There are two documents that you can put in place to ensure that your wishes are respected and followed if you are unable to make decisions about your medical care for yourself, an Advance Decision (AD) and a Health and Welfare Lasting Power of Attorney (HWLPA).
Advance Decisions (also known as Living Wills or Advance Directives)
An Advance Decision is a document that extends your right to refuse treatment to a possible future situation where you are unable to make a decision to refuse treatment at the time, due to coma, mental impairment etc. It is a legally binding document on healthcare professionals to prevent them giving you treatments that you have previously refused. You can specify the type of treatments you wish to refuse, and the conditions under which you refuse them. For example, you might choose to refuse all life sustaining treatment, including artificial feeding, hydration and breathing, if you have been in a coma for 3 months and there is a little prospect of you recovering to a level of quality of life which you specify.
MDMD recommends that everyone should complete an AD and give copies to their GP and next of kin, regardless of their age and health. None of us can predict the future. You may have a medical emergency later today which could put you in a state without mental capacity where your wishes to refuse treatment may not be followed if you do not have an AD. The case of Paul Briggs is a stark reminder to us all. You can update your AD later to reflect any changes in your situation or your views.
In addition, it is worth carrying an alert card in your wallet or handbag, notifying people that an AD exists and where it can be obtained. It is your way of informing people of what treatment you would like to refuse in the event that you are unable to tell them at the time. In addition to refusing treatment, you can request certain treatments, however it is only the refusals of treatment that are legally binding, anything else is advisory.
Health and Welfare Lasting Power of Attorney
A Health and Welfare Lasting Power of Attorney is a legal document that enables you to appoint one or more people to make decisions about your health and welfare on your behalf, if you are unable to make decisions for yourself. Your choice of attorney is important and should be someone who has a good understanding of your views on end of life care and is willing to make important decisions for you.
You can find out more about HWLPAs at this government website. Note that there are two types of LPA one for health and welfare issues, the other for managing your property and financial affairs. You can have either one or both, but only the HWLPA will allow someone to make decisions about medical treatment on your behalf when you are unable to make them for yourself.
Differences between AD and HWLPA
An AD only applies to the conditions and treatments that you specify in the AD. A HWLPA allows your attorney to make all decisions regarding your health and welfare. You can prepare both an AD and HWLPA in which case the one you have made most recently takes precedence. In practice you would hope that your attorney would follow any instructions you gave in your AD. The fact that an AD is written by you is useful as it provides a record of your views which can be seen directly by others, as opposed to relying on the word of a HWLPA to say “this is what they would have wanted”. The combination of the two, if you have a trustworthy person as your attorney, is likely to be the most comprehensive option.
See the October 2016 lecture given by Prof Celia Kitzinger, a leading expert in end-of-life planning.
Help is at hand
Free advice is available on issues to consider and how to complete ADs and HWLPAs from a number of charities including Compassion in Dying and Advance Decisions Assistance.
Compassion in Dying provide an on line advance decision form here.
- Advance Decisions provide documented evidence of your well established wishes.
- They help medical staff decide on appropriate treatment for you if you are not able to explain to them yourself at the time.
- ADs are legally binding on medical professionals.
- HWLPAs allow someone to speak for you in discussions with medical professionals to decide what would be best for you in the actual circumstances you are in.
Disadvantages and Limitations:
- MDMD would like to see the use of ADs extended so that someone can state their wish (or not) to have the option of an assisted death at some point in the future, and the criteria which they believe would make their life no longer worth living. The applicability of an AD would need to be extended to cover situations where someone still has mental capacity, but nevertheless is considered “vulnerable“. Such a statement would provide proof that the person has a long standing wish for the possibility of an assisted suicide, should they end up in a situation where their quality of life was permanently below the level they were prepared to accept. MDMD refer to this idea as an Extended Advance Decision.