What are they? Are they binding? Who can make one? Do I need advice? There are many questions about advanced decisions that make them difficult to understand what they do and what they do not do.
An advanced decisions is a written request to medical professionals, written in advance, about how future care should be managed. Simple hey? Maybe……
The advanced decision needs to be done in writing and signed. There will be special provisions for someone who is unable to sign, video would work well. It is helpful if that signature is also witnessed, but it doesn’t necessarily need to be. It would also be good if the witness was either a legal or even better, medical professional. It is helpful also for it to be dated, as the healthcare professionals needs to know when this was how the person thought regarding their treatment. If it was a long time ago, then things may have changed, either the person may have changed or medical advances may have been made.
The key issue about whether they are binding is about whether they are relevant and this will not just be in the time frame between when they were written and when they are needed but whether the contents of them is relevant.
If they are too general, then they may not cover the specific health issue that is happening. They will only be used when the person is unable to give consent at the time, so when they have lost capacity for some reason, however is the document clear about what kind of circumstances might be thought of? Is the loss of capacity intended to be long term or short term or both?
What specific health treatments is the advanced decision discussing, ideally they should be linked to specific health issues that the person had, so that they are relevant.
However if the person discusses cancer in their advanced decision and then suffer a heart attack, which is not mentioned, then the advanced decision doesn’t cover something that is not included.
If it was dated 20 years ago and in the intervening time, there has been a major medical advancement, which is not discussed, then it might not be relevant.
The medical professional standards bodies expect that doctors respect their patients clearly expressed wish, even if it is not a choice that they would make for themselves or their family. The healthcare professionals are not treating themselves or their family and we are all entitled to make our own decisions about our own bodies. So whilst the professional bodies expect that advanced decisions are followed, there may be instances where there might be mitigating factors which mean that the right thing to do is not follow the advanced decision. These situations can be judgement calls!
So the best thing to do, to make the advanced decision as reliable as possible for both patient and healthcare professional is to take advice about the patient’s own specific health issues. This can also be followed with some generic statements about loss of capacity and poor quality of life, but it is helpful if this includes examples, as poor quality of life is a subjective phrase. Then review it every few years and discuss any advances in medical care that may have occurred and re-sign the document, dating it each time it is signed. If there are any alterations, because something has changed (medical advances or patient health or life circumstances), then keeping the old ones as part of the record of thought progression is also helpful.
If in doubt, seek advice, both legal and medical to make sure that the advanced decision is robust. If you make a Lasting Power of Attorney, if made after the advanced decision, the LPA will revoke it, if the LPA is made before, it is worthwhile ensuring that the attorneys know, as they will be able to ensure that it is followed.
Take advice and choose the way that you want to be treated, its your life and ultimately, your death, you should choose how this happens.