ADVANCE DECISIONS

An advance decision (sometimes referred to as a ‘living will’) lets you avoid specified medical treatment which you don’t want in the future. So should you be unable to make a decision, because you’re incapacitated, you won’t be subjected to a treatment you’d never want. This can apply even with life-saving emergency treatment. But you need to specify the circumstances. And it all needs to be witnessed, signed and dated as you’d expect.

Advance decisions actually can be a huge help, and a relief, for not just those who make them but for relatives and healthcare professionals who might otherwise not know what to do for the best, in your interests, or what you’d want. On a purely selfish level they will stop you worrying, and being anxious or frightened about a loss of control in respect of what happens to you, when you are approaching the end of your life.

To make an advance decision you have to be an adult of 18 or over, must be of sound mind, and not show (inadvertently or otherwise) evidence of behaviour that suggests you don’t know what you want from one moment to another. Your motives to refuse treatment can be based on religious, spiritual or cultural beliefs which you don’t need to explain to anyone.

Your decisions override anything that a friend or relative or healthcare professional might think you’d want. Or what they might believe is best for you. If you are ignored then there would ordinarily be consequences in a criminal or civil court, or disciplinary proceedings. Yet that advance decision can be subsequently overridden by a Lasting Power of Attorney (LPA).

You decide. Yet only to refuse treatment(s). Not demand any. Or not to force healthcare professionals to do something that amounts to euthanasia.

What Could Happen to You, in a Worst-Case Scenario, Without an Advance Decision?

What might happen without an advance decision is our own worst fear. Or living nightmare. Often it’s being ‘locked in’ and unable to communicate from a persistent vegetative state. Being aware but unable to move when assumed to be in a coma. Being brain-dead but kept alive on life-support. Being brain-damaged by a stroke or other incident that leaves us well short of being the person we are. Being stuck forever in a wheelchair or in a cot, drooling, needing to be taken to the toilet and be spoon-fed mashed-up rusks. Being stuck in front of a TV and made to watch ‘Big Brother’. Or left beside a radio listening to Zoe Ball or Paul O’Grady. Can you imagine anything worse? Probably not.

When Are Advance Decisions Applicable? 

• only apply to proposed and impending treatment(s)
• They only apply if you are definitely incapacitated when the listed treatment(s) might be used
• They only apply if it’s assumed that nothing materially has changed that would have left you making a different decision were you capable of doing so.

Who Would Give Me Impartial Medical Advice Before I Made an Advance Decision?

Before making an advance decision you ought to talk with your GP or relevant specialists about any potential treatments as well as the likely consequences of both having and not having them. They should give you impartial medical advice. Very often they will be able to speak about the probability of outcomes in most scenarios because they will have access to the statistics. And they will be familiar with what the NHS calls an advance decision to refuse treatment or ADRT.

Where Can You Find Out More About Advance Decisions?

You can find out more on ADRTs at Goodwills though the NHS website will tell you a lot at www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/.