An advance decision is an important part of health and social care planning. It allows individuals to make informed choices about their healthcare and treatment options in advance, ensuring their wishes are respected if they later become unable to communicate or make decisions. This concept is often associated with end-of-life care but is applicable in a variety of situations.
Understanding Advance Decisions
An advance decision, sometimes known as a living will, is a legally binding document. It specifies what types of treatment an individual would like to refuse in the future. The Mental Capacity Act 2005 governs it, ensuring that a person’s autonomy is respected.
Key Elements of an Advance Decision
- Legal Binding: It’s legally enforceable, provided it meets certain conditions.
- Treatment Refusal: It focuses explicitly on treatments that one wants to refuse. It doesn’t allow for a request for treatment.
- Future Planning: It’s used when a person may lose capacity due to various reasons like illness or injury.
- Health Care Directives: It ensures that medical staff follow the specified wishes when the person can’t express their preferences.
Why Consider an Advance Decision?
Drafting an advance decision can ensure that your healthcare aligns with your personal values and preferences, even if you’re unable to communicate them. Here are a few reasons why an advance decision might be beneficial:
- Personal Autonomy: Ensures your treatment preferences are respected.
- Alleviate Burden: Relieves family and friends from making tough decisions on your behalf.
- Avoid Unwanted Treatments: Avoids procedures and treatments that may contradict your wishes.
Situations for an Advance Decision
Advance decisions can be helpful for all adults, particularly those:
- Diagnosed with Progressive Illnesses: Conditions like Alzheimer’s, Motor Neurone Disease.
- Undergoing Complex Treatments: Instances where there’s uncertainty about the treatment course.
- Preferring Natural Death: Individuals who prefer not to undergo resuscitation or life-sustaining treatment.
Making an Advance Decision
Steps to Create an Advance Decision
- Discuss with Professionals: Talk to doctors or care providers to understand the implications.
- Document Specific Wishes: Clearly state what treatments you want to refuse.
- Signature and Witness: Ensure it’s signed and possibly witnessed to strengthen its legal standing.
- Distribute Copies: Share copies with your family, GP, and healthcare providers.
Important Considerations
- Clear and Specific Language: Be precise about which treatments are refused under what circumstances.
- Revocation: It can be revoked or altered any time as long as you have the capacity to do so.
- Emergency Situations: In a medical emergency, healthcare professionals need to be aware that an advance decision exists.
Treatment Refusals That Can Be Included
- Life-Sustaining Treatments: Such as CPR (Cardiopulmonary Resuscitation), mechanical ventilation.
- Medical Interventions: Dialysis, antibiotic use for severe infections.
- Life-Prolonging Treatments: Artificial nutrition and hydration.
Legal Framework and Validity
Requirements for Validity
To be legally binding in the UK, an advance decision must:
- State Clearly: It must clearly state that the decision applies even if life is at risk.
- Be Signed and Witnessed: Particularly for life-sustaining treatments.
- Be Specific: It should be as specific as possible regarding which treatments are refused.
Legal Standing and Enforcement
Healthcare professionals must respect an advance decision if it fulfills the above criteria. If there are any doubts about its validity or applicability, they must seek legal advice before proceeding.
The Role of Family and Healthcare Providers
Family members and healthcare providers play a crucial role in the implementation of an advance decision. They need to:
- Be Informed: Ensure they know about the advance decision.
- Support Respectfully: Follow the outlined preferences without imposing their personal opinions.
- Work Together: Healthcare teams should coordinate to ensure the person’s wishes are respected.
Consultation and Communication
- Family Discussions: Regular discussions with family about preferences and values can guide smooth implementation.
- Professional Advice: Ongoing dialogues with healthcare professionals ensure the decision remains relevant.
Ethical and Practical Considerations
Ethical Dimensions
Advance decisions raise ethical questions about respect for autonomy and the quality of life versus life prolongation. Principally, they ensure that:
- Autonomy Is Respected: Upholding the individual’s right to make their own healthcare decisions.
- Prevent Suffering: Avoid procedures that may cause discomfort or unnecessary prolongation of life.
Practical Challenges
- Awareness: Ensuring all family and healthcare professionals are aware of the document.
- Ambiguity: Addressing any ambiguous language immediately.
- Storage: Keeping it in an easily accessible place for emergencies.
Regular Reviews
It’s important to review and update your advance decision periodically to ensure it remains current and applicable.
Conclusion
Advance decisions respect patients’ autonomy, ensuring their treatment preferences are followed if they become unable to communicate. This concept holds significant importance in health and social care in the UK. Creating an advance decision involves careful planning, discussions, and legal considerations. Though it offers peace of mind and clarifies preferences, clarity and regular reviews ensure its effectiveness. By understanding and implementing advance decisions, individuals can take control of their future healthcare, ensuring their wishes are respected and fulfilled.
