Advance statements about medical treatment...
commonly known as Living wills, are made by those who do not
wish to burden their family with some of the most difficult
decisions a family could have to make; Shall we allow our loved
one to die? Would he or she have wanted to live like this?
|Making a Living
Will is one of the most unselfish decisions you can make. It sets
out clearly your wishes if you are suffering from any one of a number
of critical conditions such as severe or lasting brain damage. It
states that you fear indignity far more than you fear dying and asks
that this be borne in mind when administering any treatment aimed
artificially sustaining your life.
The Legal Position
|It is clear,
in common law, that competent, informed adults have a legal right
to refuse medical procedures in advance and that an unambiguous and
informed advance directive (refusal) can be as valid as a contemporaneous
decision. Health professionals may be legally liable if they disregard
the terms of an advance directive if the directive is known to them,
is clear, unambiguous and is applicable to the circumstances.
expressing preferences about treatment decisions or requesting certain
treatments are not legally binding. In England and Wales, views expressed
by a third party about medical care are also not binding on health
professionals. The BMA believes however, that wherever possible, such
statements should be taken into account in deciding on the patient's
best interests. In all circumstances, a contemporaneous decision by
a competent individual overrides previously expressed statements by
Scope of Advance Statements
authorise or refuse in advance procedures which they could not authorise
or refuse contemporaneously. They cannot authorise unlawful procedures,
such as euthanasia, nor can they insist upon futile or inappropriate
treatment. The BMA believes that people should not be able to refuse, in advance, the provision of "basic care". This includes
the admistration of medication or the performance of any procedure
which is solely or primarily designed to provide comfort to the patient
or alieviate that person's pain symptoms or distress.
Format of Statements
statements are likely to be legally valid if supported by appropriate
evidence but there are clear advantages to recording general
views and specific refusals in writing. Advance statements are
an aid to, rather than a substitute for, open dialogue between
patients and health professionals.
|There are no
specific legal requirements concerning the format of advance statements,
but it is recommended , as a minimum that the following information
is included: full name, address, name and address of general practitioner,
a clear statement of wishes or the name, address and telephone number
of a person to be consulted, signature, two witnesses and the date
the document was written and reviewed. It is recommended that the
document be reviewed at least every five years.
|The only minimum
requirements for legal validity are that the patient is competent
at the tie of making the statement, is aware of the implications of
the decision and that the circumstances match those in the statement.
| The BMA
strongly supports the principle if an advance statement. Through advance
statements, patients have a legal right to decline specific treatment,
including life prolonging treatment.
cannot use advance statements to insist on the provision of certain
treatments but they may authorise or refuse treatments.
an advance statement is the patients responsibility. If necessary
seek advice from your general practitioner, health professional of
| It is
the patients responsibility to ensure that the existence of an advance
statement is known to those who may be asked to comply with its provisions.
Wills would undertake this on your behalf.
| No person
has the legal right to accept or decline treatment on behalf of another
adult. The BMA recognises that the nomination of a health care proxy
by the patient may be helpful if the patient is no longer capable of expressing
| It is
strongly recommended that patients review their advance statements
at regular intervals, and destroy rather than amend the statement.
with a conscientious objection to curtailing treatment are not obliged
to comply with an advance statement but must be ready to step aside.
|The BMA strongly
supports the general concept of patient choice and therefore has also
supported the concept of anticipatory decision making. Advance Directives
or 'Living Wills' are one category of anticipatory decision making
that competent people may choose to employ if there is a likelihood
that they will suffer loss of mental capacity. The BMA has classed
all types of anticipatory decision-making as "advance statements",
including within this term oral and written decisions, advance refusals
and advance authorisations of treatment and statements of future intentions as well as firm decisions. The common law has clearly
established the legally binding nature of clear and competent advance
refusals which address the particular circumstances which later arise.
can be specific, general, nominate someone else to decide matters
for them to simply list the person's fundamental values as a guide
for others to decide. Advance statements are about patient choice.
Choice is more likely to be known and respected if it has been discussed
with family and health professionals in advance. From an ethical perspective,
the BMA states all patient views - requests, refusals, preferences
- should be listened to and given respect.
|The onus for
ensuring that the advance statement is appropriately drafted and available
to whom it is addressed lies with the patient. It is suggested that
patients who have drafted an advance statement carry a card or other
means indicating that fact as well as lodging a copy with their doctor.
Making a living will
can advise and help you draw up your living Will at the same time
as preparing your Will.
|The Code of Practice
expressed within this leaflet is a summary of that of the British
Medical Association's published in April 1995 and has been endorsed
by the Conference of Royal Colleges and the Royal College of Nursing.