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 Decisions, often known as a Living Will. 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 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. This may not accord with your wishes.
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.