In health and social care, decisions should respect an individual’s autonomy and preferences, both past and present. This concept is important for ensuring that care provided aligns with the person’s desires and beliefs.
This guide will explore the nature of past and present wishes in health and social care, their importance, and how they are implemented in practice.
What Are Past Wishes?
Definition
Past wishes are preferences, decisions, and instructions expressed by an individual at an earlier time. These might be articulated through formal documents, such as advance directives, or through informal means, like conversations with family or carers.
Examples of Past Wishes
- Advance Directives: Legal documents stating what medical treatments an individual does or does not want if they become unable to make decisions.
- Living Wills: Documents specifying desired medical care in situations where the person is not able to communicate their decisions.
- Lasting Power of Attorney (LPA): A legal arrangement where an individual appoints someone else to make decisions on their behalf if they lose capacity.
What Are Present Wishes?
Definition
Present wishes refer to the desires and choices expressed by a person at the current moment. These might change from their past stated wishes as circumstances and personal views change.
Examples of Present Wishes
- Current Preferences: Immediate decisions about ongoing care, such as the desire to change a medical treatment or care setting.
- Verbal or Written Instructions: Recent communications about how the person wishes to be treated.
Importance of Respecting Wishes
Ethical Considerations
Respecting both past and present wishes is fundamental to honouring the dignity and autonomy of individuals. It ensures that care is person-centred, tailored to fit their unique needs and values.
Legal Obligations
In the UK, laws like the Mental Capacity Act 2005 require health and social care providers to consider past and present wishes before making decisions on behalf of an individual who lacks capacity. Ignoring these wishes could lead to legal repercussions and a loss of trust.
Assessing Capacity
What is Capacity?
Capacity refers to the ability to make decisions for oneself. An individual has capacity if they can understand, retain, weigh up, and communicate a decision.
Assessing Capacity
Capacity must be assessed each time a significant decision arises. The presumption is that people have capacity unless proven otherwise. If a person lacks capacity, carers must then refer to both past and present wishes.
Balancing Past and Present Wishes
Conflicting Wishes
Sometimes past wishes may conflict with present desires. This situation requires careful consideration. Professionals should try to understand the reasons behind the changes and ensure that any decisions made genuinely reflect the person’s best interests.
Best Interests
If there is a conflict and the person lacks capacity, the decision-making process must consider their best interests. This involves consulting with family, friends, and any of the person’s previous statements or wishes.
Implementing Wishes in Care Plans
Developing a Care Plan
Care plans should be comprehensive documents covering both past and present wishes. These plans guide care professionals in providing appropriate, respectful, and personalised care.
Advance Care Plans
Advance care plans are detailed documents outlining the medical care and treatments a person wishes to receive or avoid. Creating these plans involves discussions with healthcare professionals and often family members to ensure clarity and accuracy.
Practical Steps for Health and Social Care Providers
Training and Awareness
Professionals should undergo training to understand the importance of respecting past and present wishes. Training enhances empathy, informed decision-making, and the ability to navigate sensitive conversations.
Effective Communication
Clear, compassionate communication with individuals and their families helps capture accurate wishes. This practice also helps in explaining the implications of different care choices.
Documentation and Accessibility
Properly documented wishes should be easily accessible to all care providers involved. This ensures consistency in care delivery and adherence to the individual’s preferences.
Case Studies
Case Study 1: Dorothy’s Journey
Dorothy, an 82-year-old woman with Alzheimer’s, previously expressed in her advance directive a wish not to receive life-prolonging treatment. After her condition progressed, she expressed a desire to be in a comfortable care home. Care professionals honoured her advance directive when she couldn’t make complex decisions, but also ensured her current comfort by relocating her to a suitable care home, balancing both past and present wishes.
Case Study 2: Peter’s Preference
Peter, a 65-year-old man undergoing chemotherapy, had written a living will refusing resuscitation in severe illness. However, in discussions with his care team, he expressed hope for more aggressive treatments if a new, promising therapy became available. His care team recorded this change, which ensured his care plan reflected his current wishes, even though they differed from his past written preferences.
Conclusion
Respecting and implementing past and present wishes in health and social care is a cornerstone of person-centred care. It involves understanding the ethical, legal, and practical aspects of individual preferences. By maintaining open communication, thorough documentation, and consistent training, care providers can align the care they provide with the true desires of those they support. This commitment ensures dignity, autonomy, and trust within the health and social care sectors.
