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Advance decisions

If you wish to retain control of the treatment you are given when gravely ill, even if you are unconscious or otherwise unable to communicate your wishes, you may wish to make an Advance Decision. This gives you the ability to refuse certain types of medical treatment under certain circumstances, and may spare your loved ones a difficult decision at a harrowing time.

When you become ill, you can normally discuss treatment options with your GP or consultant and then arrive at a joint decision about your future care.

However, you may be admitted to hospital when unconscious, unable to communicate your wishes, or unable to make decisions over your treatment, either temporarily or permanently. This may be due to:

  • head injury, for example after a car accident or a fall
  • a stroke, or
  • the onset of dementia, such as Alzheimer’s disease

In these circumstances, you would lack “mental capacity” and your doctor would be obliged, both morally and legally under the Mental Capacity Act 2005 (MCA2005), to act in your best interests. This might involve administering “life-sustaining treatment” which could include giving you artificial hydration and nutrition if you are unable to eat or drink by mouth.

If you have made a valid Advance Decision refusing treatment, however, your medical team is bound to follow it whether or not they believe it to be in your best interests – even if your refusal is of life-sustaining treatment. Advance Decisions are governed by sections 24-26 of MCA2005 which specify:

  • the circumstances under which an Advance Decision may be made
  • the conditions for its validity
  • the consequences it has for the care you then receive

You do not have to make an Advance Decision, and can instead leave any decisions to the medical professionals providing your care. They must decide what is in your best interests, taking into account any evidence of your previous wishes, values and beliefs, and consulting your family, friends and carers where appropriate.

However, if you would like to ensure that a particular form of treatment is not offered, and the circumstances in which this decision should apply, then an Advance Decision can give you control over your own destiny. An Advance Decision can also spare your loved ones the burden of making the most difficult of decisions in extremely upsetting circumstances.

What an Advance Decision cannot do

Advance Decisions cannot be used to:

  • ask for anything illegal – e.g. euthanasia, or help to commit suicide
  • demand care which the patient’s medical team considers inappropriate
  • refuse the offer of food and drink by mouth
  • refuse the use of measures solely designed to maintain comfort, such as pain relief, warmth or shelter, or
  • refuse basic nursing care essential to keep the patient comfortable, such as washing, bathing and mouth care

Cancelling Advance Decisions

You may cancel an Advance Decision at any time, provided you retain the necessary mental capacity. We recommend that this is done in writing.

You should also review your Advance Decision on a regular basis to ensure that it takes into account the latest medical advances and your personal beliefs and preferences. Keeping your Advance Decision current will allow those providing your treatment to be confident that they are indeed following your wishes, and so it is advisable to re-sign and re-date your Advance Decision regularly, to record any changes in writing, and to ensure that anyone with a copy of your Advance Decision has the latest version.

treeNext steps

Contact us today on 07887 946 557 or online to discuss how Alex Truesdale Wills Limited can help you with a Will or associated service.