What is an advanced decision?

An Advanced Decision is different to an Advance Statement – for which it’s often confused. Whereas an Advance Statement is largely focused more on your daily routine, an advance decision relates to a specific decision that may occur later in life.

Usually, this is to do with medical treatment. This can, for example, be denying a course of clinical intervention that could ultimately prolong your life. It means you can ensure your wishes are known to your family and the health care professionals treating you, if you’re unable to communicate this yourself

Provided the person instructing the advanced decision is of sound mental capacity upon its completion, the doctor or nurse responsible will have no legal grounds to oppose. That said, for it to be accepted the specific circumstances need to be spelt out. To help you with this, it can be worthwhile employing the services of a legal professional, such as a solicitor or lawyer.

For those with early-stage Alzheimer’s, for example, making an advance decision can be an extremely unnerving experience. However, as with an advance statement, it’s really important to get completed before the disease progresses and mental capacity is lost.

Any adult with capacity can make an Advance Decision (Living Will). There’s no set form for making an Advance Decision and you can write one yourself as long as it meets the requirements needed to be ‘valid’ and ‘applicable’.

What does an Advanced Decision cover?

Your Advanced Decision can cover a large range of wishes. However, in the clinical context, the treatments you’re deciding not going to be taken must all be specifically detailed. There may be some situations in which you want to refuse treatment, yet others where you’d like to accept it. It’s essential you’re clear about these contexts – that’s why it’s advisable to seek professional legal support in drafting it.

People often use Advanced Decisions to detail whether or not they’d like to undergo what’s termed ‘life-sustaining treatment’ that may keep them alive.

• Going onto a ventilator – this is often used in situations where someone has developed a condition where they’re struggling to breathe, for example, pneumonia.
• Having cardiopulmonary resuscitation (CPR) performed – this is often used in situations where your heart stops.
• Taking a course of antibiotics or antivirals – these are often administered when your body is fighting an infection or virus respectively.

How do you make a living will?

To make an Advanced Decision, it’s best to contact a legal professional. When deciding on who to go to, we’d always recommend choosing a household name that you can trust, such as Cooperative Legal Services.

To make an Advance Decision you should:

• Consider the contexts in which you’d like to refuse treatment – this could be, for example, once you’ve lost mental capacity and are faced with a situation such as not being able to breathe.
• Discuss your options with your family – it’s never easy to discuss death with your family. However, it will avoid confusion later on if you sit down and have a discussion about what you’d like to happen if the worst comes to the worst. This will make it easier for your family to understand what to do when the time comes.
• Complete Advanced Decision – you can draft an Advanced Decision with the support of a legal professional or using Compassion in Dying’s template. For it to be valid, it must be written down and signed by you along with a witness. If you want to refuse life-sustaining treatment you must include a sentence that states that your refusals apply even if your life is at risk or shortened as a result
• Give copies of your Advanced Decision to relevant people – you should give a copy to everyone involved in your care and support. That should include your GP, Occupational Therapist and Social Worker. And, critically, your carer.

When is an Advanced Decision applicable?

You must lack capacity to make the decision, and

• Your Advance Decision must include details of the specific circumstances you are in and refuse the treatments that your doctor has proposed for you, and
• There must be no reason to believe that something has happened since making your Advance Decision which would have affected the decisions you made. For example, if there have been developments in medical treatment that you did not expect.

When is an Advanced Decision valid?

An advance decision may only be considered valid if you:

• are aged 18 or over and had the capacity to make, understand and communicate your decision when you made it
• specify clearly which treatments you wish to refuse
• explain the circumstances in which you wish to refuse them
• sign it (and by a witness if you want to refuse life-sustaining treatment)
• have made the advance decision of your own accord, without any harassment by anyone else
• have not said or done anything that would contradict the advance decision since you made it (for example, saying that you’ve changed your mind)