Advanced Medical Directives – Explained

What is an Advance Medical Directive?

An advance directive is a document which allows you to communicate decisions about your future medical care. It’s used where you would prefer to refuse certain lifesaving medical treatment, perhaps for cultural, religious or personal reasons.

Decisions like this are never easy but it may be made to prevent prolonged pain and illness and an example could be to refuse resuscitation following a heart attack.

Other names for it…

An Advance Medical Directive can also be known as a Living Will or an Advance Decision.

How does it work?

It lets your family and health professionals (doctors, nurses and carers) know your wishes about refusing treatment if you’re unable to make or communicate those decisions for yourself.

The treatments that you don’t want to receive must all be named in the document.

You may want to refuse a treatment in some situations, but not others. If this is the case, you need to be clear about all the circumstances in which you want to refuse treatment. We can talk you through some examples.

Who makes an advance decision?

Advance directives aren’t just for older adults. Unexpected end-of-life situations can happen at any age, so it’s important for all adults to prepare these documents.

You make the advance decision if you have the mental capacity to do so. This is the same for Lasting Powers of Attorney. If you’re calling us on behalf of a family member. We can undertake a mental capacity assessment.

If you wish to refuse life-sustaining treatments in circumstances where you might die as a result, you need to state this clearly in your advance decision. Life-sustaining treatment is sometimes called life-saving treatment. We can support you in creating your Advance Medical Directive.

You may find it helpful to talk to a doctor or nurse about the kinds of treatments you might be offered in the future, and what it might mean if you choose not to have them.

Is it right for me?

Presumably, you now have a good idea as to what an Advance Medical Directive is and what it communicates but remember that by planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.

Is an advance decision legally binding?

An advance decision is legally binding as long as it:

If your Advance Medical Directive is binding then it takes precedence over decisions made in your best interest by professionals etc.

What makes it valid?

An Advance decision is considered valid the following conditions are met:

  • You need to be 18 or over
  • You need to have the capacity to make it, you must understand the nature and effect of an Advanced Medical Directive. You also need to be able to communicate this.
  • When it’s created the document must clearly specify which treatments you want to refuse and under what circumstances.
  • It must be signed by you in the presence of a witness if you want to refuse life-sustaining treatment
  • There can’t be any coercion in your decision to make it.
  • You should not have said or done anything that would contradict the wishes in the document. Simply stating that you’ve changed your mind could invalidate your Advance Medical Directive.

How does an Advance Medical Directive help?

An Advance Medical Directive will only be used if, at some time in the future, you’re not able to make your own decisions about your treatment and if your incapacitated for some reason.

Where should I keep it and should I give it to anyone?

You ought to let your family or carers know about its existence and where to find it and what the wishes are. Healthcare professionals are likely to want to see it and you may wish to inform your doctor about it too. Perhaps store it with your Will but make sure it’s easy to access.

Your family or carers may have to find it quickly if you require emergency treatment and they need to tell the healthcare professionals your wishes.

You can keep a copy in your medical records.

Is it the same as a Lasting Power of Attorney?

The simple answer is no, it’s not. Whilst both your Health and Welfare LPA and your Advance Medical Directive are used during your lifetime and you need to have capacity to make them, one details who you trust to make decisions about your care, where your care is provided and by who etc. (LPA), the other details decisions about your care or the refusal of treatment (Advanced Medical Decision).

Here’s an example:

Mrs Smith chooses to appoint her Husband, Mr Smith to be her Attorney for Health and Welfare in her Lasting Power of Attorney. She then also decides to made an Advance Medical Directive to refuse resuscitation if she suffers a heart attack as she knows her husband would not want to have to make that decision. If she needed care in the future, as her attorney, Mr Smith could make decision about where she receives care and from whom. Mr Smith cannot override the wishes in the Advanced Medical Directive.

If Mrs Smith had appointed her husband to be her Attorney after making her Advance Medical Directive, and she had given him the power to make decisions about life-sustaining treatment, he would have the power to tell the doctor not to follow her Advance Medical Directive.

How can Philip Anthony Associates help?

PAA are on hand to help you create an Advance Medical Directive and can advise on all aspects including capacity, treatment wishes, where to store as well as giving you considerations. All you need to do is give us a call or contact us on the contact page on our website.