An Advance Decision to Refuse Treatment (previously known as a Living Will) is a document used for people to record their wishes relating to medical treatment and what they wish to refuse in the event that that they no longer have the capacity to communicate their views. So long as these documents are correctly created, they are legally binding documents and take immediate effect from when they are signed and witnessed. This means that a legally valid advance decision has to be followed by healthcare professionals, and if they ignore it, legal action can be taken.
In order to be valid, the document needs to be in writing, signed by the person they relate to and signed by a witness. It must also be shown that the person made the decision on their own and that there was no fraud or duress. Any person over the age of 18 years that has mental capacity can create an advance decision and it allows a person to make clear what their wishes are to friends, family and health care professionals. A valid advance decision takes precedence over the decisions of other people made in your best interests, but it will only be used in circumstances where a person can no longer communicate their wishes.
What Does an Advance Decision Allow?
Advance decisions are only valid if the person they relate to is alive. An advance decision allows a person to refuse medical treatment, such as:
- CPR if their heart stops. The person must make it clear if they wish to refuse CPR in the event their heart or breathing stops- this is a Do Not Attempt CPR (DNACPR) decision. It is usually recorded on a special form recognised by healthcare professionals and put on the person's medical records. It is recommended that family and friends are notified so that it does not come as a shock if the situation arises. A DNACPR is not a permanent order and a person can change their mind at any point.
- Ventilation or other life support if they cannot breathe on their own.
- Antibiotics for the treatment of life-threatening infections.
- Artificially receiving food or fluids via a drip through the nose or tube into the stomach.
The advance decision must contain a statement that it applies even in cases where the person's life is at risk if this is the person's wishes. Only those treatments that are documented in the advance decision are covered and so the wording must be very specific to ensure that the person's wishes are included in full. The enforceability of the advance decision could be affected by ambiguous wording. Where a doctor suggests treatment that is not covered in the advance decision, then the doctor will be able to determine whether or not to follow this treatment depending on their assessment as to what is best for the person. It is possible to refuse treatment in some situations but not in others, so again the wording has to be very clear to explain the circumstances in which you wish to refuse specific treatments.
There are certain things that an advance decision cannot be used for:
- Distributing a person’s wealth after they die.
- Allowing someone else to make decisions on behalf of the person it relates to.
- Requesting specific medical treatment- a doctor does not have to treat a patient the way they request and will assess what is appropriate for their needs and in the circumstances.
- Stopping the provision of food and water. This is a basic human need and a healthcare professional is under a duty to provide this.
- Requesting euthanasia or assisted suicide, which is illegal in the UK.
Advice from a GP
To ensure that the correct wording is used to cover all situations that may be relevant, it is highly advisable for a person to take advice from their GP to discuss what issues should be included and the impact of these decisions. There is no requirement to involve a GP in the decision process or for them to consent to the advanced decision. However, if a GP provides a signed statement to confirm that the person had the requisite mental capacity when they made the advance decision, this can help prove the validity of the document if it is queried.
Keep It up to Date and Accessible
An advance decision does not have an expiry date, though it is important to make sure it is reviewed regularly. Circumstances and treatments can change over time and that may affect a person's wishes. The advance decision must be shown to be "valid and applicable", and if there is uncertainty on whether the person's circumstances or preferences had changed over time, this could affect whether it is deemed to be valid. A healthcare professional will be more confident about accepting an advance decision that was updated within the last two years. If there is a suggestion from something a person has said or done that contradicts the advanced decision, then this will invalidate it.
Those with an advance decision should make sure that family, friends and healthcare workers know about its existence and where to find it. In the event of a situation that would be covered by the advance decision, it needs to be found quickly. It is possible to keep a copy in a person’s medical records.
An advance decision can be revoked in writing, which is then signed and then the advanced decision and any copies are destroyed.
Contact Us
At Lewis Nedas Law, we help our clients create advanced decision tailored to their specific needs and desires. For example, you may want to direct your family members to remove you from life support if you are terminally ill, but not if you are in a coma. Without advance decisions, it is up to your family members to make these incredibly difficult decisions.
Don't leave your family members without guidance during this emotional and stressful time. Consult our experienced Advance Decision Lawyers to establish an advance decision and protect your loved ones from conflicts and distress. It is important to consult a legal professional in drafting advance decisions, as the information contained in an advanced decision may allow death to occur.
We are dedicated to protecting our clients' best interests, and we take pride in offering 'City firm' standards of service at reasonable, realistic pricing levels. For more information, please contact us on 020 7387 2032 or complete our online enquiry form.
