End Of Life Care: Making An Advance Decision



An advance decision, sometimes known as a living will or ADRT (Advance Decision to
Refuse Treatment), allows you to let those around you, such as your family and your carers,
know your wishes if you become too ill while receiving end of life care to communicate with
your health team.
At a time when it feels like everything is out of your control, making an advance decision
about your end of life care - perhaps to refuse any more treatment - means that you can
continue to make decisions about thecare you receive, and retain some independence.
Any treatment you wish to refuse must be named in your advance decision, and you also
need to be clear under which circumstances you want to refuse treatment. This is because
you might want to forgo treatment in some situations, but not others.
It’s important to know that making an advance decision is not the same thing as asking
someone to end your life, or to help end your life - euthanasia and assisted suicide are both
illegal in England.



Who Makes An Advance Decision?



So long as you have the mental capacity to make such decisions, making an advance
decision is yours, and yours alone, to make, but you can talk to your healthcare team about
the kinds of treatments you might be offered and what it would mean if you refused them.
If you do want to refuse life-sustaining treatments your advance decision needs to be written
down and signed by both you and a witness.
You’ll also need to include a statement that your advance decision applies even if it puts
your life at risk.



What Is Life-Sustaining Treatment?



A life-sustaining treatment is one that will potentially keep you alive by replacing or
supporting bodily functions.
This includes:
● Antibiotics that help your body to fight infections
● Cardiopulmonary resuscitation (CPR), which is used if your heart stops

● Ventilation, used if you can’t breathe by yourself

Before you make up your mind to refuse any of these life-sustaining treatments, you might
want to discuss it with a doctor or nurse who knows your medical history.



Is An Advance Decision Legally Binding?



As long as your advance decision complies with the Mental Capacity Act in that it can’t be
proved that you are unable to make the decision for yourself, and it applies to the situation at
hand, it is legally binding.
This means that your advance decision takes precedence over any decisions made in your
best interest by other people - in other words, it can’t be overridden by a well-meaning loved
one or healthcare professional.
The advance decision also has to be considered ‘valid’, meaning that:
● You are aged 18 or over and you were able to understand and communicate your
decision to those around you when you made it.
● You have clearly specified the types of treatment you want to refuse.
● You have explained the circumstances in which you want to refuse treatment
● It has been signed by you - and a witness - vital if you want to refuse life-sustaining
treatment such as CPR
● You haven’t been harassed into making the decision - it has to have been made of
your own accord
● You haven’t said anything that contradicts the advance decision since you made it,
for example saying that you have changed your mind.



What Happens Next?



Once you have fulfilled all the criteria to make your advance decision a legal binding
document, it gives your healthcare team medical and legal instructions about your treatment.
The advance decision will then be used if in the future you aren’t able to make decisions
about your treatment.



Who Should I Show My Advance Decision To?



Once you have made an advance decision it is up to you who knows about it - but to ensure
it’s carried out you’ll have to make sure that your carers and other members of your
healthcare team know that you have made ones - and tell them where to find it. It’s a good
idea to keep a copy with your medical records.
It’s also a good idea to let your family know. Loved ones might find that fact that you have
made such a decision difficult to process at first, so discussing your wishes with them means
that they won’t be upset to discover that you’re refusing treatment if and when the time
comes.



Is Refusing CPR The Same Thing As ‘Do Not Resuscitate’?



In a word, yes. CPR is treatment that attempts to start someone breathing again after they
have gone into respiratory arrest, or to start the blood flowing to the heart again after a
cardiac arrest. This type of treatment involves chest compressions or electrical shocks to
stimulate the heart, or artificial ventilation.
For some people CPR will be of no benefit, it will depend largely on a patient’s overall health,
and why their heart or breathing has stopped. 2 out of 10 people survive CPR carried out in
hospital, but the success rate is lower for those who receive CPR in other settings.
Even if CPR is successful, it can lead to serious complications such as brain damage,
fractured ribs, or damage to the liver or spleen. This is often part of the reason someone who
is receiving end of life care makes an advance decision to refuse the treatment.



Someone receiving end of life care will feel that the choices they have left to make are very
precious, and someone you love who wants to make an advance decision about refusing
treatment isn’t doing it for any reason other than they want to be in control of how their life
ends. It can be upsetting for family members who will be left behind, but for a person who is
nearing the end of their life it can be a comfort to know that they are valued and loved
enough that their wishes will be honoured in the end.


Any queeries or concerns, we can help - dont hesitate to contact us.

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