What Is A Living Will?
A living will (or advance decision or advance directive as it is otherwise known), is a document in which you can record your decisions as to the types of medical treatment you intend to refuse in the event that you do not have the capacity to communicate the decision yourself, for example: CPR, life support and the treatment of life-threatening infections. The treatments you are deciding to refuse must all be listed in the advance decision.
You may want to refuse a specific treatment in some situations but not others. If this is the case, you need to make clear all the circumstances in which you want to refuse this treatment.
Once made, the statement, provided it is valid and legally applicable providing it has been signed by a witness.
Who Can Make A Living Will?
Anyone over the age of 18 who has mental capacity is able to implement a living will. Once the document has been signed and witnessed, it will take immediate effect.
You may want to make an advance decision with the support of a medical professional.
If you decide to document your refusal of life-sustaining treatment in the future, your requirements need to be:
- Written down
- Signed by you
- Signed by a witness
If you wish to refuse life-sustaining treatments in circumstances where as a result you might die, this needs to be stated clearly. It is a good idea to talk to a doctor or nurse about what kinds of treatments you might be offered in the future. They will explain to you what it could mean if you choose not to have them and make sure you know what you are agreeing to.
It is important to recognise that a living will only applies to the treatments and circumstances that are included in the document. Consequently, a lot of thought should be given to the content of the statements included in the document.
What Can’t A Living Will Do?
A living will cannot nominate another person to make decisions on your behalf. They cannot request a particular medical treatment, or refuse basic treatment and the administration of food and water.
It is important to acknowledge that a living will only applies to those treatments and circumstances that are included in the document, and consequently, careful thought must be given to the content of the statements included in the document.
If you were to be suffering from a medical condition, or find yourself in a position that has not been specified within the document, then it will be for the treating doctor to determine what course of action fits your best interests.
If any part of your statement has been left open to interpretation, it may affect the legality of the document.
Although a living will can be put in place at any time that you have the mental capacity to do so, it is best put in place well ahead of time, so you have the time to carefully consider your directions and speak with your GP, as well as your family and friends, about your decisions.
How Long Is My Living Will Valid?
If something happens after you’ve made your living will that would have affected what you wrote within it, it may no longer be applicable. If new life saving treatments have been developed for example, this could affect the decisions that you made.
If you have acted inconsistently with what you’ve written in your Advance Decision (such as change religion/have a massive lifestyle change), it may raise doubts over whether you wish to abide by what you have written.
These are just a couple of reasons why it is a good idea to review update your Advance Decision every now and then. The more recent and accurate it is, the more likely it is to reflect your ongoing wishes.
CPR and DNACPR (do not attempt cardiopulmonary resuscitation)
CPR is a form of life saving treatment that attempts to start breathing and blood flow in people who have gone into respiratory arrest or cardiac arrest (or both).
CPR can involve:
- Chest compressions
- Electrical shocks to stimulate the heart
- Injections of adrenaline
- Mouth to mouth breathing
In hospital, around 2 out of 10 people survive CPR, however, survival rates are usually lower in other settings. A lot of the time there will be no benefit from CPR at all but the emergency services will attempt it just in case. A lot depends on the reason your heart and breathing has stopped. Any underlying illness or medical issues you have, and your overall health could affect the outcome.
Your healthcare team will discuss the likely chance of CPR working for you and/or the possible outcomes; even when CPR is successful, a person can develop serious complications and suffer a diminished quality of life thereafter. In extreme cases a patient could suffer damage to the liver and spleen and brain damage leading to long term disability.Ithe very sick and elderly, it is understandable that this outcome would not always be the patient’s desired outcome.
Having CPR but then needing high-intensity medical support afterwards, possibly a treatment in an intensive care unit (ICU) would only add to suffering.
Everyone has the right to refuse CPR if they wish. You can make it known the circumstances in which you wish you don’t want to have CPR such as if you stop breathing or your heart stops beating. This is known as a do not attempt cardiopulmonary resuscitation (DNACPR) decision, or DNACPR order and is recorded on a standard form made for this purpose.
It is a good idea to let your family or other carers know about your DNACPR so it doesn’t come as a surprise to them should the circumstances arise.
In the event that you do not have the capacity to decide about CPR but haven’t made an advance decision to refuse treatment, the medical team may consult with your next of kin about how to proceed in your best interests.
A DNACPR can be withdrawn at any time.
Lasting Powers of Attorney
A Lasting Power of Attorney (LPA) allows you to give someone you trust (usually a close family member) the legal power to make decisions on your behalf if at some point in the future you become unable to make decisions for yourself. The person signing over LPA is known as the ‘donor’ and the person given the power to make decisions is called the ‘attorney’. There are two different types of LPA:
- An LPA for Property and Financial Affairs covering decisions about money and property.
- An LPA for Health and Welfare covering decisions about health and personal welfare.
Health and Welfare Lasting Powers Of Attorney (LPA)
There are many reasons someone might not be able to make decisions for themselves. They could become unconscious, suffer a brain injury or have dementia for example. If this is the case, the person affected is said to lack ‘capacity’.
The term ‘lack of capacity’ applies if a person cannot:
- Understand information relating to a decision
- Retain that information for long enough to make the decision
- Take that information into account when making the decision
- Communicate a decision.
The Mental Capacity Act states that people be assumed to have capacity unless proven otherwise.
In an LPA for Health and Welfare, your attorney can make decisions with regards to your health and personal wellbeing such as medical treatment, what care you receive and where you live, as well as day-to-day activities and what you eat. You can make it known beforehand of course and provide instructions that your attorney must follow in the future. You must also decide whether you want your attorney to make decisions about life-sustaining treatment. If not, then all life-sustaining treatment will be decided upon by your healthcare team, unless you have made an Advance Decision to Refuse Treatment. See above
Property And Financial Affairs Lasting Power Of Attorney
This kind of LPA gives the attorney power to make decisions about money and property for you, which might include:
- Managing a bank or building society account
- Paying bills
- Collecting benefits or a pension
- Selling your home