Drawing up an Advance Decision

Authored by Dr Laurence Knott, 10 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Hannah Gronow, 10 Jul 2017

Before drawing up an advance decision it is important that you think about discussing it with your nearest and dearest.

Before drawing up an advance decision it is important that you think about discussing it with your nearest and dearest. The following checklist may help:

Matters to consider when planning an advance decision
Opinion about the following situations:Would prefer to dieWould probably prefer to dieUncertain either wayWould probably prefer to liveEager to stay alive
Permanently paralysed but able to relate to others.     
Totally dependent on others. Needs to be fed.     
Aware but unable to communicate.     
Confused and very poor memory.     
Constant uncontrolled pain.     
Brain damage. In a coma. If regained consciousness, markedly impaired.     
Terminal illness - not necessarily cancer.     

An example of the sort of wording you may want to use in an advance decision is as follows: 

I, (name) of (address) wish the following to be considered in the event of my incapacity to give or withhold consent for medical intervention:

If ever I am unable to communicate and have an irreversible condition and I am expected to die in a matter of days or weeks, or if I am in a coma and not expected to regain consciousness, or if I have brain damage of disease that makes me unlikely ever to recognise or relate to people then I want treatment only to provide comfort and relieve distress, even if this may shorten my life. I do not want treatment that can only prolong dying.

I consent to any acts or omissions undertaken in accordance with my wishes and I am grateful to those who respect my free choice. I reserve the right to revoke or vary these conditions but otherwise they remain in force.

If I am certified brain dead, should any of my organs be of value to others, I give consent to their removal for the purpose of transplantation.

Note:

  • State where copies may be lodged.
  • The person must sign and date the document.
  • Beneath this may be two signatories, also with dates below a statement to the effect that the above signed in their presence and was, to the best of their knowledge, under no duress and of sound mind. They also believe that they will not benefit from the estate.

An advance decision can be made by anyone who is aged over 18 years (16 in Scotland), is of sound mind and cares about the issues involved. Some people may be especially likely to choose the option. For example, those with cancer which cannot be cured, those with a progressive disease of the nervous system and those with early dementia who are still of reasonably sound mind.

Further reading and references

  • Menon S; The mental capacity act: implications for patients and doctors faced with difficult choices. Ann Acad Med Singapore. 2013 Apr42(4):200-2.

  • Advance decision (Living wills); Alzheimer's Society

  1. Rietjens JAC, Sudore RL, Connolly M, et al; Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. Lancet Oncol. 2017 Sep18(9):e543-e551. doi: 10.1016/S1470-2045(17)30582-X.

  2. Gold Standards Framework

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