a brief guide for you.

Non-Contentious Department

Ellen Watkins

General

When you are ill you can usually discuss the treatment options with your G.P and agree jointly as to your future care. However, you may be admitted to Hospital when unconscious or, for other reasons, unable to communicate your wishes. This may therefore be a time when you cannot understand the implications of a specific type of treatment and you cannot therefore make an informed decision. It may arise as a result of having a car accident, stroke or perhaps some form of dementia. In these circumstances you would "lack mental capacity" to be able to make an informed decision or communicate your wishes adequately.

In cases such as these doctors have a legal and ethical obligation to act in your best interests. Guidance issued to medical professionals is that it is "good practice" to consult relatives when deciding what is in a persons best interests but relatives have no legal right to be consulted or to make decisions for you. So it would help the doctors, in determining your best interests, to have written information reflecting your views and wishes. You can do this in the form of an Advance Statement or an Advance Directive ("Living Will").

Every adult with mental capacity has the right to agree or to refuse medical treatment. "Advance Statements" can include general details about your wishes, which aren't legally binding but specific refusals of treatment called "Advance Directives" which are at present legally binding.

What is an Advance Statement?

This is a general written statement in which you can set out which treatments you feel you would or wouldn’t like to receive should you lose mental capacity ion the future. It can set out non medical things too such as food beliefs or aspects of your life which are particularly valued by you. It could even state if you prefer a bath or a shower!

Advance Statements aren't legally binding, but health professionals do have to take them into account when deciding on a course of action. Family and friends can also use them as evidence of your wishes.

You could also make your views known verbally, for example, when discussing treatment with a health care professional but having everything written down will make things clearer for everyone.

What the Statement might include:

  • Treatment you would be happy to have, and in what circumstances
  • Treatment you would not want, no matter how ill you are
  • Treatment you would prefer not to have, and in what circumstances
  • Someone you would like to be consulted about your treatment

What is an Advance Directive or "Living Will"

An Advance Directive indicates your specific wish to refuse all or some forms of medical treatment and the circumstances under which this refusal would apply. As this is, at present, the only form of advance statement to be legally binding it must be prepared when you are mentally capable and is only used once you have lost the capacity to participate in decisions relating to your best interests.

An advance directive does not need to be in writing but casual remarks about healthcare should not be used as the basis of an Advance Directive. It is therefore best for them to be in writing.

Any adult who has the capacity can refuse treatment for whatever reason even if this may ultimately lead to his/her death.

However, no-one can insist that a particular treatment is given so an Advance Directive can only include be a refusal of treatment. The Advance Directive is sometimes called a "Living Will".

What are the Advantages and Disadvantages?

You may wish to make an Advanced Statement or Advanced Directive if you have very strong feelings about certain things e.g. Would you want a blood transfusion or to have a leg amputated after an accident?

Or it may be that preparing an Advance Statement or Advance Directive after being diagnosed with an illness will provide an opportunity for you to discuss what may be difficult issues with family and friends. This may help them as you will be relieving them of some of the decision making at a stressful time later on.

What criteria are there for making a valid Advance Directive?

  • You must be over 18
  • You must be mentally capable and not suffering from any mental distress at the time the Advance Directive was signed
  • You must not have been influenced by anyone else
  • You must appear to have been fully informed about the treatment options and their implications when the Advance Directive was signed

What can't you do in an Advance Directive?

  • You cannot ask for anything which is illegal i.e. Euthanasia or help to commit suicide.
  • You cannot demand care which the medical professionals consider inappropriate to your case
  • You cannot refuse the offer of food or drink by mouth
  • You cannot refuse the use of measures designed to maintain your comfort e.g providing appropriate pain relief
  • You cannot refuse basic nursing care which is essential to keep you clean and comfortable such as washing and bathing

Who do you consult?

You should talk things through with your family and Doctor.

How often should you review an Advance Directive?

It is important that Doctors are able to feel confident that you have not changed your mind since you prepared the Statement/Directive. It is also important to bear in mind that new drugs or treatments may be introduced in the future. So you ought to review it on a regular basis.