Appendix 3: Advance Care Planning

Advance Care Planning

Advance Directive / Advance Decision / (Living Will)

Medical science has made enormous strides in the past 50-60 years. Diseases and conditions that previously meant almost certain death can now be cured or held at bay. Many more people are living into their 80‘s and 90’s with a good quality of life, although inevitably with increasing frailty. This of course is very good. However sometimes the body can be ‘kept going’ even when quality of life, in spite of all medical efforts, is very poor. Doctors themselves find it difficult to know whether or not to continue to try to keep a patient, who is not fully conscious, alive. The age, frailty and likelihood of improvement of each person need to be considered. He or she can be put onto a ventilator (breathing machine) or provided with a feeding tube. Elderly patients whose heart stops working can have attempted resuscitation, but this is unlikely to be successful and makes their last moments anything but peaceful. In my experience when doctors are unsure, they will almost always do something to keep the person alive.

It is for these reasons that those who want to be involved in decisions about their own medical care at the end of life can sign (before a witness) what is commonly known as a Living Will. This is officially known in Scotland as an Advance Directive and in England as an Advance Decision. Both are covered by the abbreviation: AD.

Most of the web sites below give more information about the medical situations where an AD might be useful.

The document I recently filled in for myself has questions about what I want to happen if:

• I have a terminal illness and my life is nearing its end
• I am unconscious and unlikely to regain consciousness
• I am severely and permanently mentally impaired.

I have recorded that in all these cases I do not want to be resuscitated if my heart stops, that I do not want to be tube fed and that I do not want to be put onto a breathing machine.

You might wish to answer the questions differently. There are no right or wrong answers, just your answers. Nevertheless, it is good to think about and discuss the possible situations listed above.

After signing, a copy can be given to those you wish – relatives, special friends and your doctor. The signed document is legally binding but if you are unconscious or severely mentally impaired, someone else has to inform the medical staff of your wishes.

Check every year or so to see if your wishes have changed. If they have, you might need a new document. If there are any changes let your family, friends and doctor know. And even if your answers have not changed, it is helpful to sign the document again with the new date.

Useful Web sites:

Age UK

http://www.ageuk.org.uk/documents/en-gb/factsheets/fs72_advance_decisions_advance_statements_and_living_wills_fcs.pdf?dtrk=true

Alzheimer’s society

https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=143

Compassion in dying

http://compassionindying.org.uk/making-decisions-and-planning-your-care/ has downloadable forms in normal and large print to download and fill in.

Dying Matters

http://dyingmatters.org/page/planning-ahead

LawDepot

http://www.lawdepot.co.uk/contracts/living-will-advance-directive/?loc=GB&pid=googleppc-health_uk-WillT1_e2-s-ggkey_advanced%20decisions&s_kwcid=advanced%20decisions|60245949383&gclid=CJv5sM6YkMkCFUHlwgodl84CYg

Macmillan

http://www.macmillan.org.uk/cancer-information-and-support/treatment/if-you-have-an-advanced-cancer/advance-care-planning/advance-decision-to-refuse-treatment

NHS choices has links to other helpful web sites.

http://www.nhs.uk/Planners/end-of-life-care/Pages/advance-decision-to-refuse-treatment.aspx