Advance directives

An 'advance directive' (also called an 'advance decision' or 'living will') allows you to refuse a specific medical treatment some time in the future, should you lose the capacity or ability to communicate your wishes regarding that treatment. If you intend this to apply to the refusal of a possible life sustaining treatment then the directive must be in writing, signed and witnessed. This may apply to you if you wish to refuse cardiopulmonary resuscitation (CPR), ventilatory support (life support machine) in the event of breathing difficulties, or the insertion of an artificial feeding tube (called 'percutaneous endoscopic gastrostomy' or PEG tube for short) that gives you the sustenance you need if you can no longer eat or swallow safely.

An advance directive is legally binding if it meets the following conditions:

• You are over 18
  
• It is clear
  
• It was made when you were mentally competent and you had been fully informed about the consequences of refusing treatment, including the fact that it may hasten death
  
• You intended the refusal to apply in the situation that has arisen
  
• The decision was made by you, on your own and not under the influence of others

 

What needs to be included in advance directives?

There are no fixed legal requirements regarding the format of advance directives, but the British Medical Association suggests that the following should always be included:

• Full name
  
• Address
  
• Name and address of GP
  
• Details of whether advice was sought from health care professionals when drawing up the directive
  
• Signature
  
• Date drafted and reviewed
  
• Witness signature
  
• A clear statement of your wishes, either general or specific
  
• The name, address and telephone number of any person nominated as an attorney, if there is one
  
• If relevant, the date of any revisions or changes to the directive, including appropriate signatures to validate the changes

An advance directive does not have to be drawn up by a lawyer to make it legal, although where there is uncertainty a lawyer may be able to help ensure that views are clearly expressed. Consultation with a doctor is not essential but may be useful to explore treatment options and demonstrate that an informed decision-making process has occurred. However, it is generally advised that it is in written format, as casual remarks about health care can not be used as the basis of an advance directive. The directive also needs to be regularly reviewed and should be updated as and when a person's wishes change. It only comes into force when a person with severe MS is unable to make or communicate a decision.

 

Advance statements

Advance statements are general statements of your views or wishes. You can make an advance statement to request certain forms of medical intervention and make positive statements about the range of treatments and types of care you wish to receive in the event that you lose capacity to express your views in the future. For example, if you are concerned that you may not be resuscitated in certain situations where breathing or circulation has stopped, you may want explicitly to state that you wish to be resuscitated. Alternatively, you may wish to specify your feelings about the type of residential care you may be placed in. These statements are not legally binding. However, health and social care professionals are obliged to consider them.  

Assisted dying

Advance directives often become confused with the euthanasia and assisted suicide debate. This is in part because the Voluntary Euthanasia Society (now known as 'Dignity in Dying') was one of the first organizations to develop a set format for writing advance directives. Advance directives actually allow you to take some control over end-of-life decisions, which may involve life-prolonging treatment. Advance directives do not permit illegal actions and are not concerned with taking measures to end a person's life. At present, euthanasia and assisted suicide are illegal under British law. 

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