Planning care in advance involves discussions with you, about you and what you would like for your care in the future. It can also involve your family, friends, doctors, nurses, social care workers and even solicitors!   You decide (unless you don’t have capacity).  There is so much that can be done to make sure you receive the care you want, and where you want it. When you know what’s available and what you would like you then you ought to make a written record of it. There are several documents that have differing legal status, but nevertheless, they will all be important for health and social care professionals in delivering the care you desire.

They include:

  • Advance Decisions
  • Lasting Power of Attorney for Health and Welfare
  • Advance Statement
  • Emergency Healthcare Plan
  • Do not attempt cardio pulmonary resuscitation (DNACPR)

An advance decision is a decision you can make now to refuse a specific type of treatment at some time in the future. An example could be where you are about to have surgery to have your gall bladder removed and you say to your surgeon ‘I don’t want you to take anything else out’ and the surgeon, during the operation sees what he believes to be cancer, he cannot remove it because your advance decision is legally binding. (Obviously he can remove it later with your consent).

To Make an Advance Decision

  • You must have the mental capacity to make your own decisions
  • You must be over the age of 18
  • You must clearly specify the treatment(s) you would wish to refuse and the circumstances when this treatment should be refused

An Advance Decision to Refuse Treatment (ADRT),

(formerly a living will) where you want to refuse life sustaining treatment (e.g. a blood transfusion) then the following conditions must also be met:

  • Make your advance decision in writing
  • Make it clear that you understand you are refusing life-saving treatment and that you understand the consequences
  • Include a statement confirming that your advance decision applies even if your life is at risk
  • Sign your advance decision in front of a witness, and get them to sign it too
  • Include all relevant personal details, including your name and address.
  • Make sure your health and social care team are aware of it, and a copy of it is not only on your medical records but also with you at home, somewhere that paramedics can easily find it.

An Advance Decision can only take effect once you have lost capacity, and only if it complies with all the above. If the Advance Decision is not compliant, it could be disregarded by the treating clinicians.

An Advance Decision can be withdrawn or altered by you at any point before you lose capacity. If you decide to put a new one in place, it too must comply with the above.

It is important that you review your ADRT every year as there could be breakthroughs in medical science that could impact on your health, or there could be a change in your personal circumstances which would call into question it’s continuing validity. For example, you are a Jehovah’s Witness and you have an ADRT in place to refuse transfusions of all blood products, but you subsequently meet and marry a non-Jehovah’s Witness and are involved in a serious accident which requires you to have a blood transfusion but haven’t destroyed or updated your ADRT

An Advance Decision cannot be used for any of the following:

  • To ask for anything that is illegal for example, euthanasia
  • To demand care that your doctor considers inappropriate for your circumstances
  • To refuse the offer of food and drink by mouth
  • To refuse palliative and basic nursing care such as providing pain relief and bathing

Please be aware, that you can cancel an Advance Decision at any time provided you still have capacity.

Lasting Power of Attorney for Health and Welfare

A Lasting Power of Attorney for Health and Welfare (LPA) is a legal document that enables a person (known as the Donor) to appoint another person (known as the Attorney) to make decisions on their behalf in relation to health and social care matters.  This includes decisions about medical treatment, where you are cared for and the type of care you receive, as well as day-to-day things like your diet, how you dress and your daily routine.  Putting in place a Power of Attorney can give you peace of mind that someone you trust is in charge of your affairs when you are unable to to manage them yourself.

An LPA for health and welfare can only be used when you are mentally incapable of making your own decisions – so putting one in place now will not jeopardise your independence.  It is really useful also if you have a temporary loss of capacity, for example if you got pneumonia which caused confusion and disorientation and lets say, you wanted to be cared for at home.  If you had an LPA in place your attorney could tell the doctor or paramedics that you would like to be cared for at home and this is generally legally binding.

There are a few reasons why a doctor may not follow an attorney’s decisions: They may believe that the attorney isn’t acting in your best interests, or the attorney may not have been given the authority to make a particular decision.   Also, if you have made an advance decision this may override an LPA.

Once your LPA is registered with the Office of Public Guardian (the OPG), it will remain valid and applicable for the rest of your life, unless, whilst you still have capacity you decide to cancel it.

Advance Statement

An Advance Statement is a written statement that sets out your preferences, wishes, beliefs and values regarding your future care.   For example, you can explain how and where you would like to be cared for or to detail any values or beliefs that inform the decisions you make.   The aim is to give those around you, such as your family, carers and healthcare team, a clear idea of what you want if you can’t communicate this yourself (even on a temporary basis).  They are also particularly useful documents if you have a progressive illness and maybe susceptible to short term illnesses such as pneumonia or urinary tract infections.

It is not legally binding, but gives good guidance to those who need to act in your best interest.  It can be updated/amended as often as you like.

Emergency Healthcare Plan

This is a document that enables you (generally with the help of a health or social care professional) to made record of the care that is needed during and after an anticipated emergency.  It will include preliminary discussions with you and anybody else you want involved.  The professional can inform you of foreseeable potential emergencies that could be planned for.  It could take several conversations but it’s important so that it is right for you.  This is because you need to be aware of :

  • What is the possible emergency?
  • How will you and your closest carers (which could be family, friends or professionals) recognise it is happening?
  • Are there any emergencies for which your carers should immediately call for medical help?
  • Are there any first-aid steps your carers could take?

It is not legally binding but it is incredibly useful in an emergency.

It can be updated as often or as little as you like whilst you have capacity.

Do not attempt cardio pulmonary resuscitation (DNACPR)

If you had a heart attack you may wish to be given the chance of survival and recovery and in that event, your medical team will generally do everything they can to save your life but for some, who are unlikely to survive even with resuscitation attempts, a decision around cardio pulmonary resuscitation (CPR) can increase the possibility of a peaceful and dignified death.  Likewise, if you have made a personal decision to have a DNACPR put in place it allows health professionals to respect your wishes.

In the event your medical team have to make a decision on your behalf, they should try to involve you or your loved ones wherever possible.  This might happen because you are so unwell from an underlying illness that CPR will not prevent your death.  You would, however, still receive appropriate treatment for your health issues and all your personal care needs will be attended to.

Your loved ones and carers cannot force your medical team to give you CPR, where to do so, it would be futile.

Once a DNACPR is put in place it should be reviewed every year.