Understanding Advance Decisions: What You Need to Know About Living Wills

Thinking about the future, especially when it comes to medical stuff, can be a bit of a head-scratcher. We all hope for the best, but sometimes, things don't go to plan. That's where something called an Advance Decision comes in. You might also hear it called a Living Will. It's basically a way to make your wishes known about medical treatments you might need down the line, just in case you can't speak for yourself later on. It sounds serious, and it is, but it's also a really sensible thing to get sorted.

Key Takeaways

• An Advance Decision, often called a Living Will, is a legally binding document that lets you say which medical treatments you don't want.

• It only kicks in if you lose the ability to make or communicate your own decisions.

• While you can refuse treatments, you can't ask for specific ones or ask someone else to make decisions for you; that's what a Lasting Power of Attorney is for.

• If you want to refuse life-sustaining treatment, your Advance Decision needs to be written down, signed by you, and witnessed.

• It's a good idea to talk to your family and healthcare providers about your Living Will so they know your wishes and where to find the document if needed.

Understanding Advance Decisions: What They Are

So, you've probably heard the term 'living will' or 'advance decision' thrown around, and maybe you've wondered what it's all about. Essentially, it's a way to make your wishes known about medical treatment, should you ever be in a situation where you can't speak for yourself. Think of it as a clear set of instructions for doctors and healthcare professionals.

What Is An Advance Decision?

An advance decision, often called a living will, is a formal document where you can state exactly which medical treatments you don't want to receive in the future. This is particularly relevant if you have a condition that might affect your ability to communicate your decisions later on, or if you have strong feelings about certain types of medical intervention. It's a legally binding document that speaks for you when you can't. It's not about planning for your death like a traditional will; it's about dictating your care while you're still alive but unable to make those choices yourself.

The Legal Standing Of Advance Decisions

In the UK, advance decisions are governed by the Mental Capacity Act 2005. For an advance decision to be legally valid, it needs to meet a few key criteria. You must be 18 or over when you make it, and you must have had the mental capacity to understand what you were agreeing to at that time. The decision itself needs to be clearly written, specifying the treatments you refuse and the circumstances under which that refusal applies. If you're refusing life-sustaining treatment, the document must be written down, signed by you, and also signed by a witness. It's important that the decision hasn't been made under duress and that you haven't done anything since to contradict it. If all these requirements are met, your advance decision takes precedence over decisions made by others in your best interest, even your doctors or family.

Advance Decisions Versus Advance Statements

It's easy to get advance decisions and advance statements mixed up, but there's a big difference. While an advance decision is legally binding, an advance statement is not. An advance statement is more like a wish list for your care. You can include things like where you'd prefer to be looked after, your likes and dislikes, or who you want to be consulted. Doctors and carers will take these statements into account, but they aren't legally obliged to follow them. An advance decision, on the other hand, is a firm refusal of specific treatments and must be followed if valid and applicable to the situation. It's worth noting that if you have a Lasting Power of Attorney for Health and Welfare, your appointed attorney will make decisions for you, but your advance decision can still guide their choices or take precedence in specific situations like refusing life-sustaining treatment [0b78].

Making Your Advance Decision Legally Sound

So, you've decided to get your affairs in order and make an advance decision, also known as a living will. That's a big step, and it's totally understandable to want to make sure it's done right. Getting it legally sound means your wishes will actually be followed when the time comes, which is the whole point, right?

Who Can Make An Advance Decision?

First off, you need to be 18 or over to make an advance decision. More importantly, you need to have the mental capacity to understand what you're doing when you make it. This means you can grasp the information relevant to the decision, appreciate the consequences, and communicate your choice. If you're unsure about your capacity, it's a good idea to chat with a doctor or other healthcare professional. They can help assess this.

Requirements For A Valid Advance Decision

To make sure your advance decision is legally binding, there are a few key things to get right. It needs to be written down, and crucially, it must clearly state which treatments you want to refuse and in what circumstances. If you're refusing life-sustaining treatment – the kind that keeps you alive – it needs to be signed by you and a witness. You also need to include a statement saying this refusal applies even if your life is at risk. It sounds a bit stark, but it leaves no room for doubt.

Here’s a quick rundown of what makes it valid:

• Age: You must be 18 or older.

• Capacity: You must have the mental capacity to make the decision at the time you create it.

• Clarity: Clearly state the treatments you refuse and the situations where this applies.

• Formality: If refusing life-sustaining treatment, it must be written, signed by you, and witnessed.

• Voluntary: It must be made freely, without any pressure from anyone else.

Making an advance decision is about taking control of your future healthcare. It's a way to ensure your personal values and preferences are respected, even if you can't voice them yourself later on. It's a powerful tool for maintaining your autonomy.

The Importance Of Clarity In Your Wishes

This is probably the most critical part. If your advance decision is vague or contradictory, doctors might not be able to follow it. They have a duty to act in your best interests, and if they can't be sure what those interests are based on your document, they might have to make a decision without it. So, be as specific as you can. Think about different scenarios and what you would want or not want in each. Talking through potential treatments with your doctor can really help clarify your thoughts. It's also a good idea to discuss your wishes with your family or anyone who might be involved in your care, so they know what to expect and where to find the document if needed. This helps avoid confusion and potential disagreements down the line. For more detailed guidance on writing a will, you can look at resources on writing a will.

What Can Be Included In An Advance Decision?

So, what exactly can you put into an advance decision, sometimes called a living will? It's all about specifying what medical treatments you do or don't want, especially in situations where you can't speak for yourself anymore. Think of it as your personal medical instruction manual for future healthcare professionals.

Refusing Specific Medical Treatments

This is the core of an advance decision. You can clearly state which treatments you want to refuse. This might include things like:

• Resuscitation: Do you want CPR if your heart stops?

• Artificial Nutrition and Hydration: Would you refuse feeding tubes or intravenous fluids if you couldn't eat or drink normally?

• Ventilation or Dialysis: Are there machines that support breathing or kidney function that you'd rather not use?

• Antibiotics: In certain situations, would you decline antibiotics?

It's really important that if you're refusing life-sustaining treatment, your advance decision is written down, signed by you, and witnessed. You also need to make it clear that this decision stands even if your life is at risk. This is a serious step, and getting it right is key to making sure your wishes are followed.

When making these decisions, it's a good idea to think about the specific circumstances under which you'd want to refuse treatment. For example, you might specify that you only want to refuse a particular treatment if you have a terminal illness and are unlikely to recover.

Palliative Care Preferences

An advance decision isn't just about refusing treatments; it can also be about what you do want. A significant part of this is often related to palliative care. You can state that you want to receive palliative care, which focuses on comfort and pain relief, even if that care might, as a side effect, shorten your life. This allows you to prioritise quality of life and dignity at the end of life, rather than the continuation of life at all costs. It’s about ensuring you’re comfortable and pain-free, whatever happens.

Organ Donation And Body Donation

While not strictly a medical treatment refusal, you can also use your advance decision to express your wishes regarding organ donation and body donation. If you want to donate your organs or your body for medical research or education, you can state this clearly. This avoids any confusion for your family and medical teams later on. It’s another way to have your final wishes respected and to contribute in a way that feels right to you. You can find more information on organ donation on the NHS website organ donation.

Making an advance decision is a powerful way to take control of your future healthcare. It gives you a voice, even when you can no longer speak.

How Your Advance Decision Works In Practice

So, you've gone and made an advance decision, which is brilliant. But what happens next? How does this document actually kick into gear when you might not be able to speak for yourself anymore? It's not like a will that gets read out after you're gone; this is about your care while you're still here.

When Your Advance Decision Becomes Active

Your advance decision only really comes into play when two things happen. First, you need to have lost the mental capacity to make or communicate your own decisions about your medical treatment. This could be due to illness, injury, or a condition that affects your thinking. Second, the specific situation you're in must match what you've written in your advance decision. For example, if you've stated you don't want a particular treatment if you have a severe stroke, then that's when the decision about that treatment would be guided by your advance decision.

Ensuring Your Wishes Are Known

This is a big one. Having an advance decision is one thing, but making sure the right people know about it and can find it when it's needed is another. It's no good if it's tucked away in a drawer nobody ever looks at. You should tell your close family, friends, or anyone who might be involved in your care about it. It's also a really good idea to let your GP and any other regular healthcare providers know. They can then make a note of it in your medical records. Think of it like leaving a map for your care.

The Role Of Family And Carers

Your family and carers often play a vital role, especially in emergencies. They might be the ones who have to quickly inform medical staff about your advance decision. While the decision itself is legally binding, they can help by making sure it's presented clearly and promptly. They aren't making the decision for you, but they are helping to make sure your pre-stated wishes are heard and acted upon. It can be tough for them, so having clear instructions from you beforehand can ease their burden.

It's important to remember that an advance decision is a legally binding document. If it's valid and applies to your situation, healthcare professionals must follow it. They can only override it in very specific, limited circumstances, usually if they believe you no longer have the capacity to make decisions and the advance decision doesn't cover the current situation, or if it's no longer valid.

Here's a quick rundown of what to do:

• Tell people: Inform your GP, hospital doctors, and your next of kin about your advance decision.

• Keep copies: Have copies readily available. You might keep one with your important papers, give one to your doctor, and let a trusted friend or family member have one too.

• Review it: Life changes, and so might your wishes. It's a good idea to look over your advance decision every few years or if your health circumstances change significantly.

Advance Decisions And Other Legal Documents

Living Wills And Lasting Power Of Attorney

It's easy to get confused between different legal documents that help you plan for the future, especially when it comes to healthcare. An Advance Decision, often called a Living Will, is one piece of the puzzle. Then there's the Lasting Power of Attorney (LPA) for Health and Welfare. They sound similar, but they do different jobs. An LPA lets you appoint someone you trust – an attorney – to make decisions about your care if you can't yourself. This could be anything from where you live to what medical treatments you receive. An Advance Decision, on the other hand, is more specific. It's your direct instruction about treatments you don't want, under certain circumstances. Think of an Advance Decision as a veto, and an LPA as appointing a decision-maker.

How Advance Decisions Interact With LPAs

So, how do these two work together? If you have an LPA for Health and Welfare, your appointed attorney will generally make decisions for you if you lose capacity. However, your Advance Decision can override their choices in specific situations. For example, you might have an LPA appointing your daughter to make decisions, but you've also made an Advance Decision stating you don't want any blood transfusions, even if your daughter thinks it's best. In this case, your Advance Decision takes priority for that specific treatment.

It's really important that your attorney knows about your Advance Decision. They need to be aware of your wishes so they can act in accordance with them, even if it means disagreeing with medical advice. If there's a conflict, the Advance Decision usually wins out for the specific treatments it covers.

When An Advance Decision Takes Precedence

An Advance Decision is legally binding, provided it's valid and applies to the situation you're in. This means healthcare professionals must follow it. If you've clearly stated you don't want a particular life-sustaining treatment in a specific scenario, and you've met all the legal requirements (like getting it witnessed if it's life-sustaining treatment), then that decision must be respected. It overrides any other decision, including one made by your appointed attorney under an LPA, or even a decision made by doctors in your 'best interests' if you've lost capacity.

Here's a quick rundown:

• Advance Decision: Your direct, legally binding instruction to refuse specific treatments.

• LPA for Health and Welfare: Appoints someone to make decisions for you when you can't.

• Interaction: The Advance Decision usually takes precedence for the specific treatments it covers, even if your LPA attorney disagrees.

It's not uncommon for people to have both an LPA and an Advance Decision. This combination offers a robust way to ensure your wishes are known and respected, covering both general decision-making and specific treatment refusals. Making sure all these documents are clear and communicated is key.

Communicating Your Advance Decision

So, you've gone through the process of making an advance decision, or a living will as it's often called. That's a big step, and it's great that you're thinking ahead. But honestly, just having the document tucked away in a drawer isn't quite enough. For it to actually work when you need it to, people have to know it exists and where to find it. It’s like buying a fire extinguisher but never telling anyone where you keep it – pretty useless in an emergency, right?

Talking To Your Relatives About Your Living Will

This is probably the most important bit. You need to have a chat with your family, or whoever is closest to you. Don't just spring it on them when things get serious. Having open conversations beforehand means your loved ones will understand your wishes and won't be caught off guard. It can be a difficult conversation, no doubt about it, but it’s a necessary one. Think about what you want to say and how you want to say it. You might want to explain why you've made certain decisions, especially if they might seem unusual to them. It’s also a good idea to give them a copy or tell them exactly where the original is kept. This way, if a situation arises where your advance decision needs to be used, they can quickly provide it to medical staff. It’s about making things as easy as possible for them during a stressful time.

Informing Your Healthcare Professionals

Your doctors and nurses need to be aware of your advance decision. When you make one, especially if it involves refusing life-sustaining treatment, it's a good idea to discuss it with your GP or the relevant medical team. They can then make a note of it in your medical records. This is really important because if you're ever admitted to hospital or need medical attention, the healthcare professionals involved can check your records and see your wishes. It helps them make sure they're following your instructions. You can also ask them about your medical decisions and how they align with your advance decision.

Keeping Copies Accessible

Having your advance decision readily available is key. Think about where you'll keep the original document and where you'll keep copies. It’s not just about having it, but about making sure the right people can get to it when it matters.

Here are a few ideas:

• Keep the original in a safe place at home, like a fireproof box or with your important legal papers.

• Give a copy to your next of kin or a trusted friend.

• Provide a copy to your solicitor if you have one.

• Ask your GP or hospital to keep a copy on file and note its existence in your medical records.

It's not enough to simply create an advance decision; its effectiveness hinges on clear communication and accessibility. Without it, your carefully considered wishes might not be known or acted upon when you most need them to be.

Remember, the goal is to make sure your voice is heard, even if you can't speak for yourself. Making your advance decision known is just as important as making the decision itself.

Making sure your wishes are known is really important. This section helps you understand how to tell people about your advance decision. It's about making your preferences clear so they can be followed.

Don't leave it to chance; ensure your voice is heard. Visit our website today to learn more about how to communicate your advance decision effectively and get the support you need.

So, What's the Takeaway?

Right then, we've gone through what a Living Will, or Advance Decision, actually is and why it's a good idea to sort one out. It's basically your way of saying what you want, or don't want, when you can't speak for yourself anymore. It’s not the easiest topic to think about, I know, but getting it sorted can really take a load off your mind and, more importantly, your loved ones. Make sure you chat with your family about it too, so there are no big surprises down the line. It’s all about making sure your wishes are heard, even when you’re not around to say them yourself. Give it some thought, yeah?

Frequently Asked Questions

What exactly is a 'Living Will' or Advance Decision?

Think of a Living Will, or Advance Decision, as a way to tell doctors and nurses what medical treatments you do or don't want in the future, especially if you can't speak for yourself later on. It's a legally binding document that makes your wishes clear, so your healthcare team knows exactly how to look after you.

Can I refuse any medical treatment with an Advance Decision?

You can refuse specific treatments, like things that keep you alive artificially, such as breathing machines or artificial feeding. However, you can't use it to ask for a specific treatment or to refuse basic care like comfort or pain relief. It's mainly about saying 'no' to certain medical interventions.

Does my Advance Decision need to be written down?

Yes, it always needs to be written down. If you're planning to refuse treatments that keep you alive, like CPR, your document needs to be signed by you and a witness. It's a good idea to have it written down anyway, to make sure your wishes are understood clearly.

What's the difference between an Advance Decision and an Advance Statement?

An Advance Decision is legally binding – doctors have to follow it. An Advance Statement, on the other hand, is more like a set of strong suggestions. It can include things like where you'd like to be cared for or what makes you happy, but healthcare staff aren't legally required to act on it, though they should consider it.

Who should know about my Advance Decision?

It's really important that your family, friends, or anyone who might be looking after you knows you have an Advance Decision and where to find it. You should also make sure your doctors have a copy. This way, if something happens, they can quickly find it and follow your instructions.

Can I use an Advance Decision to appoint someone to make decisions for me?

No, an Advance Decision can't be used to appoint someone else to make decisions for you. For that, you'd need a separate legal document called a Lasting Power of Attorney for Health and Welfare. This allows you to choose someone you trust to make medical and care decisions on your behalf if you can't.