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Advance decision, or living will

An advance decision, more commonly known as a living will, allows you to make important choices to be carried out when end of life medical decisions have to be taken. Jessica Tomlin describes the benefits.

Living Will

What is an advance decision?

An advance decision - formerly known as a 'living will' - is a document that enables health care professionals to know your treatment wishes should you no longer be able to communicate them.

Advance decision can also be known as advance directive.

The most relevant feature of an advance decision is the section that enables you to state that you wish to refuse treatment, including life-sustaining treatment, should you lose the capacity to make these decisions in the future.

Compassion in Dying have produced an advance decision document, including very helpful guidance notes.

My Last Song suggest you download the form.  Before you fill it in, discuss your decisions with your GP and close family members.

Why make an advance decision?

There are many benefits associated with making an advance decision, or more commonly, having a living will:

  • Taking control: Advance decisions give you more control of your end of life care and treatment;
  • Peace of mind: Advance decisions provide you and your family with the peace of mind that your wishes will be respected and that, in certain circumstances, your life will not be prolonged against their wishes;
  • Legally binding: Advance decisions have been given statutory force under the Mental Capacity Act in October 2007 so that any decision to refuse treatment is legally binding;
  • Better decision making: Making an advance decision is a good opportunity to discuss your wishes with close family and your doctor.

Limitations of advance decisions

An advance decision can't be used to:

  • ask for your life to be ended;
  • force doctors to act against their professional judgement;
  • nominate someone else to decide about treatment on your behalf.

As with advance statements, bear in mind that new drugs or treatments may be introduced in the future so you may wish to allow for new treatments even if refusing a current one.

Who can make an advance decision?

Anyone who is mentally competent and over 18 can make an advance decision.

You should review your advance decision regularly - perhaps every couple of years - to check that you are still happy with what it contains. You may want to change certain treatment requests or change your mind about refusing treatment.

Who should have a copy?

Five copies may seem a lot, but as with a will, it is vital that this document is found as soon as it is required to ensure your wishes are carried out. These are the people who you should give a copy to:

  • One copy to your GP;
  • One copy to a trusted friend;
  • One copy to a trusted family member;
  • One copy with your solicitor;
  • One copy to keep yourself. You can also carry a credit-card sized card stating that you have an advance decision.

Consider keeping a digital copy in your Lifebox. You will be the only person able to access it, and then update it if required.

You can give your second key holder permission to open your Lifebox when you feel you losing the capacity to make cohesive decisions about your end of life care.

Remember to replace old copies with new copies if you update your advance decision.

Resuscitation choices

An advance decision enables you to state the scenarios in which you would or would not wish to receive further treatment.

Examples are:

  • if you are terminally ill with no reasonable prospect of recovery;
  • if you suffer a serious mental impairment; or
  • if you are persistently unconscious for X amount of weeks.

In a Pro-Choice advance decision - which also lets you state which treatments you do consent to - you can also state any spiritual and personal wishes that you wish to be taken into account, although this section is purely advisory and not legally binding.

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