- Care decisions
- Lasting power of attorney
- Making or updating a will
- Digital legacy
- Thinking about a funeral
- More support
Advance care planning is a way to think, discuss, plan, document and share your views, thoughts and decisions about future care. It's helpful for you, your friends, family or the doctors and nurses to know what your future wishes and decisions are about care.
All of the ways to plan ahead below are only used if you’re unable to make or communicate decisions yourself. It may be that someone has capacity to make some decisions and not others so an assessment should be done for each individual decision.
Your medical team will always consider your best interest when taking medical or care action on your behalf. If you’re unable to make decisions, your medical team will firstly consider any records of your wishes for treatments and care that you’ve made. If you haven’t left a record of your wishes, they will consider all of the circumstances to help them decide what action to take.
There are clinical systems in place to ensure the below decisions are communicated to doctors, nurses and paramedics who might be called unexpectedly to see you at the weekend or at night. It’s worth asking your GP or palliative care CNS about this. Sharing your documents yourself with anyone involved in your care can also help to give you peace of mind that they’re aware of your wishes. This includes your treatment team, GP and local ambulance service.
Care decisions
Advance statement
This is a way for you to write down and tell others your future wishes and decisions. It lets everyone involved in your care know your wishes if you’re unable to tell them. It could include:
- Whether you would want to be treated in hospital if you were unwell
- Who’s important to you and who you would want to be involved in decision making
- Whether you would want hospice care at the end of your life
- Simple pleasures such as your favourite fragrances, songs and music, or wanting to have your hair and makeup done every day because it’s important to you
- Sometimes people also add in their wishes about their funeral
An advance statement isn’t legally binding but will be used as a guide when making a decision in your best interests.
Advance decision to refuse treatment (ADRT)
An advance decision to refuse treatment (ADRT) is a legal document in England and Wales. In Scotland it’s called an advance directive (or living will). In Northern Ireland it’s also called an advance decision to refuse treatment (or an advance directive).
It must be made when someone has the capacity to make decisions. An ADRT can be used to show certain treatments that you wouldn’t wish to receive in particular situations. This can help you to stay in control of future treatment decisions and maintain a quality of life that’s meaningful to you. This is used if, in the future, you can’t say what you want yourself. It must be signed and witnessed, and is there to ensure that your decisions about treatment you don’t want are upheld, if you can’t say so at the time.
If an ADRT is in place for the particular decision that needs to be made then a best interests decision wouldn’t be needed. This is because an ADRT is legally binding and, if it’s in place for the particular situation, 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 it can be used as a guide when making the best interests decision.
Do not attempt cardio pulmonary resuscitation (DNACPR)
This is a decision not to attempt to restart the heart (cardio pulmonary resuscitation) if a person suffers cardiac arrest in future. A cardiac arrest is when the heart stops pumping blood around the body.
A DNACPR is made and recorded in advance to guide those present whether to attempt to restart the heart. Your medical team are likely to advise you that resuscitation would be unsuccessful in advanced disease and often people feel as they near the end of their life that they don’t want this medical treatment. You may wish to start this discussion, or sometimes a doctor or nurse may discuss it with you if they feel it’s unlikely that your heart could be restarted due to your condition.
The Resuscitation Council (UK) has useful FAQs where you can find out more.
The ReSPECT process
This is a very specific type of advance care planning available in some areas across the UK. It summarises the emergency care part of a wider advance planning process. The process covers more decisions about treatment and care beyond DNACPRs. ReSPECT records your emergency care information so that professionals in different care settings who need to make decisions about care and treatment in a crisis, can access it quickly.