Living Wills: A Guide to Advance Directives

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When you’re in relatively good health, advance care planning is something you may not have thought about.

But it’s sensible to plan for end-of-life care by creating a living will or advance directive even though this could be years into the future.

This guide will take you through advance care planning and what you need to do make an advance directive.

What is an advance care plan?

Advance care planning allows you the chance to make decisions about the care you wish to receive to maximise your independence and health as you near the end of your life.

An advance care planning document which also known as a living will, will cover big decisions, from refusing certain life-prolonging interventions that you would not wish to have to expressing more personal wishes for your comfort.

Making an advance care plan should involve having a number of conversations with health workers and loved ones about what you want to happen, should you lose the ability to make those decisions later in life.

It is important that you write down or record these conversations so that your intentions are made clear to everyone before your end of life care begins.

What are the benefits of advance care planning?

Advance care planning goes a long way in reducing the anxiety of having to make rushed, impulsive decisions about your care as you near the end of your life.

It may also be helpful for your loved ones who may feel comforted knowing that with the care plan in place, you have the freedom to live your final days as you choose to.

What is a living will or advance directive?

A living will or advance directive allows you to write down the actions that your family or healthcare professionals must take when you are unable to communicate with them due to a terminal illness or condition.

Also known as an advance decision to refuse treatment (ADRT), it outlines the medical treatment you wish to receive after you become unable to make the decision for yourself.

When properly signed, this kind of living will is legally binding. You can choose to:

• Specify certain treatments that you want to refuse.
• Mention the circumstances under which this would apply.
• Refuse certain life-saving or life-prolonging treatment such as CPR or a ventilator to help you breathe.
• Donate your tissue and organs when you die.
• Make a lasting power of attorney.

Bear in mind that an ADRT cannot be used to end your life, request certain treatment or care to make you feel comfortable.

What to consider before making an advance directive?

• Think about potential situations where you might want to refuse treatment.
• Spend some time with healthcare professionals or your doctor or nurse to understand different options, the risks, benefits and consequences of refusing treatment.
• Discuss your wishes with family members.

How do I make an advance directive?

Once you have decided what you want regarding treatment options, and have understood and discussed the consequences with your health care team and family members, you can:

• Fill in the Advance Decision form, outlining your decisions.
• Sign and date it, in the presence of a witness who will also sign and date it.
• Once it has been signed, the advance directive or living will is then legally binding, and your loved ones cannot overrule what you decide in this document.

If you are undergoing treatment at the stage you write your advance decision, it is important to talk with healthcare professionals about your condition and the outcome of any treatment, so you fully understand the decisions you are making.

An advance care decision has to be valid which means that you were fully capable of decision-making and were not influenced by other people in any way. In order to be carried out, an advance directive also has to be applicable meaning that the way it is written is specific about the medical circumstances that your wishes refer to, leaving no room for doubt.

Who should see your advance directive?

It is important that your family or those involved in your care including your GP or healthcare providers are aware and have access to your living will.

• Give a copy of your advance care planning documents to close family members and emergency contacts.
• Have your GP file it with your medical records.
• Leave a copy with any others involved in caring for you such as a nurse, care worker or other health or social care professionals.

While a living will is different from a will, it is sensible to prepare both when you are planning for end of life care. Read our blog on why it is a good idea to write a will.