What is an Advance Decision?
An Advance Decision is used to specify situations where you would want to refuse particular kinds of medical treatment in the future. If you find yourself in circumstances where this medical treatment is required, and you do not have the capacity to consent or refuse consent at the time, your Advance Decision would take effect.
This could be because you have suffered an accident, are unconscious, or you are suffering from a condition that means you are no longer mentally capable to make decisions about the medical treatment you receive.
You always have the right to choose how – or even if – you are treated. An Advance Decision is a way to insure against the possibility that you are unable to make your choice, or unable to communicate it, at the time in question. It effectively moves the time of your choice forward, to a point where you have the mental capacity to make your decision.
Every Advance Decision is different because it is tailored to reflect the views of the person who has made it. Many people have strong beliefs in relation to certain kinds of medical treatment.
Examples of treatments which could be subject to an Advance Decision include:
- Blood transfusions.
- Kidney dialysis.
- Organ transplants.
- Artificial nutrition (administered intravenously).
- Life-sustaining treatment.
It is important to note, however, that although you can specify circumstances in which you would want to refuse life-sustaining treatment, you cannot use an Advance Decision to request or authorise assisted dying.
A valid Advance Decision will be legally binding on the healthcare professionals who are treating you. This means they will have to follow it as though you had made this decision at the time in question.
How do I make an Advance Decision?
You must meet certain requirements to be able to make an Advance Decision for it to be valid. If your Advance Decision includes any refusal of life-sustaining treatment then there are additional requirements. All of these requirements are detailed in the Code of Practice to the Mental Capacity Act 2005, summarised as follows:
- You must be aged 18 or over
- You must have mental capacity at the time you are making the Advance Decision. For more information have a look at our factsheet on ‘Mental Capacity’.
If you are refusing life-sustaining treatment, your Advance Decision:
- Must be in writing.
- Must be signed and witnessed.
- Must clearly state that your decision applies even if your life is at risk.
Although not actually required, it can be helpful in some cases to include an explanation of your wishes, for example, stating that it is based on your religious beliefs. This provides context to your decision, which can be helpful if any disputes arise as to whether the Advance Decision represents your true feelings.
For an Advance Decision to take effect, your loved ones and your doctors must be aware of it. It is a good idea to tell your loved ones you have made an Advance Decision and discuss this with them. You should also inform your doctor and make sure a copy of your Advance Decision is lodged with your medical records.
In addition, if you make an Advance Decision, you should also keep it under review. Your feelings or wishes might change in future. If so, you should update or cancel your Advance Decision as soon as it no longer represents your intentions.
You do not need a solicitor to make an Advance Decision, but it is recommended that you seek legal advice before going ahead. Not only does this help to explain the full implications of your exact wishes, it allows you to ensure all requirements are met for a valid Advance Decision. Remember that Advance Decisions take effect when you do not have the mental capacity to make a choice at the time so, it if turns out to be invalid, it will be too late to do anything about it.