Once you’ve thought about your future care and treatment you can write down your decisions.
To support you as much as possible, it’s helpful for your family, friends, doctors and nurses to know:
There are three main ways to write down your preferences for your future treatment and care:
- Advance statement
An advance statement is a way for you to write down what’s important to you about your care. This is so that everyone involved in your care knows what care you would prefer.
An advance statement isn’t legally binding, but it must be taken into account for any best interests decision and it does hold legal weight.
In your advance statement you could include:
- Where you want to live and be cared for at the end of your life.
- Who’s important to you and who you would want to be involved in making decisions about your care. But be aware that these people won’t have legal rights to make decisions if they are only named in an advance statement.
- Whether you would want to go to a hospice for care at the end of your life.
- How you like spending your time and things that bring you pleasure.
- Any spiritual, religious or cultural practices that are important to you.
- Important information about your health.
- Important people in your life.
- Your lifestyle and habits which are important to you such as your favourite fragrances, songs or music, or things like wanting to have your hair and makeup done every day.
- Your food preferences and allergies.
- Advance decision to refuse treatment (ADRT)
An advance decision to refuse treatment (ADRT) is a legal document that anyone in the UK can make. ADRTs are legally binding in England and Wales. They also hold legal weight in Scotland and Northern Ireland.
In Scotland an ADRT is called an advance directive. In Northern Ireland it is called an advance decision to refuse treatment. You may also hear ADRTs called a living will.
An ADRT must be made when you have capacity (the ability) to make decisions. It can be used to record any tests and treatments you don’t want to have if you become more unwell. This can help you to stay in control of future treatment decisions and keep a quality of life that’s meaningful to you. Your ADRT is used if you can’t say what you want yourself in future.
An ADRT must be signed and witnessed to make sure that your decisions about treatment you don’t want (refuse) are upheld, if you can’t say so at the time.
If you don’t make an ADRT and lose mental capacity to make decisions, a doctor will have the final say on decisions that need to be made about your treatment or care.
- Lasting power of attorney (LPA)
Lasting power of attorney (LPA) is a legal document that lets you appoint one or more people to make decisions on your behalf.
In Scotland this is called a power of attorney and in Northern Ireland it is called enduring power of attorney.
In England and Wales there are two types of LPA. You can choose to make one type or both:
- Property and financial affairs (in all areas of the UK) – you can give this person the power to make decisions about money and property, for example managing a bank account or paying bills. This person can speak on your behalf from any time that you authorise them to do so.
- Health and welfare (in England and Wales only) – you can give this person the power to make decisions about things like your daily routine and medical care. It can only be used if you’re unable to make your own decisions or express your wishes at the time.
Having a health and welfare LPA can be reassuring. It means someone that you trust will act on your behalf if you’re unable to say your wishes and decisions yourself. This might include accepting or refusing medical treatment for you.
It’s very important to choose someone who understands your wishes for treatment, especially if you know that there’s specific treatment that you don’t want in the future or have thought about making an ADRT.
It can also be helpful to make sure you have an advance statement and advance decision in place. This is so that your LPA can evidence your wishes if challenging decisions need to be made.
In Scotland and Northern Ireland, you can only give someone power of attorney for your property and financial affairs.
In Northern Ireland, you can nominate an enduring power of attorney under the Mental Capacity Act 2016. This currently only allows your chosen person to make decisions about your property and financial affairs, it doesn’t yet cover health decisions.
- Can I have both an ADRT and an LPA?
You can have both an ADRT and an LPA for health and welfare. If you do, the one that you made more recently will take priority when a decision needs to be made about your treatment or care.
- Making a decision for someone else
If someone can’t make a decision for themselves because they have lost mental capacity, then the decision needs to be made by someone else. This is called making a best interests decision. The responsibility for making decisions falls to health professionals not family members unless:
- you have made an ADRT
- you have appointed an LPA for health and welfare.
A best interests decision is needed for anything not covered in your ADRT if you don’t have capacity to make the decision yourself. For example, if you have a medical condition, like a stroke, that isn’t covered in your ADRT. In this situation, a best interests decision will need to be made for you, either by the doctor in charge of your care or your LPA for health and welfare if you have appointed one.
If an ADRT is in place for the decision that needs to be made, then a best interests decision wouldn’t be needed. As the ADRT is legally binding, it takes priority over decisions made in your best interest by other people.
If you have an ADRT but it doesn’t apply to the situation in which a best interests decision needs to be made, then the ADRT can be used as a guide when making the best interests decision.
- Do not attempt cardiopulmonary resuscitation (DNACPR)
Do not attempt cardiopulmonary resuscitation (DNACPR) is a decision not to attempt cardiopulmonary resuscitation (CPR). CPR is a treatment used to try to restart someone’s heart and/or breathing.
A DNACPR is a document signed by a doctor and made in advance to guide health professionals whether to attempt to restart the heart. You may also hear it called a DNAR or a ReSPECT form.
Often people feel as they near the end of their life that they don’t want CPR. Doctors are likely to advise you that resuscitation would be unsuccessful if you have advanced ovarian cancer. With a DNACPR, while CPR wouldn’t be attempted, this doesn’t mean that other treatments wouldn’t be offered to you.
Sometimes a doctor or nurse may talk to you about it if they feel that it’s unlikely that your heart could be restarted due to your condition. You may also wish to start the conversation with your healthcare team.
Doctors, nurses and paramedics have clinical handover systems which mean they can know decisions about people’s DNACPR if they are called unexpectedly to see them. This is the case if they are in hospital, a care home or at home.
Talk to your GP or CNS if you would like important decisions you have made about your care or any specific information about you shared in this way.
You may also choose to share your documents yourself with anyone involved with your care. This includes your clinical team, palliative care team, GP and local ambulance trust. It can give you peace of mind that they’re aware of your wishes.
- The ReSPECT process
The ReSPECT process stands for Recommended Summary Plan for Emergency Care and Treatment. ReSPECT records your emergency care information so that health professionals can access it quickly. This means that in different care settings they can make immediate decisions about your care and treatment in a crisis. It covers more decisions about treatment and care than DNACPRs.
The ReSPECT process is used in some areas of England and Scotland. Northern Ireland is currently working towards using it.
By making a will, you can make sure that when you die your assets and belongings go to those who you feel should or would benefit most. Your will should set out:
You can write your will yourself, but you should get advice if your situation isn’t straightforward. You also need to get your will formally witnessed and signed to make it legally valid.
