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Living Wills

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A living will lets you refuse specific types of care and ensures your wishes regarding future care and medical treatment are adhered to. A living will can give you more control over your end of life care and ensure your wishes are always respected. Below you will find information about living wills, also known as advance decisions in England, Wales and Northern Ireland and advance directives in Scotland.

What is an advance decision?

An advance decision, formerly known as and generally referred to as a living will, is a decision you can make now that lets you refuse specific types of medical treatment in the future if you become unable to make or communicate this decision later in life. It is sometimes also referred to as an advance decision to refuse treatment (ADRT). In Scotland, the term advance directive is used as opposed to advance decision.

An advance decision can be made by anyone who has the mental capacity to do so. It is advisable to discuss this with healthcare professional and close family. An advance decision informs your family, care workers and health professionals of your wishes to refuse certain treatment if you lack the mental capacity to communicate yourself. An advance decision lets you refuse any medical treatment except basic care, such as being offered food and drink by mouth, and includes refusal of life-sustaining treatment.

Life-sustaining treatments, which replaces or supports body functions and could keep you alive, include

Ventilation to help with breathing if you cannot do so yourself

Cardiopulmonary resuscitation if your heart stops

Antibiotics against infections

Clinically assisted nutrition and hydration

Chemotherapy or other cancer treatment

Organ transplant

In the UK you cannot ask for assistance to end your life, such as euthanasia and assisted suicide as they are illegal.

The decision can also not be used to give someone else the power to make decisions for you. If that is what you want, you will need to make a lasting power of attorney.

Each individual treatment you are refusing must be named and in what circumstances your decision applies. Your advance decision will only come in effect if you lose the capacity to communicate or make decisions about your treatment. In this event, the people caring for you are legally obliged to do as they are instructed.

In England and Wales an advance decision is legally binding provided it meets certain criteria, which means that if health professionals do not follow your instructions, they could face legal action. In Northern Ireland, similar rules apply. A living will in Scotland, commonly referred to as an advance directive, differs slightly from an advance decision.

Like an advance decision, the advance directive is used to refuse any future medical treatment should you wish to. This includes life-sustaining treatment, such as CPR if your heart stops and receiving food through a tube.

Advance directives are evidence of a person’s wishes about their care. This is important because if you lack capacity to make, understand or communicate a decision about your medical treatment, the doctor or other health professional must consider your past and present wishes, but are not bound by law to do so.

Making a living will

How to make an advance decision (living will) in the UK

The most important thing about an advance decision is to make sure that the relevant people are aware of it. Unless your doctor or other medical staff know about your decision, it will not be recorded in your medical files and your wishes may not come true. It's strongly recommended that you write it down and provide the relevant health professionals as well as your family and friends that you would like to inform with a copy. Always ensure that your decision is clearly written to avoid any issues in the future.

To refuse life-sustaining treatment, you must include a sentence stating that your refusal of specific treatments apply even if life is at risk as a result. You should also periodically review the document, which you are free to change, ensuring that your advance decision still reflects your wishes.

Although it's not mandatory, it's advisable to speak to a doctor before you make the decision who can inform you of the risks and benefits of refusing certain treatments. You don't need to use a solicitor, but it could be beneficial to seek legal advice as the rules can be complicated.

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What to include in your advance decision

You should always write down your advanced decision, remembering that it needs to be clear regarding what treatments you wish to refuse and in what situations. If you want to refuse life-sustaining treatment, such as CPR, you must state your living will applies even if your life is at risk as a result.

Things to include

Your name, address, date of birth and NHS number

Distinguishing features to help identify you quickly if necessary

Details of your doctor, such as name, surgery and contact details

Who you have discussed this with including family and friends

A detailed statement of what treatments you refuse and in what situations

An explaination, why you have made the advance decision

Requests regarding who should be involved in your care

Power of attorney details if applicable

Signatures from you and witnesses, including date, relationship to witnesses and address

All this information will provide health professionals with guidance as to how to care for you in specific events. They will know who to contact about your advance decision, such as your doctor and family members if your wishes are unclear.

It's very important to be as clear as possible in your statement and to avoid any words that are open to interpretation. Make sure that you note down exactly what treatments you want to refuse and when it applies.

If you write “I refuse all life-sustaining treatment” that will make it clear to a health professional and is not open to interpretation.

Explaining why you have decided to refuse specific treatment will help those involved in your care make decisions that are in your best interest and to avoid doubt.

Living Wills

What happens if I don’t have a living will?

If you have'nt made an advance decision and made your wishes clear about future treatments, healthcare professionals will be unaware of these. In this instance, you will not have the same control over decisions made about your care in the future. This then could result in a number of complications, including being kept alive against your will.

This could mean heartbreak both for you and your family members and friends.

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Frequently Asked Questions

What is a Living Will?

A Living Will, also known as an Advance Decision or Advance Directive, lets you refuse specific types of future care, such as life-sustaining treatment. A Living Will informs your family, care workers and doctors of your wishes to refuse certain treatment if you are unable to make or communicate the decision yourself.

How do you make a Living Will?

To make a Living Will, you must be over 18 and have the capacity to make the decisions and understand the consequences. Write down clearly and in detail the treatments you wish to refuse and in what situations and who you have discussed it with. Include signatures from yourself and witnesses and give copies to relevant health professionals and family members.

What should you put in a Living Will?

Write down any future treatments you wish to refuse and why, along with your name, address, date of birth, NHS number, who you have discussed it with and the people who should be involved in your care. If you want to refuse life-sustaining treatment, such as CPR, you must state your living will applies even if you may die as a result.

What happens if you do not have a Living Will?

If you lose the capacity to make decisions about your care and do not have a valid Living Will in place, you may receive treatment in the future to be kept alive even though it may be against your wishes.