Advance Decision (Living Will)

If you were being kept alive in a coma, would you wish your nearest and dearest the trauma of deciding whether or not to continue your life-sustaining treatment?

An Advance Decision (also know as Advance Directive or Living Will) enables you to make these decisions for yourself in advance and spare your loved ones the responsibility and distress of having to make them for you.

An Advance Decision comes into play when you are not able, either temporarily or permanently, to make your own decisions about your treatment or to communicate your wishes to medical staff. This may happen, for example, if you have an accident, a stroke, or develop dementia.

In your Advance Decision you can state which medical treatments you would wish to refuse and the circumstances in which that refusal is to apply. You could, for example, refuse:

  • invasive procedures;
  • the use of intravenous fluids;
  • artificial ventilation;
  • CPR;
  • blood transfusion.

A properly written, signed and witnessed Advance Decision is legally binding on the medical profession.

With your Advance Decision you can include a general statement of your wishes and views. This allows you to state your preferences and indicate what treatment or care you would (rather than would not) like to receive should you be unable to decide or communicate your wishes in the future. It can include non medical things such as your food beliefs or preferences or whether you would prefer a bath to a shower.

It could reflect your religious or other beliefs and any aspects of life that you value. It can help those involved in your care to know more about what is important to you. It must be considered by the people providing your treatment, but they are not legally bound to follow your wishes.

You may also nominate a Health Care Proxy. This is someone who has the authority to represent your health care when you are unable to do so. However, the views of this person cannot override any valid and applicable request you have made to refuse treatment.

Advance Decisions and the Health and Welfare LPA

An Advance Decision states legally binding decisions that you have made on your own behalf. A Health and Welfare LPA empowers someone else (your Attorney) to make decisions for you within any conditions and restrictions you stipulate.

The only legally binding decisions you can make in an Advance Decision are those concerning the refusal of medical treatment; everything else is purely guidance. A Health and Welfare LPA is much broader, allowing your Attorney to make decisions about what medical treatment you may receive (as opposed to may not receive) and all aspects of your everyday care such as your diet, your dress, where you live and so on.

The best advice is to combine the two:

Make a Health and Welfare LPA and expressly exclude the ability to make decisions regarding life sustaining treatment which you make yourself in an Advance Decision. This way you retain control over those all important life-sustaining decisions and relieve your attorney of that terrible burden.

But remember:

Both Advance Decisions and Lasting Powers of Attorney must be made while you still understand what you are doing. You never know when they may be needed so don’t procrastinate.

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