A Living Will is a formal, legal, written document that you can (and should!) put in place to ensure your specific desires are known about the types of medical treatments you would (or would not!) want. Also commonly referred to as an Advance Decision, a Living Will is used to spell out end-of-life medical care wishes. You can also use it to note your preferences about pain management, organ donation and more

Background

In most instances, when you’re ill, you’re able to discuss treatment options with your doctor and jointly reach a decision about your treatment.  A mentally competent adult cannot be given medical treatment without his or her valid consent

However, an occasion may arise in the future when you’re admitted to hospital when unconscious or unable, on a temporary or permanent basis, to communicate your wishes concerning your treatment.  A time may come when you’re not able to process information and understand the implications of treatment being proposed

Should any of these situations arise, doctors have an ethical and legal obligation to act in your best interests. BMA (British Medical Association) guidance states that it’s good practice for relatives to be consulted when determining the patient’s best interests.  They don’t, however, have a legal right to be consulted or to make decisions on your behalf.  Under these circumstances, it would assist your doctor if he/she were able to access information that reflects your views and wishes.  This could be in the form of an Advance Decision or ‘living will’

Who can make an advance decision

Most people who may be thinking of writing an Advance Decision are usually older persons or who are seriously ill.   But it may be just as important for people of all ages and who are in good health to consider making one

Requirements for Validity:

For an Advance Decision to be valid and legally binding in the UK, it must meet certain requirements:

Age: You must be 18 years of age or over

Capacity: You must have the mental capacity to create the Advance Decision at the time of its formation

Specificity: The document must be specific about the treatments or interventions it covers. Vague or unclear language may lead to misinterpretation

No external pressure: Your decisions must be made voluntarily, without any external pressure or influence.

In writing: The Advance Decision must be in writing, and it is advisable to sign and date it. While there is no specific requirement for witnessing, it is often recommended to strengthen the document’s evidential value.
It’s advisable that the witness/es is/are not your spouse, partner, relative or anyone who stands to benefit from your ordinary Will or directly from your estate following your death.  However, it would advisable to make members of your family and friends aware of the document’s existence

It’s also advisable to discuss your intentions fully with a medical professional and your family and friends.  A doctor involved in your care can help you understand the implications of refusing treatment, or for opting for a particular type of treatment and give advice as to the likely course of your illness.  This doctor can also help you express your wishes clearly and verify you were competent at the time you prepared and signed the document.   If this doctor or your GP acts as witness to the document, it will show they fully understand your wishes

Scenarios to cover in a Living Will 

A Living Will is useful for both families as well as medical teams and doctors. They can consult your Living Will if you ever become incapacitated and unable to make decisions on your own. You can cover the following types of scenarios in your Living Will:

Resuscitation (CPR & DNR): If you do/do not want to be intubated or resuscitated, you can include what’s known as a Do-Not-Resuscitate (DNR) in your Living Will. DNRs can also be stand alone documents

Palliative care and pain management: Palliative Care directives can include instructions about the types of pain management you would/wouldn’t want; if you want to die at home; any other interventions you want for comfort and pain management; etc.

Tube feeding: Leave directions about if and for how long you would want tube feeding to be used to supply the body with nutrients and fluids

Mechanical ventilation: State if and for how long you would want to be on a mechanical ventilator if you could not breathe on your own

Organ/Tissue donations: Specify if you want to donate organs or tissues for transplant. Understand that you will likely receive life-sustaining measures until any procedures are completed to remove organs; consider including a statement noting you are aware of this to avoid confusion and help your healthcare agent understand your desires

Antibiotics/Antivirals:Express if (and how aggressively) you would want infections to be treated toward the end of your life

What can’t be included

The document can’t be used to request any form of treatment or actions which are illegal.  For example it cannot be used to:

– Request euthanasia or assistance to commit suicide
– Refuse treatment administered solely for the purpose of pain relief
– Give advance direction to insist on specific treatment; they may only authorise or refuse treatment
– Refuse food or drink
– Refuse basic nursing care such as cleansing, washing etc.
– Demand anything that the doctor or the carers consider to be inappropriate

Updating and reviewing the document

It’s important that the document is kept up-to-date and still confirms your wishes.  This is necessary because of new or improved medical treatments becoming available.  Your Doctor may check its validity, particularly if it was signed a long time ago.  You may have simply have changed your views.  So it’s advisable that you undertake a regular review and reaffirm your wishes

When you’ve carried out a review, you should also make sure that all who have a copy are informed of amendments

Safe keeping

An up-to-date document should be kept with your medical records at your General Practitioner’s surgery, and if appropriate with your hospital records.  It’s advisable to make members of your family and friends aware of the document’s existence

Advance Decisions in the UK serve as a powerful tool for individuals to maintain control over their medical treatment even when they cannot actively participate in decision-making. By clearly expressing their preferences in advance, individuals can contribute to a more patient-centered and respectful approach to medical care, aligning with the principles of autonomy and dignity in healthcare

As with any legal document, seeking professional advice when creating an Advance Decision is recommended to ensure its validity and clarity. The process involves thoughtful consideration of personal values, beliefs, and medical preferences, providing individuals with a mechanism to assert their autonomy and make choices that reflect their unique wishes