Advance Decisions: Understanding What They Are Also Sometimes Known As

It's a bit of a minefield, isn't it? Thinking about what might happen down the line if you can't speak for yourself. That's where advance decisions come in. They're basically a way to make your wishes known about medical treatment, even if you're not able to communicate them yourself later on. People sometimes call them different things, which can be confusing, so let's clear things up a bit. We'll look at what they are, how they work, and what you need to know to get one sorted.

Key Takeaways

• An advance decision is a way to state now which medical treatments you don't want in the future, should you be unable to communicate your wishes later.

• These decisions are legally binding if they meet certain requirements, meaning healthcare professionals must follow them.

• Advance decisions are also sometimes known as living wills or advance directives, though there can be subtle differences.

• To be valid, especially when refusing life-sustaining treatment, an advance decision usually needs to be written down, signed by you, and witnessed.

• It's important that your family, carers, and medical team know about your advance decision and where to find it, so your wishes can be respected.

Understanding Advance Decisions And Their Alternative Names

What Is An Advance Decision?

So, what exactly is an advance decision? Put simply, it's a way for you to make your healthcare wishes known for the future, in case you're ever unable to communicate them yourself. This usually happens if you lose mental capacity due to illness or injury. It's a formal way of saying what you do and don't want when you can't speak for yourself. Think of it as a set of instructions for doctors and other healthcare professionals, guiding them on the treatments you'd prefer or refuse. It’s important to know that you can only make one of these if you currently have the mental capacity to understand your choices. It’s not about predicting the future perfectly, but about stating your preferences now for potential future scenarios.

Advance Decisions Are Also Sometimes Known As Living Wills

You might hear advance decisions referred to by other names, and one of the most common is a 'living will'. While 'living will' is a widely used term, it's worth noting that an advance decision is specifically about refusing treatments. It can't be used to request specific treatments or to ask for your life to be ended. It’s a document that clearly states which medical interventions you do not want to receive under certain circumstances. It's a good idea to discuss your options with a healthcare professional who knows your medical history before you make one.

The Role Of Advance Directives

Advance decisions fall under a broader category known as advance directives. These are legal documents that allow individuals to communicate their healthcare wishes if they become unable to speak for themselves. Common types include living wills, which specify medical treatments desired, and medical power of attorney, which designates a person to make healthcare decisions. Understanding these options empowers individuals to plan for future medical care. An advance decision is a specific type of advance directive, focusing on the refusal of treatment. It's a powerful tool for maintaining control over your medical care, even when you're not able to make decisions in the moment. You can find more information on advance directives to help you understand these options better.

The Legal Standing Of Advance Decisions

When Is An Advance Decision Legally Binding?

An advance decision is a pretty serious document, and for good reason. It's your way of saying what you want, or don't want, when you might not be able to speak for yourself later on. For it to be legally binding, it needs to tick a few important boxes. Think of it like a contract; if the terms aren't met, it might not hold up. It has to be valid, and crucially, it must apply to the specific situation you find yourself in. If all these conditions are met, then healthcare professionals are legally obliged to follow it, just as if you were making the decision yourself at that very moment.

Requirements For A Valid Advance Decision

So, what makes an advance decision 'valid' in the eyes of the law? Well, there are a few key things to get right. Firstly, you need to be 18 or over when you make it, and you must have had the mental capacity to understand what you were agreeing to. It's no good making a decision when you're not really with it, or if someone's pressured you into it. You also need to be really clear about which treatments you're refusing and in what circumstances. If you're refusing life-sustaining treatment, it gets a bit more formal: the decision needs to be written down, signed by you, and then signed by a witness too. This witness isn't just a random person; they need to understand what they're signing. It's all about making sure your wishes are clear and that you've made the decision freely.

Here's a quick rundown:

• Age and Capacity: You must be 18 or over and have the mental capacity to make the decision when you create it.

• Clarity: Clearly state the treatments you refuse and the specific circumstances.

• Written and Signed: If refusing life-sustaining treatment, it must be written down and signed by you and a witness.

• Voluntary: The decision must be made freely, without any pressure or coercion.

• No Contradiction: You shouldn't have done anything since making the decision that clearly shows you've changed your mind.

The Binding Nature Of Refusing Life-Sustaining Treatment

This is where advance decisions carry the most weight. If you've made a valid advance decision to refuse life-sustaining treatment, and it applies to your current situation, then healthcare professionals must follow it. It's as powerful as you refusing that treatment yourself right now. This means that if you're in a situation where such treatment is being considered, and you've clearly stated you don't want it in your advance decision, doctors can't just go ahead and give it to you. It takes precedence over what anyone else might think is in your best interests. It's a really strong statement of your autonomy, even when you can no longer express it yourself.

It's important to remember that while an advance decision is legally binding, it's only effective if it's clear, valid, and relevant to the medical situation you're facing. Healthcare professionals have a duty to follow it, but they also need to be sure it applies. If there's any doubt, they might seek further clarification or legal advice, but the intention is always to respect your stated wishes.

Making And Implementing Your Advance Decision

So, you've decided to get your ducks in a row and make an advance decision. That's a really sensible move, honestly. It's all about making sure your wishes are known, especially if you're ever in a situation where you can't speak for yourself. It sounds a bit morbid, I know, but it's a practical way to take control of your future healthcare.

Who Can Make An Advance Decision?

Basically, if you're 18 or over and have the mental capacity to understand what you're doing, you can make an advance decision. This means you're able to grasp the information given to you about your treatment options, understand the consequences of your choices, and communicate your decision clearly. It's not about being a medical genius; it's about being able to make a reasoned choice. If you're unsure about your capacity, it's worth having a chat with your doctor.

How To Document Your Wishes

Putting your wishes down on paper is the most solid way to go. While you can make an oral advance decision, it's much harder to prove and can lead to confusion. A written document is best. What you put in it really depends on what you want to say, but there are some key things to include:

• Your personal details: Full name, date of birth, and address. This helps identify you clearly.

• Your GP's details: Name and address, and whether they have a copy of your decision.

• A clear statement: This is the core of it. You need to state exactly which treatments you are refusing and under what specific circumstances. For example, "I do not want to be put on a ventilator if I have a severe stroke and am unlikely to recover consciousness." A vague statement like "I don't want any life support" might not be specific enough.

• When it applies: A statement that this document should be used if you lose the capacity to make decisions about your treatment.

• Signatures and dates: You need to sign and date it. If you're refusing life-sustaining treatment, it must be in writing, signed by you, and also signed by a witness. This witness shouldn't be someone who stands to benefit from your death or someone who is already involved in your care.

It's really important that your advance decision is clear and specific. If it's too general, healthcare professionals might not be able to follow it, even if they want to. Think about the specific treatments you're concerned about and the situations where you wouldn't want them.

Ensuring Your Decision Is Known

Having a perfectly written advance decision tucked away in a drawer is no good if nobody knows about it. You need to make sure the right people know it exists and where to find it. This could involve:

• Telling your GP and asking them to put a note on your medical records.

• Giving copies to your family, close friends, or anyone who might be involved in your care.

• Letting your healthcare team know about it.

• Keeping a copy with your important personal documents.

Some people even choose to wear a medical alert bracelet or carry a card that states they have an advance decision, especially if it relates to life-sustaining treatment. The goal is to make it as easy as possible for healthcare professionals to be informed of your wishes when they need to be. You can find more information about advance decisions and how to make them on the NHS website.

Remember, you can change your advance decision at any time, as long as you have the mental capacity to do so. Just make sure you update the document and inform everyone who needs to know about the changes.

When An Advance Decision Applies

So, you've gone to the effort of making an advance decision, which is brilliant. But when does it actually kick in? It's not like a general instruction manual for your whole life; it's specifically for those times when you can't speak for yourself anymore. The key is that your advance decision must be relevant to the exact situation you're in. It's not a crystal ball, but it's designed to guide decisions when you're unable to make them yourself.

Situations Where An Advance Decision Is Used

An advance decision comes into play when you've lost the capacity to make decisions about your medical treatment. This could be due to a sudden illness, an accident, or a condition that affects your mental state over time. It's that point where you can no longer communicate your wishes or understand the information needed to make a choice about your care.

• Sudden incapacitation: Following an accident or a severe, unexpected illness.

• Deterioration of a known condition: For example, if you have a progressive illness like advanced dementia or motor neurone disease.

• Temporary loss of capacity: Such as during a period of severe delirium or after a significant medical event.

How Healthcare Professionals Assess Applicability

When you're unable to make decisions, the medical team will look at your advance decision. They need to be sure it fits the current circumstances. They'll check a few things:

1. Is the decision valid? Did you have the capacity to make it when you wrote it? Is it clearly written and signed (especially if it's about refusing life-sustaining treatment)?

2. Does it apply to the treatment being offered? If your advance decision refused a specific blood transfusion, but the current issue is about a different procedure, it might not apply.

3. Does it apply to the current situation? For instance, if you made an advance decision before becoming pregnant, it might not cover decisions related to pregnancy.

They'll also consider how long ago the decision was made. Medical advancements or changes in your personal life could mean the decision needs re-evaluation, though a valid, clear decision usually stands. It's about matching your past wishes to your present reality.

It's really important that your advance decision is specific. Vague statements can be hard for medical staff to interpret when time is critical. Being clear about the treatments you would refuse and the circumstances under which you'd refuse them makes it much more likely that your wishes will be followed.

Factors Influencing The Decision's Relevance

Several things can affect whether your advance decision is relevant. The medical team will think about:

• Clarity of the document: Was it written clearly, leaving no room for doubt about your wishes?

• Changes in medical understanding: Have new treatments or understandings of a condition emerged since you made the decision that might have influenced your original choice?

• Your personal circumstances: Have there been significant changes in your life (like a new relationship or family situation) that might have altered your perspective?

• The specific treatment: Does the treatment being proposed directly match what you specified in your advance decision?

If your advance decision clearly states you refuse life-sustaining treatment in a specific scenario, and that scenario arises, it should be followed. This is a core part of the Mental Capacity Act framework, aiming to respect your autonomy even when you can't express it directly. The goal is always to act in your best interests, and respecting a valid advance decision is often the best way to do that.

Circumstances Where An Advance Decision May Not Be Followed

So, you've gone to the trouble of making an advance decision, outlining exactly what you want or don't want when it comes to medical treatment. That's a really sensible thing to do. But, and it's a bit of a big 'but', it's not always a done deal. There are situations where healthcare professionals might not follow your wishes, even if you've clearly stated them. It can feel a bit disheartening, I know, but there are specific reasons why this might happen.

Withdrawing Or Contradicting Your Decision

This is probably the most straightforward reason. If you're still able to make decisions for yourself, and you decide you've changed your mind, you can absolutely withdraw or change your advance decision. You could do this by telling someone verbally or in writing. It's a good idea to make sure anyone who knew about your original decision is also aware of the change. Sometimes, people don't formally withdraw it but do something that clearly shows they no longer want it to apply. For example, if you've made an advance decision refusing a particular treatment, but then you start talking enthusiastically about wanting that very treatment, it suggests you've had a change of heart. The key here is that if you have the mental capacity to make decisions, your current wishes usually take precedence over any past written ones.

Changes In Circumstances Or Medical Understanding

Life happens, and medical science moves on. Sometimes, an advance decision might not be followed because the situation has changed in a way you couldn't have predicted when you made it. For instance, if you made a decision about a specific treatment, but a new, much safer or more effective version of that treatment becomes available, your original decision might not apply. Similarly, if your personal circumstances change dramatically – say, you become pregnant after making a decision about end-of-life care – that could also affect how your advance decision is viewed. Professionals have to consider if the new circumstances are so different from what you knew at the time that you would have made a different decision.

Detention Under The Mental Health Act

There's a specific carve-out for individuals who are detained under the Mental Health Act. In these particular circumstances, an advance decision might not be followed. This is a complex area, and it's designed to ensure that decisions about treatment for mental health conditions are handled appropriately within the legal framework of the Act. It doesn't mean your wishes are ignored entirely, but the specific rules of the Mental Health Act take precedence in these situations. It's always best to discuss this with a legal professional if you have concerns about how this might affect you. You can find more information about advance directives and their legal standing.

Advance Decisions Versus Other Legal Instruments

It's easy to get confused between different types of legal documents that relate to future healthcare wishes. While an advance decision is a powerful tool, it's not the only one, and understanding how it fits with others is important.

Distinguishing From Advance Statements

Think of an advance decision as a firm 'no' to specific treatments in certain situations. An advance statement, on the other hand, is more of a 'wish list'. It's a way to share your general preferences, values, or beliefs about your care, but it's not legally binding in the same way an advance decision is. For example, you might state in an advance statement that you'd prefer to be cared for at home if possible, or that you dislike a particular type of music. These are important for your care team to know, but they don't carry the same legal weight as refusing a specific medical intervention.

The Relationship With Lasting Powers Of Attorney

A Lasting Power of Attorney (LPA) is a bit different. This document appoints someone you trust – your 'attorney' – to make decisions on your behalf if you lose the mental capacity to make them yourself. There are two types: property and financial affairs, and health and welfare. It's the health and welfare LPA that often gets compared to advance decisions. While an attorney can make many decisions about your care, they cannot override a valid and applicable advance decision you've made. Your advance decision speaks directly about your wishes regarding specific treatments, and it must be respected.

It's really important that these documents work together. If you have an LPA, you should discuss your advance decisions with your appointed attorney. They need to understand your wishes and values so they can act in your best interests, which includes respecting any advance decisions you've made. You can find out more about Lasting Powers of Attorney and how they work.

When An Attorney Cannot Override Your Decision

So, when exactly can an attorney not override your advance decision? The key is that the advance decision must be valid and applicable to the current situation. If you've clearly stated you refuse a specific life-sustaining treatment in writing, signed it, had it witnessed (if refusing life-sustaining treatment), and it applies to the circumstances you're in, then your attorney must follow it. They can't simply decide they know better or that circumstances have changed in a way that contradicts your clearly stated wishes, unless specific legal exceptions apply (like you withdrawing the decision yourself while you had capacity).

Here's a quick breakdown:

• Advance Decision: You state specific treatments you refuse.

• Advance Statement: You share general preferences and values.

• Lasting Power of Attorney (Health & Welfare): You appoint someone to make decisions for you if you lose capacity.

It's vital to ensure all these documents are consistent and that anyone appointed as an attorney is fully aware of your advance decisions. This prevents potential conflicts and ensures your wishes are respected when you can no longer speak for yourself.

It's easy to get confused between Advance Decisions and other legal documents. While they all help plan for the future, they do different things. Advance Decisions are specifically about your medical treatment wishes if you can't speak for yourself later on. Want to know more about how these important documents can protect your choices? Visit our website today to get all the facts.

Wrapping Up: What Advance Decisions Mean

So, we've had a look at what advance decisions are, and sometimes what they're called, like 'living wills'. Basically, they're a way for you to make your wishes known about future medical treatments, just in case you can't speak for yourself later on. It's about having a bit of control, even when things get tricky. Making one means you've thought about what you'd want, and it gives your loved ones and doctors clear instructions. It’s not the most exciting topic, I know, but it’s pretty important for peace of mind, both for you and for those who care about you.

Frequently Asked Questions

What exactly is an advance decision?

An advance decision is a way for you to decide now about medical treatments you don't want to receive in the future, if you're ever unable to make those choices yourself. It's like a set of instructions for your doctors and nurses, ensuring your wishes are known and respected if you can't speak for yourself.

Are advance decisions legally binding?

Yes, if your advance decision is properly made and applies to your situation, it is legally binding. This means healthcare professionals must follow your instructions, just as they would if you were able to tell them your wishes directly.

Can I refuse life-sustaining treatment with an advance decision?

You can indeed refuse life-sustaining treatment, which is treatment that keeps you alive, like breathing machines or CPR. If you choose to refuse this type of treatment, your advance decision must be written down, signed by you, and also signed by a witness. You need to be very clear that this decision stands even if your life is at risk.

What's the difference between an advance decision and an advance statement?

An advance decision is specifically about refusing certain medical treatments. An advance statement, on the other hand, is a broader document where you can express your general wishes, preferences, or values for your future care. It might include who you'd like to be involved in decisions or what kind of environment you'd prefer, but it's not legally binding in the same way as an advance decision to refuse treatment.

What happens if my situation changes after I make an advance decision?

Healthcare professionals will check if your advance decision still fits the current situation. If things have changed significantly in a way you couldn't have predicted, and it's believed this would have changed your mind, the decision might not be followed. It's good to review your advance decision from time to time to make sure it still reflects what you want.

Who needs to know about my advance decision?

You decide who sees your advance decision, but it's really important that your family, carers, and healthcare team know about it and where to find it. This way, if it's needed urgently, they can quickly inform the medical professionals about your wishes.