These types of advance medical directive or decisions all sound very similar and as far as the public are concerned, they are. But in terms of what is fully legally effective, times have changed since the Mental Capacity Act of 2005.
In most cases, a Health and Welfare Lasting Power of Attorney is more flexible and offers far wider protection. But that is not what the more informed users of advance directives and Living Wills are looking for. Advance Medical Directives etc are generally used when people have specific concerns or fears on a specific medical matter.
For example, Jehovah’s Witnesses believe that the Bible prohibits ingesting blood and that Christians should not accept blood transfusions or donate or store their own blood for transfusion. It would be common for them to have the appropriate advance medical directive in place. You can use an Advance Directive to refuse any medical treatment including life-sustaining treatment.
Life-sustaining treatment may include:
- cardiopulmonary resuscitation (CPR) if your heart stops.
- being put on a ventilator if you cannot breathe on your own.
- being given food or fluids artificially, for example through a drip, a tube through the nose or through a tube directly into the stomach.
- antibiotics for a life-threatening infection.
Only Medical Directives set up correctly under the legislation have any legal power, and usually, we would recommend the Health Lasting Power of Attorney. But Advance Medical Directives/ Living Wills are much faster to set up and cheaper, so they certainly have their uses.
What is an advance decision?
An advance decision (or advance decision to refuse treatment, an ADRT, or a living will) is a formal written decision you can make now to refuse a specific type of treatment at some time in the future. It lets your family, carers and health professionals know your wishes about refusing treatment should you be unable to make or communicate those decisions yourself should the time come.
You may want to refuse a treatment in some situations, but not others. If this is the case, you need to be crystal clear about all the circumstances in which you want to refuse this treatment. Lasting Powers of Attorney can be much more flexible, allowing your attorneys to make decisions based on what they believe your wishes would have been when unexpected circumstances arise. You can’t cover every possible scenario in a medical directive!
An advance decision isn’t the same as an advance statement. More on advance statements below.
Deciding to refuse a treatment isn’t the same as asking someone to end your life or help you end your life. Euthanasia and assisted suicide are illegal in England.
Is an advance statement the same as an advance decision?
No. An advance decision (also known as a living will, or advance decision to refuse treatment) is a decision you can make now to refuse specific treatments in the future.
An advance decision is legally binding, as long as it meets the necessary criteria for it to be considered valid and applicable.
Who makes an advance statement?
You write an advance statement yourself, as long as you have the mental capacity to make these statements. You can write it with support from relatives, carers, or health and social care professionals.
Is an advance statement legally binding?
No, an advance statement is not legally binding, but anyone who is making decisions about your care must take it into account.
Lasting Powers of Attorney Health and Welfare are a much broader version of a living Will.
Advance Directives (Medical Directive) (often known as Living Wills in the UK) An alternative view, which we understand but have concerns that Health and Welfare Lasting Powers of Attorney cannot be registered quickly in an emergency. But this is their view:
Advance directives are a badly underused and most important facility, which can go part way towards offering what a Personal Welfare Lasting Power of Attorney will do, at far lower cost: indeed, we believe it is sensible to write both as it costs up to £82 to register EACH LPA, and registration may never be required if a Medical Directive (which does not require Registration) is in place. as most people concentrate on the least important aspect of them. They can accomplish two things:
- Putting someone you appoint in charge of your medical decision making if you are unconscious or otherwise rendered incapable. Without the appointment of a Medical Proxy, no one has any rights – not your husband, wife, partner or children. They may be consulted, but their opinions have no real weight. The British Medical Association has made it a disciplinary offence to disregard a properly appointed Medical Proxy. So everyone over 18 should appoint one, and single people and unmarried couples should consider doing so vital.
- Making your views on treatments known in advance – some people have very strong views, others do not, and the Advance Medical Directive / Living Will can be tailored to give Medical Proxies wide latitude or none.