Your advance care plan
An advance care plan is different to a will. It is a way to tell others what’s important to you and how you would like to be cared for if you are unable to tell them yourself.
At all times your current wishes and decisions about care and treatment overrule any previous documents or decisions. But considering, discussing, deciding and documenting them in advance is very helpful to make the best type of decision for those times when you cannot say so yourself.
Best interests: The 2005 Mental Capacity Act outlines the process of how to make ‘best interests’ decisions about your care and treatment if you lack the capacity to decide or are unable to say yourself.
Working out what is in your ‘best interests’ means taking into account:
- the views of your family, key professional carers and other people you have appointed to act for you.
- any information about what your views might have been about the issue at hand, including your earlier advance care planning.
Your advance care planning may include one or more of the following:
- An advance statement*: This is a way for you to write down and tell those who are important to you, including health and social care teams, what you know about your illness, and what is important to you about your care and treatment.
It can be used to share your wishes and thoughts as well as help make ‘best interests’ decisions on your behalf in the future if you are unable to say so yourself at the time. Talk to your doctor or nurse and ask for examples of documents that you can use.
- An advance decision to refuse treatment (ADRT)*: This is a document in which you write down in advance your decisions about any treatments you wish to refuse in the future. It is only used if you cannot express your wishes yourself and only for decisions about treatments that you describe in the document.
It is helpful for those who are important to you, including health and social care teams, in order to make the ‘best interests’ decisions on your behalf in the future (if you are unable to say so yourself at the time). Your ADRT must comply with the legal specifications for ADRTs outlined in the 2005 Mental Capacity Act. Talk to your doctor or nurse and ask for examples of documents that you can use.
- A Lasting Power of Attorney (LPA)*: This enables you to give another person the right to make decisions on your behalf. There are two types of LPA:
- property and financial affairs. With your permission, it can be used as soon as it is registered. The person you nominate will need to show the document, stamped ‘validated’ on each page, when they act on your behalf.
- health and welfare. It only comes into force if you lose the ability to tell those who are important to you your preferences and wishes. Anything done under the authority of the LPA must be in your ‘best interests’.
You have to be over 18 to make an LPA. There are special rules about appointing someone as your LPA, and you must complete and register the forms with the Office of the Public Guardian. It takes up to ten weeks to register an LPA.
- Do not attempt cardiopulmonary resuscitation (DNACPR): If your heart stops, what decision should be made about attempting to restart it? Talk to your doctor or nurse about what this means and ask for examples of documents that are used.
- Practical issues such as your will or plans you have for your funeral: Your will is usually made through your solicitor, who can also help with completing and registering your LPA. Some people also like to spend time planning their funeral, such as the music and readings they would like to be included.
The term ‘living will’ doesn’t have a legal meaning, and can be used to refer to either an advance statement or an advance decision.
* These terms are used in England and Wales. In Scotland and Northern Ireland, advance decisions are governed by common law. In Scotland, the equivalent of an LPA is a continuing power of attorney, and in Northern Ireland an enduring power of attorney.