Living wills - Advance Directives

Advance Directives are growing in popularity because they offer a way for individuals to retain personal autonomy at the end of life, and to maintain some degree of choice and control.

Sometimes called a "Living Will", the advance directives can express your wishes to your doctor in the event of there being no reasonable prospect of recovery from serious illness or injury resulting in severe pain and distress or rendering you incapable of a rational existence.

Making a decision to refuse treatment

If you're 18 or older, you can make an Advance Decision to Refuse Treatment (ADRT) specifying which treatments you don't want in future and the circumstances in which this would apply. This is one type of a document known as an advance directive.

Advance Directives inform people of your views about any aspect of your life and care should you no longer be able to do so yourself, from generalities about the sort of food you'd like to be given to preferences about how you're washed or dressed.

An ADRT, focusing on refusal of treatment, is also known as an advance directive or 'living will' and, when the Mental Capacity Act is fully implemented in the Autumn of 2007 it will be the only type of advance directive that is legally binding.

An ADRT is used to record a decision to refuse artificial life support, resuscitation or drugs such as antibiotics, even if this hastens death. Advance directives can only be about refusing treatment because you're not allowed to request or demand specific medical treatments, including any form of euthanasia.

The Mental Capacity Act includes a code of practice covering ADRTs. For example, under the Act ADRTs can generally be either verbal or written but if they involve refusal of life-saving treatment (which will apply to many ADRTs) they must be in writing, signed (you can direct someone else to sign for you) and witnessed, with a statement that the decision stands even if your life's at risk.

Doctors are required to act in the best interests of patients who've lost mental capacity. This might mean over-riding a person's requests in certain situations, for example, if a recent development in treatment radically changes the outlook for their particular condition.

An ADRT can be drawn up before an illness and still be valid and applicable if you become ill. It can also be the result of a discussion between a patient and their doctor. However it's drawn up, it must adhere to the code of practice.

The patient's decisions should always be recorded in their medical notes or in an electronic record and fully witnessed and signed if necessary (see above).

You can nominate someone to speak to the doctor on your behalf if you're incapable of doing so yourself.

In thinking about making an ADRT, you may want to consider such questions as:

What if I become too sick to eat except through a tube?

What if I can't talk or write or signal my thoughts?

Ideally, your decisions should be known and understood by your family, GP and the people who provide your care. They can be shared with your local hospital and ambulance service too, and only become active when you're unable to understand the issues and/or make an informed decision or give consent in the normal way (perhaps because you are unconscious, for example).

Bear in mind that new treatments may be introduced in future that could affect your decision. Review your ADRT regularly to ensure it's still an accurate reflection of your decisions. You can always change your mind, but be sure to let people know.